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Haney V, Arnautovic A, Lee SM, Lee J. Risk of Bleeding Versus Venous Thromboembolism After Surgery for Breast Cancer: A National Surgical Quality Improvement Program Analysis. J Surg Res 2024; 300:432-438. [PMID: 38861867 DOI: 10.1016/j.jss.2024.05.004] [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: 11/02/2023] [Revised: 04/26/2024] [Accepted: 05/06/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Patients who undergo surgery for breast cancer are at risk for venous thromboembolism (VTE) and bleeding, which can lead to significant consequences on outcomes. This study examined factors related to VTE and bleeding risk in breast cancer surgery, with and without reconstruction. We also investigated the relationship between operative time and resident involvement on bleeding and VTE risk. METHODS Using the ACS-NSQIP database, patients who underwent mastectomy, implant, pedicled, or free flap reconstruction from 2005 to 2021 were identified. Resident involvement was available from 2007 to 2010. We fitted two logistic regressions to model the log odds of bleeding occurrence and VTE as linear functions of procedure type, controlling for age, body mass index, and comorbidities. RESULTS Implant reconstruction had significantly reduced 30-d incidence of bleeding, compared to those who underwent transverse rectus abdominus muscle flap (P < 0.001). Free flap was associated with a significant increase in bleeding but not VTE risk (P < 0.001; P = 0.132). Increase in operative time significantly increased the risk of bleeding and VTE (P < 0.001). For surgeries with resident involvement coded, there was no significantly increased risk of bleeding or VTE (P = 0.600; P = 0.766). CONCLUSIONS Implant reconstruction remains the procedure with the lowest risk of both bleeding and VTE. Free flap reconstruction did not show a significantly increased risk of VTE, potentially expanding reconstruction options for patients previously excluded from autologous reconstruction. Surgeons should be mindful of operative time, with re-evaluation of risk factors with each additional hour of surgery, irrespective of reconstruction type. Resident involvement in surgeries should continue to be encouraged by faculty.
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Affiliation(s)
- Victoria Haney
- Department of Surgery, GW School of Medicine & Health Sciences, Washington, District of Columbia.
| | - Alisa Arnautovic
- Department of Surgery, GW School of Medicine & Health Sciences, Washington, District of Columbia
| | - Sean M Lee
- Department of Surgery, GW School of Medicine & Health Sciences, Washington, District of Columbia
| | - Juliet Lee
- Department of Surgery, GW School of Medicine & Health Sciences, Washington, District of Columbia
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Ahmed SH, Shekouhi R, Gerhold C, Mattia A, Azizi A, Donath G, Chim H. Contributors to post-operative venous thromboembolism risk after breast cancer surgery: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2024; 94:106-118. [PMID: 38776625 DOI: 10.1016/j.bjps.2024.05.003] [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: 03/06/2024] [Revised: 04/19/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Venous thromboembolism (VTE) events are a preventable complication for patients undergoing surgery for breast cancer. However, there is a lack of consistency in the existing literature regarding the potential risk factors affecting these individuals. METHODS This study aimed to investigate the potential risk factors associated with an increased risk of VTE following surgery for breast cancer. Data on patient characteristics such as age, body mass index (BMI), existing comorbidities, smoking history, surgical interventions, duration of hospitalization, and post-operative complications were recorded and analyzed. RESULTS Thirty-one studies investigating the incidence of VTE following surgical interventions for breast cancer were included. This study included 22,155 female patients with a mean age of 50.8 ± 2.9 years. The weighted mean length of surgery and hospital stay were 382.1 ± 170.0 min and 4.5 ± 2.7 days, respectively. The patients were followed-up for a weighted mean duration of 13.8 ± 21.2 months. The total incidence of VTE events was 2.2% (n = 489). Meta-analysis showed that patients with post-operative VTE had a significantly higher mean age and BMI, as well as longer mean length of surgery (P < 0.05). Comparing the techniques of autologous breast reconstruction showed that the risk of post-operative VTE is significantly higher with deep inferior epigastric perforator (DIEP) flaps, compared with the transverse rectus abdominus myocutaneous and latissimus dorsi myocutaneous flaps (P < 0.05). Compared with delayed reconstruction, immediate reconstruction was associated with a significantly higher incidence of VTE (P < 0.05). Smoking history, length of hospital stay, and Caprini score did not correlate with increased incidence of post-operative VTE. CONCLUSION The incidence rate of VTE events in patients receiving surgical treatment for breast cancer is 2.2%. Risk factors for developing post-operative VTE in this patient population were found to be older age, increased BMI, extended length of surgical procedures, and DIEP flap reconstruction.
