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Exploration of high-risk factors for pulmonary embolism in patients undergoing postoperative anti-thrombotic therapy among gynecologic oncology surgery: a retrospective study.

ABSTRACT: Background:The aim of this study was to find the high-risk factors of patients undergoing postoperative anti-thrombotic therapy that had a pulmonary embolism (PE). Methods:In this retrospective analysis, a total of 35 patients with gynecologic oncological surgery were included from April 3, 2013, to January 12, 2018. Variable characteristic selection (Boruta's method), binary logistic regression (Fifth's method), and elastic network analysis were used to establish models and screen the high-risk factors. The decision curve analysis (DCA) was used to discriminate differences on these models as well. Results:Three models were established, and the clinical efficiency of these three models was similar. Within the risk range of 0.1-0.3, the elastic network model was shown to have a good net benefit rate. The preoperative cholesterol levels were selected in all three models. The high-risk factors that were selected in both models were operative time, preoperative fibrinogen level, crystal rehydration on the day of surgery in the ward, a preoperative low-density lipoprotein (LDL) level, deep venous catheters, and presence of colloids. Other factors included crystal fluid intake during surgery, age, and chemotherapy before surgery. Conclusions:Positive anti-thrombotic therapy may be required among the patients with increased risk and further research might be needed to verify high-risk factors.

SUBMITTER: Liu T

PROVIDER: S-EPMC6511568 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Exploration of high-risk factors for pulmonary embolism in patients undergoing postoperative anti-thrombotic therapy among gynecologic oncology surgery: a retrospective study.

Liu Tongyu T Lin Shao-Wei SW Lin Su S Yang Lin L Ji Haizhou H Zou Jianping J Xie Rong R

Annals of translational medicine 20190401 7

<h4>Background</h4>The aim of this study was to find the high-risk factors of patients undergoing postoperative anti-thrombotic therapy that had a pulmonary embolism (PE).<h4>Methods</h4>In this retrospective analysis, a total of 35 patients with gynecologic oncological surgery were included from April 3, 2013, to January 12, 2018. Variable characteristic selection (Boruta's method), binary logistic regression (Fifth's method), and elastic network analysis were used to establish models and scree ...[more]

PMID: 31157264

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Project description:ObjectiveTo compare post-operative length of stay and complication rates of matched obese and non-obese patients in an enhanced recovery (ERAS) program after open gynecologic cancer surgery.MethodsWe performed an observational cohort study of patients (n=1225) undergoing open surgery from November 2014 to November 2018 at a tertiary cancer center. Patients undergoing multidisciplinary procedures, non-oncologic surgery, or procedures in addition to abdominal surgery were excluded (n=190). Obese and non-obese patients were matched by date, age, disease status, and surgical complexity. The primary outcome was post-operative length of stay. Secondary outcomes included 30-day peri-operative complications, re-operation, re-admission, opioid use, and program compliance.ResultsAfter matching, 696 patients (348 obese, 348 non-obese) with median age of 57 years (IQR 48-66) were analyzed. Obese patients had a longer median procedure time (218 min vs 192.5 min, p<0.001) and greater median estimated blood loss (300 mL vs 200 mL, p<0.001). Median (IQR) post-operative length of stay was the same for obese and non-obese patients: 3 days (IQR 2-4). Obese and non-obese patients had similar rates of grade III-IV complications (10.9% and 6.6%, respectively, p=0.06), re-operation (2.3% and 1.4%, respectively, p=0.58), and re-admission (11.8% and 8.0%, respectively, p=0.13). Grade I-II complications were more common among obese patients (62.4% vs 48.3%, p<0.001) because they had more wound complications (17.8% vs 4.9%, p<0.001). Obese patients received more opioids both during surgery (morphine equivalent dose 57.25 mg (IQR 35-72.5) vs 50 mg (IQR 25-622.5), p=0.003) and after surgery (morphine equivalent daily dose 45 mg/day (IQR 10-96.2) vs 29.37 mg/day (IQR 7.5-70), p=0.01). Obese and non-obese patients had similar ERAS program compliance (70.1% and 69.8%, respectively, p=0.32).ConclusionsNeither post-operative length of stay nor the rate of serious complications differed significantly despite longer surgeries, greater blood loss, and more opioid use among obese patients. An ERAS program was safe, effective, and feasible for obese patients with suspected gynecologic cancer.

Project description:Pulmonary embolism (PE) is a major cause of cardiovascular morbidity and mortality. Recent hospitalization or surgery is a leading risk factor for PE, yet there are minimal data examining its effect on treatment and outcomes. We conducted a retrospective review of institutional billing codes for hospitalized patients with acute PE from August 2012 to August 2018. Patients were stratified based on whether they had a recent major medical encounter (MME), defined as surgery or hospitalization within 90 days. Primary outcomes included in-hospital mortality and 30- and 90-day readmission rates. Secondary outcomes included length of stay (LOS), use of advanced therapies, major bleeding, discharge anticoagulation and recurrent venous thromboembolism (VTE) at 90 days. Outcomes were adjusted for confounders using multivariable regression modeling. 2063 patients were hospitalized for an acute PE; 633 (30.7%) had a recent MME. Patients with a recent MME had a higher average Charlson Comorbidity Index (4.6 vs. 4.0, p < 0.01). Both 30- and 90-day readmission rates were higher in patients with a recent MME (21.7% vs. 14.4%; adjusted OR 1.06 [1.00, 1.12], p = 0.037; 30.8% vs 18.7%; adjusted OR 1.11 [1.11, 1.62], p = 0.003, respectively). After adjustment, there were no between-group differences in in-hospital mortality, LOS, use of advanced therapies, major bleeding, or recurrent VTE at 90 days. In-hospital mortality was higher for patients with a recent medical hospitalization compared to those with a recent surgery (10.2% vs. 5.6%, adjusted OR 1.08 [1.01, 1.15] p = 0.032). Despite recent hospitalization and/or surgery and greater number of comorbidities, patients admitted with a PE and recent MME had similar in-hospital outcomes, but experienced higher readmission rates. In-hospital mortality was higher in those with a recent medical compared to surgical encounter. Clinicians should optimize post-discharge transitional care in this subset of patients.

Dataset Information

Exploration of high-risk factors for pulmonary embolism in patients undergoing postoperative anti-thrombotic therapy among gynecologic oncology surgery: a retrospective study.

Publications

Exploration of high-risk factors for pulmonary embolism in patients undergoing postoperative anti-thrombotic therapy among gynecologic oncology surgery: a retrospective study.

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