Background

Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), represents a common cause of morbidity and mortality following complex gastrointestinal surgery. Whether perioperative VTE also exposes patients to a higher long-term risk of VTE events remains poorly defined.

Methods

The Medicare 100% Standard Analytic Files were used to identify patients undergoing esophageal, hepatic, pancreatic, and colorectal resection between 2013 and 2017. The impact of perioperative VTE, defined as a VTE episode occurring during the index hospitalization or within 30 days of discharge, on the risk of developing subsequent long-term VTE episodes (i.e., more than 30 days following discharge) was examined.

Results

Among 253,212 patients who underwent complex gastrointestinal surgery, 1.9% (n=4763) developed a VTE episode perioperatively. With a median follow-up period of 553 days (IQR 194–1052), a total of 11,052 patients (4.4%) developed a long-term VTE episode. Of note, patients who developed a DVT perioperatively had a higher risk of experiencing a long-term VTE episode than patients who had no perioperative thromboembolic complications (HR 6.50, 95%CI 6.04–6.98). The increase in risk was more pronounced among patients who had a PE (HR 27.97, 95%CI 25.39–30.80) at the time of surgery. Risk factors for long-term thromboembolic events following complex GI surgery included Black patients (HR 1.20, 95%CI 1.11–1.30), receipt of surgery at a teaching hospital (HR 1.09, 95%CI 1.04–1.13), nonelective surgery (HR 1.19, 95%CI 1.14–1.24), as well as a diagnosis of cancer (HR 1.10, 95%CI 1.05–1.16). The development of a perioperative DVT was associated with an increased long-term risk of VTE in both cancer (HR 5.59, 95%CI 5.29–6.61) and non-cancer patients (HR 6.98, 95%CI 6.37–7.64). Similarly, experiencing a PE at the time of surgery led to a higher long-term risk of VTE in cancer (HR 24.30, 95%CI 21.08–28.02), as well as non-cancer (HR 30.81, 95%CI 27.01–35.15) patients.

Conclusions

Patients with a history of perioperative VTE had a higher risk of developing subsequent VTE events within 1–2 years following complex GI surgery. The risk was more pronounced among patients who had perioperative PE rather than DVT. These findings were consistent among both cancer and non-cancer patients.

中文翻译：

---

围手术期血栓栓塞并发症对接受复杂胃肠手术的医疗保险受益人未来静脉血栓栓塞长期风险的影响

背景

静脉血栓栓塞 (VTE)，包括深静脉血栓 (DVT) 和肺栓塞 (PE)，是复杂胃肠手术后发病率和死亡率的常见原因。围手术期 VTE 是否也会使患者暴露于更高的 VTE 事件长期风险仍然不清楚。

方法

Medicare 100% 标准分析文件用于识别 2013 年至 2017 年期间接受食管、肝脏、胰腺和结直肠切除术的患者。 围手术期 VTE 的影响，定义为在住院期间或出院后 30 天内发生的 VTE对发生后续长期 VTE 发作（即出院后 30 天以上）的风险进行了检查。

结果

在接受复杂胃肠道手术的 253,212 名患者中，1.9%（n=4763）在围手术期发生了 VTE。中位随访时间为 553 天（IQR 194-1052），共有 11,052 名患者（4.4%）发生了长期 VTE 发作。值得注意的是，围手术期发生 DVT 的患者发生长期 VTE 发作的风险高于没有围手术期血栓栓塞并发症的患者（HR 6.50，95%CI 6.04–6.98）。手术时发生 PE 的患者风险增加更为明显（HR 27.97，95%CI 25.39–30.80）。复杂胃肠道手术后长期血栓栓塞事件的危险因素包括黑人患者 (HR 1.20, 95%CI 1.11–1.30)、在教学医院接受手术 (HR 1.09, 95%CI 1.04–1.13)、非选择性手术 (HR 1.19, 95% CI 1.14–1.24), 以及癌症的诊断（HR 1.10，95% CI 1.05–1.16）。在癌症（HR 5.59，95%CI 5.29-6.61）和非癌症患者（HR 6.98，95%CI 6.37-7.64）中，围手术期 DVT 的发展与 VTE 的长期风险增加有关。同样，在手术时经历 PE 导致癌症 (HR 24.30, 95%CI 21.08–28.02) 和非癌症 (HR 30.81, 95%CI 27.01–35.15) VTE 的长期风险更高） 耐心。

结论

有围手术期 VTE 病史的患者在复杂 GI 手术后 1-2 年内发生后续 VTE 事件的风险较高。围手术期 PE 而非 DVT 的患者风险更明显。这些发现在癌症和非癌症患者中都是一致的。