Risk Factors And Its Risk Assessment About Venous Thromboembolism After Operation

?Background?Postoperation venous thromboembolism is a common complication and a important cause of death for surgery patients.The patient with acute massive pulmonary embolism could suddenly die.So it is critical to evaluate risk assessment of VTE and apply the standard postoperative VTE prophylaxis for the high-risk group.?Objective?To seek risk factors of VTE in surgery patients through analysis of clinical features of patients undergone surgery and to analysis the factors of postoperation venous thromboembolism(VTE)in critically ill patients in intensive care units(ICU).Three risk assessments of VTE and the prediction effect of D-dimer were evaluated.?Method?(1)Retrospective investigation was performed on patients undergone surgery who were hospitalized in Guangzhou first People's Hospital from January 1,2015 to December 31,2015.According to the presence of VTE,patients were distributed into two groups,VTE group and control group.(2)Patients' clinical data and laboratory parameters were collected.Single factor analysis was applied to compare the differences between the two groups.T test or nonparametric test was applied for intragroup comparison of measurement data,and chi—square test was applied for the comparison of counting information.Logistic regression analysis was applied to explore risk factors of venous thromboembolism.(3)There were 78 cancer patients in this study.Risk factors of venous thromboembolism about the 78 cancer patients were explored.(4)The Kaplan-Meier statistics and log-rank test was applied to analysis the factors for postoperationvenous thromboembolism(VTE)in critically ill patients in intensive care units(ICU).(5)The areas under the ROC curve of the Caprini score,the Padua score and the E-alerts score for the 322 patients was analysised.(6)The areas under the ROC curve of the Caprini score,the Padua score and the E-alerts score for 48 critically ill patients in intensive care units whose ICU stay time was over 24 hours were analysised.The SPSS 13.0 statistical software was applied for statistical management and analysis.?Results?322 patients undergone surgery were include in theinvestigation,with average age of(64±15)years old,72 patients in VTE group and 250 patinets in control group.(1)D-dimer,the tumor stage,operation time,multiple operations(?2 times),patient confined to bed(>72 hours),Central venipucture and catheterization,diabetes,Coronary heart disease,VTE prophylaxis has statistical significance(P<0.05).(2)Logistic regression analysis showed patient confined to bed(>72 hours)was a independent risk factor(OR 6.96,95 % CI: 2.858-16.955,P=0.000)and VTE prophylaxis was a protective factor(OR 0.397,95%CI:0.197-0.801,P=0.01).(3)Logistic regression analysis showed the tumor stage was the independent risk factor of postoperation venous thromboembolism in 78 cancer patients.(OR7.127,95 % CI: 1.96-25.911,P=0.003).(4)The stay time in ICU over 24 hours was proved as a risk factor of a reliably increased hazard of DVT in the surgery patients.Kaplan-Meier statistics confirmed the reliability of the distinction(P=0.000).(5)The area under the curve formed by D-dimer predicting VTE was 0.746(P<0.001).The D-dimer more than 1965ug/L may be an independent predictor of surgery patient VTE events.(6)The area under the curve of the Caprini score and the Padua score about 322 patients was more than 0.6.The Padua score may be the best VTE predictive model.The Caprini score can better predict the cancer patients' risk of postoperative VTE risk.(7)The area under the curve of theCaprini score and the Padua score about 48 critically ill patients was ciosed to 0.6.The Caprini score and the Padua score can not be better assess the risk of VTE for the surgery patiens in th eICU.It reavealed that a more accurate VTE risk assessment should be used for the surgery patiens in the critically ill population.?Conclusions?This study suggeststhat patient confined to bed(>72 hours)is the only risk factor for patients undergone surgery and VTE prophylaxis is a protective factor for the surgery patients.Tumor stage is the only risk factor for cancer patients undergone surgery.The stay time in ICU over 24 hours was proved as a risk factor of a reliably increased hazard of DVT in the surgery patients.The D-dimer more than 1965ug/L may be an independent predictor of surgery patient VTE events.It may be more suitable to apply Caprinirisk assessment for the cancer surgery patients.It reavealed that a more accurate VTE risk assessment should used for the surgery patiens in the critically ill population.However.because this study is a retrospective study,other potential high risk factors causing VTE cannot be excluded.