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Wang M, Zhang G, Chen J, Li J, Che Y, Tang J, Li H, Li J, Ma Y. Current prevalence of perioperative early venous thromboembolism and risk factors in Chinese adult patients with inguinal hernia (CHAT-1). Sci Rep 2020; 10:12667. [PMID: 32728130 PMCID: PMC7391649 DOI: 10.1038/s41598-020-69453-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 07/13/2020] [Indexed: 11/08/2022] Open
Abstract
Venous thromboembolism (VTE) is an important postoperative complication. We investigated and analyzed the current inguinal hernia treatment methods and occurrence of early postoperative VTE in Chinese adults. This study involved data for patients with inguinal hernia hospitalized in 58 general hospitals in mainland China from January 1st, 2017 to December 31st, 2017. Data were retrospectively analyzed using a questionnaire. After data inputting and cleaning, we stratified and statistically analyzed patients' data using Caprini scores to create a high-, middle-, and low-risk group. A total of 14,322 patients with inguinal hernia were admitted to the 58 participating hospitals. After data collation and cleaning, 13,886 patients (97.0%) met our inclusion and exclusion criteria. The percentages of laparoscopic surgery and open surgery were 51.2% and 48.8%, respectively. 16 VTEs occurred during the hospitalization, accounting for 0.1% of all adverse events (95% confidence interval (CI) 0.11-0.13). The incidence of VTE was 0.2% (95% CI 0.18-0.2) in the high-risk group and 0.02% (95% CI 0.01-0.03) in the middle-risk group, based on Caprini scoring, with a significant difference (p < 0.0001). No VTE occurred in the low-risk group. Only 3,250 (23.4%) patients underwent Caprini risk assessment regarding treatment, with 13.2% receiving any prevention and only 1.2% receiving appropriate prevention. The treatment of inguinal hernia in Chinese adults has progressed somewhat; however, the evaluation and prevention of perioperative VTE was seriously neglected, in our study, and the incidence of postoperative VTE was underestimated postoperatively. Risk factors continue to be inadequately considered.
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Affiliation(s)
- Minggang Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043 China
| | - Guangyong Zhang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, 250012 China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043 China
| | - Jianwen Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200020 China
| | - Yan Che
- NHC Key Laboratory of Reproduction Regulation, Shanghai Institute of Planned Parenthood Research, Fudan University, Shanghai, 200020 China
| | - Jianxiong Tang
- Department of General Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040 China
| | - Hangyu Li
- Department of General Surgery, The Fourth Affiliated Hospital, China Medical University, Shenyang, 110000 China
| | - Junsheng Li
- Department of General Surgery Affiliated Zhong-da Hospital, Southeast University, Nanjing, 210009 China
| | - Yingmin Ma
- Beijing Institute of Respiratory Diseases, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043 China
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Edeer AD, Comez S, Damar HT, savci A. Prevalence and risk factors of venous thromboembolism in postoperative patients: A retrospective study. Pak J Med Sci 2018; 34:1539-1544. [PMID: 30559819 PMCID: PMC6290213 DOI: 10.12669/pjms.346.16021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 07/12/2018] [Accepted: 09/22/2018] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To investigate the prevalence of and risk factors for Venous Thromboembolism (VTE) in postoperative patients. METHODS This descriptive, cross-sectional, retrospective study was conducted from August 2016 to October 2016 at two university hospitals and one public hospital. Total 217,354 patients records who underwent surgery in between 2010 and 2015 were examined. The study sample consisted of 123 patients who had postoperative venous thrombosis and pulmonary embolism, and whose discharge details, consultation data, diagnostic reports, and tests were examined in detail. RESULTS The prevalence of VTE in postoperative patients was 5.6/10,000. The mean age of the patients was 60.22±18.56 years. Of 123 patients, 51.20% were male, 30.90% were smokers, 46.30% had a comorbid disease, and 27.60% were diagnosed with cancer. Of the patients who had postoperative VTE, 65.0% had major surgery. Pharmacologic thromboprophylaxis was used in only 24.4% of patients (n=30). CONCLUSION The prevalence of VTE in the present study is lower than that in other studies. Because surgery is a risk factor for VTE, patients who will be operated should be assessed. Considering the present results, we can assume that patients' conditions are not being assessed appropriately. In addition, findings indicate that a standard for preventing VTE has not yet been established.