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Affiliation(s)
- Syeda Hoorulain Ahmed
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Ramin Shekouhi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Cameron Gerhold
- College of Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | | | - Armina Azizi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Gary Donath
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Harvey Chim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA.
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Wang Q, Chen H, Yang Q, Qiu J, Guo S, Zhou Y, Huang L, Li C, Zhang X. Awareness and associated factors of venous thromboembolism in breast cancer surgical patients: a cross-sectional study. BMC Cancer 2024; 24:610. [PMID: 38773439 PMCID: PMC11106856 DOI: 10.1186/s12885-024-12231-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/08/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major complication of breast cancer surgical patients. Assessing VTE awareness enables medical staff to tailor educational programs that improve patient self-management and reduce VTE risk. Therefore, this study aimed to assess VTE awareness among breast cancer surgical patients and identify factors influencing their awareness level. METHODS A multicenter cross-sectional study was conducted on breast cancer patients scheduled for surgery from May 2023 to November 2023. Data were collected using a general information form and a validated self-assessment questionnaire on VTE awareness for breast cancer surgical patients. Univariate analysis and multiple linear regression analysis were used to analyze the data. RESULTS Of 1969 patients included, the term awareness rates for deep vein thrombosis and pulmonary embolism were 42.5% and 26.1%, respectively. Information about VTE was primarily obtained from doctors (30.4%), nurses (24.0%), and social media (23.3%). The overall average VTE awareness score was 1.55 ± 0.53, with the dimension of VTE preventive measures scoring highest, and VTE clinical symptoms/signs scoring lowest. Multivariate analysis identified education level, personal VTE history, chemotherapy and surgical history, and the hospital's regional location as significant factors associated with VTE awareness level (p < 0.05). CONCLUSION This study highlights a critical need for improved VTE awareness among breast cancer surgical patients, particularly regarding clinical symptoms/signs. Health education programs are recommended especially tailored for patients with lower education levels, no history of VTE, or without prior surgery or chemotherapy, to improve their understanding of VTE.
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Affiliation(s)
- Qiuzhou Wang
- Division of Breast Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hongxiu Chen
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Qingyu Yang
- Division of Breast Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiajia Qiu
- Department of Nursing Administration, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Sijin Guo
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Yi Zhou
- Department of Breast Surgery ward II, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Lihong Huang
- Division of Breast Surgery, Department of General Surgery, PLA General Hospital, Beijing, China
| | - Chen Li
- Department of Gynecology, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoxia Zhang
- Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.
- West China School of Nursing, Sichuan University, Chengdu, China.
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
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Guo Q, Zhao J, Du X, Hu H, Huang B. Incidence, risk factors, and outcomes of venous thromboembolism in patients undergoing surgery for retroperitoneal tumors: a propensity-matched retrospective cohort study. Int J Surg 2023; 109:2689-2695. [PMID: 37578462 PMCID: PMC10498861 DOI: 10.1097/js9.0000000000000429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/21/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a common postoperative complication; however, the incidence and risk stratification of postoperative VTE in patients with retroperitoneal tumor remains unclear. The authors aim to quantify the incidence, identify risk factors, and determine the outcomes of VTE in patients undergoing retroperitoneal tumor surgery. METHODS The authors retrospectively reviewed the characteristics, perioperative outcomes, and overall survival (OS) of patients (VTE and non-VTE) who underwent retroperitoneal tumor surgery between 2015 and 2020. Perioperative and oncologic outcomes were compared using propensity-matching and Cox analyses. RESULTS Of 1223 patients with retroperitoneal tumor surgery, 2.1% had VTE. Age [odds ratio (OR) 1.140, 95% CI: 1.053-1.239, P =0.004], recurrence (OR 1.851, 95% CI: 1.241-2.761, P =0.003), and vascular resection (OR 2.036, 95% CI: 1.054-3.934, P =0.034) were independent risk factors, with significant between-group differences regarding age, recurrence, sarcoma, organ resection, vascular resection, and operation time. No between-group differences in 30-day all-cause mortality (8 vs. 4%, OR 0.657, 95% CI: 0.375-1.151, P =0.427) and major complications (12 vs. 8%, OR 0.775, 95% CI: 0.483-1.244, P =0.572) were observed. Mean hospitalization duration (20.1 vs. 22.9 days, OR 1.153, 95% CI: 1.022-1.386, P =0.033) and ICU stay (3.2 vs. 5.5 days, OR 1.193, 95% CI: 1.034-1.347, P =0.012) were shorter in non-VTE versus VTE, respectively, with inferior OS (hazard ratio 2.090, 95% CI: 1.014-4.308, P =0.046) in VTE. CONCLUSIONS Age, recurrence, and vascular resection are positively associated with VTE, which is associated with inferior OS.
