Risk Factors For Perioperative Venous Thromboembolism in Patients With Gynecological Malignancies

Abstract

Introduction：Venous thromboembolism (VTE), is a frequent postoperative complication of gynecologic malignancies during perioperative period.Although a number of risk factors for perioperative VTE with gynecological malignancies have been reported, the findings are diverse or even contradictory .In addition, most of the existing studies were retrospective case-control studies with small sample sizes .This study was a prospectively matched case-control study and aimed to specifically explore the risk factors related to surgery for perioperativeVTE in gynecologic malignancies.Material and methods：Overall,734 patients with gynecologic malignancies were enrolled in this study.54 patients who developed VTE were included as the case group. A total of 270 non-VTE patients matched in a ratio of 1:5 as a control group with the matched principle of the same ethnicity and similar date of surgery (difference ± 3 days). The demographic characteristics, clinical data, laboratory tests, surgical data, and data related to the occurrence of VTE were collected during the follow-up period. Conditional logistic regression models were used for univariate and multifactorial analyses. Factors related to surgical treatment, especially those could be intervened and prevented, were used as target factors, which were gradually corrected by demographic data, clinical data, laboratory tests and other factors related to surgery, and sensitivity analysis was performed.Results:The results of univariate analysis showed that age, place of residence, occupation, high-fat diet, menopause, comorbid chronic diseases, duration of upper extremity indwelling needle retention, disease diagnosis, sleep during hospitalization, admission albumin, surgical approach , duration of intensive care unit(ICU)admission, start of anticoagulant use, time to resume postoperative anal evacuation, duration of bed rest, duration of drinking abstinence, difference between postoperative and admission Caprini scores,duration of abdominal drainage tube retention, and intraoperative bleeding were risk factors for VTE in patients with perioperative gynecologic malignancies (P<0.05). Stepwise corrected multifactorial conditional logistic regression analysis showed that admission albumin<46.40 g/L and large difference between postoperative and admission Caprini scores were risk factors for the development of VTE in patients with gynecologic malignancies in the perioperative period, and the risk of VTE in patients with admission serum albumin<46.40 g/L was 4.885 times higher than that in patients with admission serum albumin≥46.40 g/L; The larger difference between postoperative and admission Caprini scores, the higher the risk of VTE, and a 1-point increase in the difference between postoperative and admission Caprini scores was associated with a 2.174-fold increase in the risk of VTE (95% CI: 1.255 to 3.766, P= 0.006).Conclusions: The main risk factors for perioperative VTE in gynecologic malignancies are serum albumin lower than 46.40 g/L and large difference between postoperative and admission Caprini scores. More attention should be paid to the dynamic changes of serum albumin and Caprini scores of patients in the perioperative period and those factors should be targeted to intervene in order to reduce the perioperative VTE.