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Affiliation(s)
- Aylin Durmaz Edeer
- Dr. Aylin Durmaz Edeer, PhD. Department of Surgical Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Saadet Comez
- Dr. Saadet Comez, PhD. Department of Anesthesia, Mehmet Akif Ersoy University, Burdur, Turkey
| | - Hale Turhan Damar
- Dr. Hale Turhan Damar, PhD. Department of Surgical Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Aysegul savci
- Dr. Aysegul Savci, PhD. Department of Nursing, Health Science Faculty, Kutahya Health Science University, Kutahya, Turkey
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Zhai Z, Kan Q, Li W, Qin X, Qu J, Shi Y, Xu R, Xu Y, Zhang Z, Wang C. VTE Risk Profiles and Prophylaxis in Medical and Surgical Inpatients: The Identification of Chinese Hospitalized Patients' Risk Profile for Venous Thromboembolism (DissolVE-2)-A Cross-sectional Study. Chest 2018; 155:114-122. [PMID: 30300652 DOI: 10.1016/j.chest.2018.09.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/20/2018] [Accepted: 09/05/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Limited data exist on VTE risk and prophylaxis in Chinese inpatients. The Identification of Chinese Hospitalized Patients' Risk Profile for Venous Thromboembolism-2 (DissolVE-2), a nationwide, multicenter, cross-sectional study, was therefore designed to investigate prevalence of VTE risks and evaluate VTE prophylaxis implementation compliant with the latest prophylaxis guidelines (American College of Chest Physicians [CHEST], 9th edition). METHODS Adults admitted (≥ 72 h) to 60 urban, tertiary Chinese hospitals due to acute medical conditions or surgery from March to September 2016 were assessed for VTE risk. Risk assessments were made by using the Padua Prediction Scoring or Caprini Risk Assessment model, risk factors, and prophylaxis based on the CHEST guidelines, 9th edition. RESULTS A total of 13,609 patients (6,986 surgical and 6,623 medical) were analyzed. VTE risk in surgical inpatients was categorized as low (13.9%; 95% CI, 13.1-14.7), moderate (32.7%; 95% CI, 31.6-33.8), and high (53.4%; 95% CI, 52.2-54.6); risk in medical patients was categorized as low (63.4%; 95% CI, 62.2-64.6) and high (36.6%; 95% CI, 35.4-37.8). Major risk factors in surgical and medical patients were major open surgery (52.6%) and acute infection (42.2%), respectively. Overall rate of any prophylaxis and appropriate prophylactic method was 14.3% (19.0% vs 9.3%) and 10.3% (11.8% vs 6.0%) in surgical and medical patients. CONCLUSIONS A large proportion of hospitalized patients reported VTE risk and low rate of CHEST-recommended prophylaxis. The data highlight the insufficient management of VTE risk and show the great potential for improving physicians' awareness and current practices across China. TRIAL REGISTRY Chinese Clinical Trial Registry; No.: ChiCTR-OOC-16010187; URL: http://www.chictr.org.cn/showproj.aspx?proj=17077.
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Affiliation(s)
- Zhenguo Zhai
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, No. 2 Yinghua Dongjie, Hepingli, Beijing, China
| | - Quancheng Kan
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Weimin Li
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan, China
| | - Xinyu Qin
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jieming Qu
- Department of Respiratory Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Department of Respiratory Medicine, Huadong Hospital affiliated to Fudan University, Shanghai, China
| | - Yuankai Shi
- Department of Medical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted Drugs, Beijing, China
| | - Ruihua Xu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong, China
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Zhu Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, No. 2 Yinghua Dongjie, Hepingli, Beijing, China; Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, No. 2 Yinghua Dongjie, Hepingli, Beijing, China; Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China; Department of Respiratory Medicine, Capital Medical University, Beijing, China.