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Affiliation(s)
| | | | | | | | - Bin Huang
- Department of General Surgery, Division of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
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Ohsumi S, Watanabe K, Kondo N, Kosaka Y, Ishikawa T, Kitahara M, Kubo S, Oba MS, Kimura T, Takita A, Mukai H. Venous thromboembolism in Japanese patients with breast cancer: subgroup analysis of the Cancer-VTE Registry. Breast Cancer 2023; 30:607-616. [PMID: 37069366 PMCID: PMC10284999 DOI: 10.1007/s12282-023-01452-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/07/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND This subgroup analysis of the Cancer-VTE Registry, a nationwide, large-scale, multicenter observational study with a 1-year follow-up, assessed real-world data on venous thromboembolism (VTE) among Japanese patients with breast cancer. METHODS Patients with stage II-IV pretreatment breast cancer screened for VTE at enrollment were included. During the 1-year follow-up period, incidences of VTE, bleeding, and all-cause death, and background factors associated with VTE risk were examined. RESULTS Of 9,630 patients in the Cancer-VTE Registry analysis set, 993 (10.3%) had breast cancer (973 [98.0%] did not have and 20 [2.0%] had VTE at baseline). The mean age was 58.4 years, 73.4% of patients had stage II cancer, and 94.8% had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0. Risk factors for VTE at baseline by univariable analysis were age ≥ 65 years, ECOG PS of 2, VTE history, and D-dimer > 1.2 μg/mL. During follow-up, the incidence of symptomatic VTE was 0.4%; incidental VTE requiring treatment, 0.1%; composite VTE (symptomatic VTE and incidental VTE requiring treatment), 0.5%; bleeding, 0.2%; cerebral infarction/transient ischemic attack/systemic embolic event, 0.2%; and all-cause death, 2.1%. One patient with symptomatic VTE developed pulmonary embolism (PE) and died. Incidences of VTE and all-cause death were higher in patients with VTE vs without VTE at baseline. CONCLUSIONS In Japanese patients with breast cancer, VTE screening before initiating cancer treatment revealed a 2.0% prevalence of VTE. During follow-up, one patient had a fatal outcome due to PE, but the incidences of VTE were low. CLINICAL TRIAL REGISTRATION UMIN000024942; UMIN Clinical Trials Registry: https://www.umin.ac.jp/ctr/ .
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Affiliation(s)
- Shozo Ohsumi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minami-umemoto-machi, Matsuyama, Ehime, 791-0280, Japan.
