Incidence, prevention, risk factors, and prediction of venous thromboembolism in Chinese patients after colorectal cancer surgery: a prospective, multicenter cohort study.
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Wei Qi, Wei Zheng-Qiang, Jing Chang-Qing, Li Yong-Xiang, Zhou Dong-Bing, Lin Mou-Bin, He Xian-Li, Li Fan, Liu Qian, Zheng Jian-Yong, Wang Gui-Ying, Tu Shi-Liang, Wang Zhen-Jun, Li Ang, Xiao Gang, Zhuang Jing, Bai Lian, Huang He, Li Yong, Song Wu, Liang Zhong-Lin, Shen Zhan-Long, Liu Fan-Long, Dai Yong, Zhou Xiao-Jun, Dong Ming, Wang Hui, Qiu Jian, Zhou Lei, Li Xin-Xiang, Wang Zi-Qiang, Zhang Hong, Wang Quan, Pang Ming-Hui, Wei Hong-Bo, Hu Zhi-Qian, Yan Yi-Dan, Che Yan, Gu Zhi-Chun, Yao Hong-Wei, Zhang Zhong-Tao, and for the CRC-VTE investigators
Аннотация
METHODS: Participants were recruited from 46 centers in 17 provinces in China. Patients were followed up for 1 month postoperatively. The study period was from May 2021 to May 2022. The Caprini score risk stratification and VTE prevention and incidence were recorded. The predictors of the occurrence of VTE after surgery were identified by multivariate logistic regression analysis, and a prediction model (CRC-VTE score) was developed.
RESULTS: A total of 1836 patients were analyzed. The postoperative Caprini scores ranged from 1 to 16 points, with a median of 6 points. Of these, 10.1% were classified as low risk (0-2 points), 7.4% as moderate risk (3-4 points), and 82.5% as high risk (≥5 points). Among these patients, 1210 (65.9%) received pharmacological prophylaxis, and 1061 (57.8%) received mechanical prophylaxis. The incidence of short-term VTE events after CRC surgery was 11.2% (95% CI 9.8-12.7), including deep venous thrombosis (DVT) (11.0%, 95% CI 9.6-12.5) and pulmonary embolism (PE) (0.2%, 95% CI 0-0.5). Multifactorial analysis showed that age (≥70 years), history of varicose veins in the lower extremities, cardiac insufficiency, female sex, preoperative bowel obstruction, preoperative bloody/tarry stool, and anesthesia time at least 180 min were independent risk factors for postoperative VTE. The CRC-VTE model was developed from these seven factors and had good VTE predictive performance ( C -statistic 0.72, 95% CI 0.68-0.76).
CONCLUSIONS: This study provided a national perspective on the incidence and prevention of VTE after CRC surgery in China. The study offers guidance for VTE prevention in patients after CRC surgery. A practical CRC-VTE risk predictive model was proposed.