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Gorosabel Calzada M, Hernández Matías A, Andonaegui de la Madriz A, León Ledesma R, Alonso-Lamberti Rizo L, Salazar Carrasco A, Ruiz de Adana JC, Jover Navalón JM. Thrombotic and hemorrhagic risk in bariatric surgery with multimodal rehabilitation programs comparing 2 reduced guidelines for pharmacological prophylaxis. Cir Esp 2022; 100:33-38. [PMID: 34986974 DOI: 10.1016/j.cireng.2021.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/06/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To determine the thrombotic and hemorrhagic risk in bariatric surgery with multimodal rehabilitation programs, comparing two guidelines of pharmacological prophylaxis recommended in the Guide to the Spanish Society for Obesity Surgery and the Obesity Section of the AEC. METHODS Cohorts retrospective study from January-2010 to December-2019. Cases of vertical gastrectomy or gastric bypass were recorded, systematically applying multimodal rehabilitation protocols. Two reduced chemoprophylaxis regimens were analyzed, starting after surgery and maintained for 10 days; one with fondaparinux (Arixtra®) at a fixed dose of 2.5mg/day and the other with enoxaparin (Clexane®) with a single daily dose adjusted to BMI: 40mg/day for BMI of 35-40 and 60mg/day for BMI 40-60. RESULTS 675 patients were included; 354 with Fondaparinux-Arixtra® during the period 2010-2015 and 321 with Enoxaparin-Clexane® during the period 2016-2019. There were no cases of DVT or clinical PE. However, the incidence of hemorrhage requiring reoperation, transfusion, or a decrease of more than 3g/dL hemoglobin was 4.7%, with no difference between groups. Mortality was nil. The average stay was 2.8 days and the outpatient follow-up was 100% during the first 6 months and 95% at 12 months. CONCLUSIONS The combination of multimodal rehabilitation programs and mechanical and pharmacological thromboprophylaxis by experienced teams, reduces the risk of thromboembolic events and could justify reduced chemoprophylaxis regimens to decrease the risk of postoperative bleeding.
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Affiliation(s)
- Manuel Gorosabel Calzada
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Alberto Hernández Matías
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | | | - Raquel León Ledesma
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Laura Alonso-Lamberti Rizo
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Andrea Salazar Carrasco
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Juan Carlos Ruiz de Adana
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Getafe, Getafe, Madrid, Spain.
| | - José María Jover Navalón
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Getafe, Getafe, Madrid, Spain
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Wang MF, Li FX, Feng LF, Zhu CN, Fang SY, Su CM, Yang QF, Ji QY, Li WM. Development and validation of a novel risk assessment model to estimate the probability of pulmonary embolism in postoperative patients. Sci Rep 2021; 11:18087. [PMID: 34508171 PMCID: PMC8433319 DOI: 10.1038/s41598-021-97638-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/25/2021] [Indexed: 11/24/2022] Open
Abstract
Pulmonary embolism (PE) is a leading cause of mortality in postoperative patients. Numerous PE prevention clinical practice guidelines are available but not consistently implemented. This study aimed to develop and validate a novel risk assessment model to assess the risk of PE in postoperative patients. Patients who underwent Grade IV surgery between September 2012 and January 2020 (n = 26,536) at the Affiliated Dongyang Hospital of Wenzhou Medical University were enrolled in our study. PE was confirmed by an identified filling defect in the pulmonary artery system in CT pulmonary angiography. The PE incidence was evaluated before discharge. All preoperative data containing clinical and laboratory variables were extracted for each participant. A novel risk assessment model (RAM) for PE was developed with multivariate regression analysis. The discrimination ability of the RAM was evaluated by the area under the receiver operating characteristic curve, and model calibration was assessed by the Hosmer–Lemeshow statistic. We included 53 clinical and laboratory variables in this study. Among them, 296 postoperative patients developed PE before discharge, and the incidence rate was 1.04%. The distribution of variables between the training group and the validation group was balanced. After using multivariate stepwise regression, only variable age (OR 1.070 [1.054–1.087], P < 0.001), drinking (OR 0.477 [0.304–0.749], P = 0.001), malignant tumor (OR 2.552 [1.745–3.731], P < 0.001), anticoagulant (OR 3.719 [2.281–6.062], P < 0.001), lymphocyte percentage (OR 2.773 [2.342–3.285], P < 0.001), neutrophil percentage (OR 10.703 [8.337–13.739], P < 0.001), red blood cell (OR 1.872 [1.384–2.532], P < 0.001), total bilirubin (OR 1.038 [1.012–1.064], P < 0.001), direct bilirubin (OR 0.850 [0.779–0.928], P < 0.001), prothrombin time (OR 0.768 [0.636–0.926], P < 0.001) and fibrinogen (OR 0.772 [0.651–0.915], P < 0.001) were selected and significantly associated with PE. The final model included four variables: neutrophil percentage, age, malignant tumor and lymphocyte percentage. The AUC of the model was 0.949 (95% CI 0.932–0.966). The risk prediction model still showed good calibration, with reasonable agreement between the observed and predicted PE outcomes in the validation set (AUC 0.958). The information on sensitivity, specificity and predictive values according to cutoff points of the score in the training set suggested a threshold of 0.012 as the optimal cutoff value to define high-risk individuals. We developed a new approach to select hazard factors for PE in postoperative patients. This tool provided a consistent, accurate, and effective method for risk assessment. This finding may help decision-makers weigh the risk of PE and appropriately select PE prevention strategies.