| | - Kenichi Watanabe
- Department of Breast Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Hokkaido, Japan
| | - Naoto Kondo
- Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Yoshimasa Kosaka
- Department of Breast and Endocrine Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
- Department of Breast Surgery, Japanese Red Cross Sagamihara Hospital, Sagamihara, Kanagawa, Japan
| | - Takashi Ishikawa
- Department of Breast Oncology and Surgery, Tokyo Medical University Hospital, Shinjuku-ku, Tokyo, Japan
| | - Miyuki Kitahara
- Department of Breast Surgery, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Kasama, Ibaraki, Japan
| | - Shinichiro Kubo
- Division of Breast and Thyroid Gland Surgery, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
| | - Mari S Oba
- Department of Medical Statistics, Toho University, Ota-ku, Tokyo, Japan
- Department of Clinical Data Science, Clinical Research and Education Promotion Division, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Tetsuya Kimura
- Primary Medical Science Department, Daiichi Sankyo Co., Ltd., Chuo-ku, Tokyo, Japan
| | - Atsushi Takita
- Data Intelligence Department, Daiichi Sankyo Co., Ltd., Shinagawa-ku, Tokyo, Japan
| | - Hirofumi Mukai
- Division of Medical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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Maesaka JY, Reis YN, Elias LM, Akerman D, Baracat EC, Filassi JR. Venous thromboembolism incidence in postoperative breast cancer patients. Clinics (Sao Paulo) 2023; 78:100229. [PMID: 37307626 PMCID: PMC10757280 DOI: 10.1016/j.clinsp.2023.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Venous Thromboembolism (VTE) is an important cause of morbidity in cancer patients. Breast cancer patients undergoing surgical treatment are at an increased risk of VTE. The aim of this study was to determine the frequency of VTE in patients who underwent surgery for the treatment of breast cancer and to identify the related risk factors. METHODS A historical cohort of patients at the São Paulo State Cancer Institute (ICESP) underwent surgery for breast cancer. The inclusion criteria covered patients with invasive breast cancer or ductal carcinoma in situ who had breast surgery anytime from January 2016 to December 2018. RESULTS Of the 1672 patients included in the study, 15 had a confirmed diagnosis of VTE (0.9%), and 3 of these had deep vein thrombosis (0.2%), and 12, had pulmonary thromboembolism (0.7%). Clinical and tumoral characteristics did not differ between the groups. The incidence of VTE was higher in patients who had undergone skin-sparing mastectomy or nipple-sparing mastectomy (p = 0.032). Immediate reconstruction, particularly with abdominal-based flaps (4.7%), increased VTE events (p = 0.033). Median surgical time was higher in patients with VTE episodes (p = 0.027), and total hospital length of stay increased in days (6 days vs. 2 days, p = 0.001). Neoadjuvant chemotherapy and postoperative prophylaxis with Low Molecular Weight Heparin (LMWH) were associated with lower VTE rates (0.2% vs. 1.2%, p = 0.048 and 0.7% vs. 2.7%, p = 0.039; respectively) in these patients. CONCLUSIONS The incidence of VTE events in breast cancer patients who underwent surgery was 0.9%. Immediate reconstruction (especially with abdominal-based flaps), skin-sparing/nipple-sparing mastectomies, and longer surgeries were associated with increased risk. The LMWH postoperative prophylaxis reduced this risk.
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Affiliation(s)
- Jonathan Yugo Maesaka
- Setor de Mastologia, Divisão de Ginecologia, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BR.
| | - Yedda Nunes Reis
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - Livia Menezes Elias
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - Denise Akerman
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - Edmund Chada Baracat
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
| | - José Roberto Filassi
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, BR
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Park JH, Ahn SE, Kwon LM, Ko HH, Kim S, Suh YJ, Kim HY, Park KH, Kim D. The Risk of Venous Thromboembolism in Korean Patients with Breast Cancer: A Single-Center Experience. Cancers (Basel) 2023; 15:3124. [PMID: 37370734 DOI: 10.3390/cancers15123124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
The relationship between cancer and venous thromboembolism (VTE) has long been described. The risk of VTE in Asian patients with breast cancer remains largely unknown. This study described the incidence and risk factors of VTE in Korean patients with breast cancer. Data were collected from a retrospective database of patients who underwent breast cancer surgery between 2011 and 2020 at a single institution. The Cox proportional-hazards model was used to identify factors associated with VTE occurrences. Among the 2246 patients with breast cancer, 48 (2.1%) developed VTE during a median follow-up period of 53 months. The average incidence of VTE was 459 per 100,000 person-years. Age ≥ 60 years, male sex, chronic kidney disease, reconstructive procedures, and stage II or higher were independent predictive factors for VTE. VTE was associated with poor disease-free survival (hazard ratio (HR), 6.140; 95% confidence interval (CI), 3.480-10.835), and overall survival (HR, 8.842; 95% CI 4.386-17.824). Most VTE events were manageable with anticoagulation; three (6.3%) patients died of VTE, despite intensive care. The incidence of VTE was significantly elevated in Korean patients with breast cancer. Since VTE has a negative effect on oncologic outcomes of breast cancer, clinicians should manage its risk throughout their lifetime.
