Annals of surgical oncology · 2025
Comprehensive Risk Score for Prophylaxis Guidance of Postoperative Pulmonary Embolism in Laryngopharyngeal Cancer Patients: A Multicenter Cohort Study.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Lei Han, Chen Lin, Lyu Kexing, Peng Liang, Ye Jin, Liu Tianrun, Chen Weixiong, Xie Xingqiang, Lei Wenbin, Gao Wenxiang
Аннотация
BACKGROUND: Prophylactic low-molecular-weight heparin (LMWH) treatment helps reduce the incidence of postoperative venous thromboembolism (VTE) and pulmonary embolism (PE), while also carrying a risk of bleeding. Currently, there are little specific recommendations for postoperative prophylactic anticoagulation in laryngopharyngeal cancer (LPC) patients.
METHODS: In this multicenter retrospective study, we identified potential risk factors for PE following open surgery of LPC by logistic regression. An applicable scoring system for risk stratification of postoperative PE was developed based on the risk factors and compared with other PE risk scores. The efficacy and safety of prophylactic LMWH treatment among different risk patients were compared.
RESULTS: Among 2033 included patients (551 with LMWH and 1482 without), 97 (4.8%) developed PE, with 84 (5.6%) not receiving prophylactic LMWH. A PE risk score comprised of age, body mass index (BMI), history of chronic obstructive pulmonary disease (COPD), postoperative D-dimer level, operation duration, intraoperative hypotension, and flap repair was developed based on data from patients not receiving prophylactic LMWH treatment. This risk score stratified patients into high- and low-risk groups, with high-risk patients exhibiting a significantly higher incidence of PE (68 [21.6%] vs. 16 [1.4%]; p < 0.001) in the absence of prophylactic LMWH treatment. Moreover, we observed that prophylactic use of LMWH in high-risk patients is associated with a lower risk of postoperative PE (4 [4.8%] vs. 15 [17.9%]; p = 0.013) after propensity score matching.
CONCLUSIONS: This study proposes a comprehensive postoperative PE risk score for LPC patients, assisting clinicians in assessing PE risk and informing prophylactic LMWH treatment decisions.
METHODS: In this multicenter retrospective study, we identified potential risk factors for PE following open surgery of LPC by logistic regression. An applicable scoring system for risk stratification of postoperative PE was developed based on the risk factors and compared with other PE risk scores. The efficacy and safety of prophylactic LMWH treatment among different risk patients were compared.
RESULTS: Among 2033 included patients (551 with LMWH and 1482 without), 97 (4.8%) developed PE, with 84 (5.6%) not receiving prophylactic LMWH. A PE risk score comprised of age, body mass index (BMI), history of chronic obstructive pulmonary disease (COPD), postoperative D-dimer level, operation duration, intraoperative hypotension, and flap repair was developed based on data from patients not receiving prophylactic LMWH treatment. This risk score stratified patients into high- and low-risk groups, with high-risk patients exhibiting a significantly higher incidence of PE (68 [21.6%] vs. 16 [1.4%]; p < 0.001) in the absence of prophylactic LMWH treatment. Moreover, we observed that prophylactic use of LMWH in high-risk patients is associated with a lower risk of postoperative PE (4 [4.8%] vs. 15 [17.9%]; p = 0.013) after propensity score matching.
CONCLUSIONS: This study proposes a comprehensive postoperative PE risk score for LPC patients, assisting clinicians in assessing PE risk and informing prophylactic LMWH treatment decisions.