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Ye F, Bell LN, Mazza J, Lee A, Yale SH. Variation in Definitions of Immobility in Pharmacological Thromboprophylaxis Clinical Trials in Medical Inpatients: A Systematic Review. Clin Appl Thromb Hemost 2016; 24:13-21. [PMID: 28301904 DOI: 10.1177/1076029616677802] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although immobility is a common risk factor for venous thromboembolism (VTE) in medical inpatients, lack of a consistent definition of this term may limit accurate assessment of VTE risk for thromboprophylaxis. OBJECTIVE To examine various definitions of immobility used in recent pharmacological thromboprophylaxis clinical trials. DATA SOURCES PubMed and relevant references from articles/reviews from 2008 to 2016 were searched. Randomized controlled trials (RCTs) and other clinical studies involving adult hospitalized medical patients in acute care hospital settings that used the term immobility were selected. Two investigators independently abstracted data in duplicate, and accuracy was checked by a third investigator. RESULTS Twenty-one clinical studies were included. There was heterogeneity among individual VTE risk factors, with respect to the definition of immobility in medical inpatients in these trials. Thirteen studies utilized objective criteria to define "immobility" including duration (12 studies) and distance or time walked (6 studies). In contrast, 7 studies focused principally on subjective definitions (ie, describing the nature of immobility rather than specifying its quantitative measurement). Three RCTs vaguely defined the level of patient's immobility after hospitalization. CONCLUSION Despite the well-known effectiveness of pharmacological thromboprophylaxis for the prevention of VTE in acutely ill medical patients, there is no current consensus on how to define immobility. The heterogeneous nature of definitions of immobility has led to uncertainty about the importance of immobility in VTE risk assessment models. Although clinical studies have incorporated varying definitions of immobility into their inclusion criteria, immobility as a specific VTE risk factor has not been clearly defined.
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Affiliation(s)
- Fan Ye
- 1 North Florida Regional Medical Center, UCF COM/HCA GME Consortium Internal Medicine, Gainesville, FL, USA
| | - Lauren N Bell
- 1 North Florida Regional Medical Center, UCF COM/HCA GME Consortium Internal Medicine, Gainesville, FL, USA
| | - Joseph Mazza
- 2 Marshfield Clinic Research Foundation, Marshfield, WI, USA
| | - Arthur Lee
- 3 North Florida Regional Medical Center, The Cardiac and Vascular Institute, Gainesville, FL, USA
| | - Steven H Yale
- 1 North Florida Regional Medical Center, UCF COM/HCA GME Consortium Internal Medicine, Gainesville, FL, USA
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Ongen G, Demir M, Molinas N, Ince B, Ongen Z. Evaluation of the Practice Pattern of Medical Patients’ VTE Prophylaxis With a Standard Risk Assessment Model Form. Clin Appl Thromb Hemost 2015; 21:412-9. [DOI: 10.1177/1076029613505765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hospitalized acutely ill patients face high risk for venous thromboembolism (VTE) unless appropriate thromboprophylaxis is applied. This study aimed to determine VTE prophylaxis practices for inpatients in Turkey and to evaluate the impact of physicians’ training via a modified “Standard Medical Patients’ VTE Risk Assessment Model (MERAM).” A total of 607 inpatients included in this national multicenter noninterventional observational registry were evaluated in terms of demographics, VTE risk, and preventive measures at 2 consecutive cross-sectional visits. Physicians were asked to complete a questionnaire on current VTE method risk assessment and other models including MERAM. The VTE prophylaxis rates significantly increased from 49.4% to 62.4% between visits ( P < .05). The lack of risk evaluation decreased from 74.6% to 19.5% ( P < .001). Percentage of physicians using prophylaxis and use of MERAM increased between visits. Physician training proved effective for providing general “awareness” of VTE prophylaxis and led to higher rates of risk assessment model-based appropriate VTE prophylaxis.
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Affiliation(s)
- Gul Ongen
- Department of Chest Medicine, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Muzaffer Demir
- Department of Hematology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Nil Molinas
- Department of Oncology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Birsen Ince
- Department of Neurology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Zeki Ongen
- Department of Cardiology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
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