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Affiliation(s)
- Jung Ho Park
- Division of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Republic of Korea
| | - So Eun Ahn
- Division of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Republic of Korea
| | - Lyo Min Kwon
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang 14068, Republic of Korea
| | - Ho Hyun Ko
- Department of Thoracic and Cardiovascular Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Republic of Korea
| | - Sanghwa Kim
- Division of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Republic of Korea
| | - Yong Joon Suh
- Division of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Republic of Korea
| | - Ho Young Kim
- Division of Hematology-Oncology, Hallym University Sacred Heart Hospital, Anyang 14068, Republic of Korea
| | - Kyoung-Ha Park
- Division of Cardiovascular Disease, Hallym University Sacred Heart Hospital, Anyang 14068, Republic of Korea
| | - Doyil Kim
- Division of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Anyang 14068, Republic of Korea
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Chen F, Sun Y, Zhang C, Li L, Du Y, Zhou M, Cheng W. Risk Factors of Venous Thromboembolism in Inpatients With Colorectal Cancer in China. Clin Appl Thromb Hemost 2023; 29:10760296231221133. [PMID: 38105233 PMCID: PMC10729642 DOI: 10.1177/10760296231221133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/14/2023] [Accepted: 11/26/2023] [Indexed: 12/19/2023] Open
Abstract
To explore the risk factors for venous thromboembolism (VTE) in inpatients with colorectal cancer. The demographic factors, comorbidities, and hematological indices of patients with colorectal cancer treated in our hospital from 2016 to 2021 were collected and recorded. Venous thromboembolism events, including deep venous thrombosis and/or pulmonary embolism, were recorded and the patients were divided into the VTE group and the non-VTE group. We compared clinical data between the two groups and explored risk factors for VTE. Comparing the clinical data of 293 cases of non-VTE group and 235 cases of VTE group, we found significant differences in age, smoking, temperature, amount of blood loss, differentiation degree, peripherally inserted central catheter (PICC), radiotherapy, anemia, infection, white blood cell count, prothrombin time (PT), PT%, prothrombin ratio, international normalized ratio, thrombin time, CA199 and CEA between the two groups (P < 0.05). Logistic regression analysis showed that age (P = 0.0444), temperature (P = 0.0317), amount of blood loss (P = 0.0067), PICC (P < 0.0001), chemotherapy (P = 0.0459), anemia (P = 0.0007), international normalized ratio (P = 0.003) and CA199 (p = 0.0234) were independent risk factors for VTE. Receiver operating characteristic curve analysis showed that the amount of blood loss predicted thrombosis better (AUC = 0.778, P < 0.001), when the cutoff value was 20 mL, the sensitivity was 76.17%, and the specificity was 79.18%, respectively. And PICC predicted thrombosis better (AUC = 0.808, P < 0.001), the sensitivity was 70.21%, and the specificity was 91.47%, respectively. Clinical parameters are associated with VTE in inpatients with colorectal cancer, which will help to guide clinicians to take effective measures to improve the patients' prognosis.
