| Objective:The study aims to investigate the risk factors related to postoperative venous thromboembolism in patients with gynecological cancer,evaluate the ability of Caprini risk assessment model,Rogers risk assessment model and G-Caprini risk assessment model to predict the occurrence of postoperative venous thromboembolism in gynecologic oncology patients,and explore the best stratification strategies of three risk assessment models.Methods:We undertook a retrospective case-control study We included 71 patients with gynecological disease who were confirmed VTE and hospitalized for surgery in the Second Hospital of Jilin University from Januanry 2016 to Decemeber 2020,41 patients suffered from gynecological malignant tumor.With the same age and the same diagnosis,142 cases were randomly selected as the control group at a ratio of 1:2.A self-designed gynecological malignant tumor information collection form was used to collect clinical data of 213 patients.Three risk assessment models were used to calculate the risk scores and risk classifications of each patient.Univariate and multivariate Logistic regression analysis were used to determine the risk factors of postoperative VTE in patients undergoing gynecological surgery and the risk factors of postoperative VTE in gynecologic oncology patients.Receiver operating characteristic curve analysis were used to calculate sensitivity,specificity,determine the best cutoff value.The predictive value of the three models was determined by drawing the ROC curve and comparing the area under the curve for postoperative VTE in gynecologic oncology patients.Results:1.Univariate analysis results showed that varicose veins,serious lung disease,including pneumonia(<1 month),patients confined to bed(>72 hours),central venous access,preoperative hematocrit ≤38%,ASA physical status class III～V,operation time(≥3hours),postoperative bed rest time(≥48hours)and open surgery were significantly related to postoperative VTE(P<0.05).Multivariate analysis results showed that varicose veins,ASA physical status class III～V,operation time(≥3hours)and post-operation bed rest time(≥48hours)were independent risk factors of postoperative VTE in patients with gynecological surgeries.2.Univariate analysis results showed that postoperative hospital stay >7days,FIGO stage III/IV,varicose veins,patients confined to bed(>72 hours)and postoperative bed rest time(≥48hours)were significantly related to postoperative VTE in patients with gynecological malignant tumors(P<0.05).Multivariate analysis results showed that postoperative hospital stay >7days,varicose veins,and post-operation bed rest time(≥48hours)were independent risk factors of postoperative VTE in gynecologic oncology patients.3.All gynecologic oncology patients were classified by the Caprini risk assessment as the highest risk(score≥5),and there were no patients in other risk groups.According to the,62.6% of the patients with gynecologic oncology were classified by the Rogers risk assessment model as medium risk(score7～10),46 cases were high risk(score>10),and there were no patients in the low-risk group.The proportion of VTE patients in the high risk group is higher than that in the medium risk group(43.5% vs.27.3%).There was no statistically significant difference in the incidence of VTE between the two groups.The gynecologic oncology patients were distributed in four risk groups.,2patients were classified by the G-Caprini risk assessment model as low risk(score=0),12 patients were moderate risk(score=1),38 patients were higher risk(score=2)and 71 patients were highest risk(score≥3).The results showed that the G-Caprini risk assessment model had good grading ability.Trend chi-square test results showed that the incidence of VTE in the G-Caprini model was statistically significant in different risk groups.And as the score level increasing,the incidence of VTE showed a gradually increasing trend.4.The Caprini scores and G-Caprini scores of the VTE group in gynecologic oncology patients were higher than the control group,and the difference of the scores between the two groups was statistically significant(P<0.001).The Rogers scores did not show statistical differences between the two groups.Taking Caprini score of 9,Rogers score of 10,and G-Caprini score of 4 as cut-off values,the ability to screen postoperative VTE of gynecologic oncology patients was the strongest.The risk stratification of the three risk assessment models predicts the AUC of postoperative VTE for gynecologic oncology patients were respectively 0.610,0.598,0.687.Rogers risk assessment model,G-Caprini risk assessment model and Caprini risk assessment model were in weak agreement.Conclusion:1.Independent risk factors for post-operative VTE in gynecologic oncology patients included post-operative hospital stay >7days,varicose veins,and postoperative bed rest time(≥48hours).2.After comparing and analyzing the results of three risk assessment models,we found that G-Caprini risk assessment model had the strongest ability to predict the risk of postoperative VTE in gynecologic oncology patients,and the ability of Caprini risk assessment model and Rogers risk assessment model were worse.3.It is recommended that gynecologic oncology patients were risk stratified by means of G-Caprini risk assessment model. |
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