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Affiliation(s)
- Mao-Feng Wang
- Department of Biomedical Sciences Laboratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, Zhejiang, China
| | - Fei-Xiang Li
- Department of Cardiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Wuning West Road No. 60, Dongyang, 322100, Zhejiang, China
| | - Lan-Fang Feng
- Department of Respiratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, Zhejiang, China
| | - Chao-Nan Zhu
- Shanghai Key Laboratory of Artificial Intelligence for Medical Image and Knowledge Graph, Hangzhou, 310000, Zhejiang, China
| | - Shuang-Yan Fang
- Department of Respiratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, Zhejiang, China
| | - Cai-Min Su
- Department of Respiratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, Zhejiang, China
| | - Qiong-Fang Yang
- Department of Respiratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, Zhejiang, China
| | - Qiao-Ying Ji
- Department of Respiratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, Zhejiang, China
| | - Wei-Min Li
- Department of Cardiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Wuning West Road No. 60, Dongyang, 322100, Zhejiang, China.
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Gorosabel Calzada M, Hernández Matías A, Andonaegui de la Madriz A, León Ledesma R, Alonso-Lamberti Rizo L, Salazar Carrasco A, Ruiz de Adana JC, Jover Navalón JM. Thrombotic and hemorrhagic risk in bariatric surgery with multimodal rehabilitation programs comparing 2 reduced guidelines for pharmacological prophylaxis. Cir Esp 2021; 100:S0009-739X(20)30382-1. [PMID: 33454109 DOI: 10.1016/j.ciresp.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/12/2020] [Accepted: 11/06/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE to determine the thrombotic and hemorrhagic risk in bariatric surgery with multimodal rehabilitation programs, comparing 2guidelines of pharmacological prophylaxis recommended in the Guide to the Spanish Society for Obesity Surgery and the Obesity Section of the AEC. METHODS Cohorts retrospective study from January-2010 to December-2019. Cases of vertical gastrectomy or gastric bypass were recorded, systematically applying multimodal rehabilitation protocols. Two reduced chemoprophylaxis regimens were analyzed, starting after surgery and maintained for 10 days; one with fondaparinux (Arixtra®) at a fixed dose of 2.5mg / day and the other with enoxaparin (Clexane®) with a single daily dose adjusted to BMI: 40mg / day for BMI of 35-40 and 60mg/day for BMI 40-60. RESULTS 675 patients were included; 354 with Fondaparinux-Arixtra® during the period 2010-2015 and 321 with Enoxaparin-Clexane® during the period 2016-2019. There were no cases of DVT or clinical PE. However, the incidence of hemorrhage requiring reoperation, transfusion, or a decrease of more than 3g / dL hemoglobin was 4.7%, with no difference between groups. Mortality was nil. The average stay was 2.8 days and the outpatient follow-up was 100% during the first 6 months and 95% at 12 months. CONCLUSIONS The combination of multimodal rehabilitation programs and mechanical and pharmacological thromboprophylaxis by experienced teams, reduces the risk of thromboembolic events and could justify reduced chemoprophylaxis regimens to decrease the risk of postoperative bleeding.
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Affiliation(s)
- Manuel Gorosabel Calzada
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - Alberto Hernández Matías
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Getafe, Getafe, Madrid, España
| | | | - Raquel León Ledesma
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - Laura Alonso-Lamberti Rizo
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - Andrea Salazar Carrasco
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - Juan Carlos Ruiz de Adana
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Getafe, Getafe, Madrid, España.
| | - José María Jover Navalón
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Getafe, Getafe, Madrid, España
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