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Affiliation(s)
- Fengjiao Chen
- Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Yixin Sun
- Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Cui Zhang
- Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Lei Li
- Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Yu Du
- Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Mingyan Zhou
- Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Wen Cheng
- Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
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Li Y, Liu Z, Chen C, Li D, Peng H, Zhao P, Wang J. Risk factors and potential predictors of pulmonary embolism in cancer patients undergoing thoracic and abdominopelvic surgery: a case control study. Thromb J 2022; 20:80. [PMID: 36550497 PMCID: PMC9783998 DOI: 10.1186/s12959-022-00442-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Postoperative pulmonary embolism (PE) is a severe complication leading to death and poor prognosis. The present study investigated the risk factors and potential predictors of PE in cancer patients undergoing thoracic and abdominopelvic surgery. METHODS A retrospective study was conducted on the patients with cancer who underwent thoracic and abdominopelvic surgery in Sichuan Cancer Hospital from December 2016 to January 2022. A total of 189 patients were included, in which 63 patients diagnosed PE after operation were collected as PE group, and 126 patients matched by age, type of cancer and cancer location were enrolled as control group. Conditional logistic regression was conducted to analyze the association between PE and risk factors. Predictive values of key factors were compared by the area under the curve (AUC) in receiver operating characteristic curve (ROC) curve. RESULTS Conditional multivariate logistic regression showed that BMI (odds ratio [OR] 4.065, 95% confidence interval [CI] 1.138-14.527; p = 0.031), intraoperative hypotension time (OR 4.095, 95% CI 1.367-12.266; p = 0.009), same day fluid balance (OR 0.245, 95% CI 0.061-0.684; p = 0.048), and postoperative D-Dimer (OR 1.693, 95% CI 1.098-2.611; p = 0.017) were significantly related to the occurrence of postoperative PE. Postoperative D-Dimer had the maximal AUC value 0.8014 (95% CI: 0.7260-0.8770) for predicting PE, with a cutoff value of 1.505 μg/ml. CONCLUSIONS BMI, intraoperative hypotension time, lower same day fluid balance and postoperative D-dimer are independent risk factors associated with PE in cancer patients undergoing thoracic and abdominopelvic surgery. Postoperative D-Dimer seems to be a good indicator to predict postoperative PE for cancer patients.
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Affiliation(s)
- Yi Li
- grid.415880.00000 0004 1755 2258Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Surgical Building, No. 55 4th section of South Renmin Road, Chengdu, Sichuan China
| | - Zhenjun Liu
- grid.415880.00000 0004 1755 2258Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Surgical Building, No. 55 4th section of South Renmin Road, Chengdu, Sichuan China
| | - Chen Chen
- grid.415880.00000 0004 1755 2258Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Surgical Building, No. 55 4th section of South Renmin Road, Chengdu, Sichuan China
| | - Dan Li
- grid.415880.00000 0004 1755 2258Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Surgical Building, No. 55 4th section of South Renmin Road, Chengdu, Sichuan China
| | - Huan Peng
- grid.415880.00000 0004 1755 2258Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Surgical Building, No. 55 4th section of South Renmin Road, Chengdu, Sichuan China
| | - Pei Zhao
- grid.415880.00000 0004 1755 2258Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Surgical Building, No. 55 4th section of South Renmin Road, Chengdu, Sichuan China
| | - Jiuhui Wang
- grid.415880.00000 0004 1755 2258Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Surgical Building, No. 55 4th section of South Renmin Road, Chengdu, Sichuan China
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Venous Thromboembolism in Cancer Patients Undergoing Chemotherapy: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12122954. [PMID: 36552961 PMCID: PMC9777086 DOI: 10.3390/diagnostics12122954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/06/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Objective: Venous thromboembolism (VTE) is a life-threatening complication that may exacerbate cancer prognosis. Whilst some studies indicate an increased risk of VTE in cancer patients undergoing chemotherapy, the prevalence estimates on the pooled prevalence of VTE in cancer patients undergoing chemotherapy are not known. This study aims to calculate the pooled prevalence of VTE in chemotherapy-treated cancer patients. Methods: Studies on VTE occurrence in cancer patients undergoing chemotherapy were retrieved after database search. The terms used included “cancer”, “chemotherapy”, and “venous thromboembolism”. A random-effects meta-analysis was conducted to obtain a pooled estimate of VTE prevalence in cancer patients undergoing chemotherapy. Results: A total of 102 eligible studies involving 30,671 patients (1773 with VTE, 28,898 without) were included in the meta-analysis. The pooled estimate of VTE prevalence was found to be 6%, ranging from 6% to 7% (ES 6%; 95% CI 6−7%; z = 18.53; p < 0.001). Conclusions: The estimated pooled prevalence rate of VTEs was 6% in cancer patients undergoing CRT, which was higher than the overall crude prevalence rate (5.78%). Comprehensive cancer care should consider stratified VTE risk assessment based on cancer phenotype, given that certain phenotypes of cancer such as bladder, gastric and ovarian posing particularly high risks of VTE.
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Thalji SZ, Cortina CS, Guo MS, Kong AL. Postoperative Complications from Breast and Axillary Surgery. Surg Clin North Am 2022; 103:121-139. [DOI: 10.1016/j.suc.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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