Influencing factors of venous thromboembolism in the perisurgical period of gynecological surgery
Objective To analyze the risk factors of venous thromboembolism(VTE)in the perisurgical period of gynecological surgery and to explore the value of postsurgical individualized therapy to the prevention of pulmonary embolism(PE).Methods A retrospective analysis was conducted on the clinical data of 57 cases of VET(VTE group)and 114 cases without VTE(control group)in the perisurgical period of gynecological surgery in the Third Hospital of Shanxi Medical University from February 2022 to October 2023.The deep venous thrombosis(DVT)preventive method and occurrence of PE were recorded in VTE group.The age,body mass index,type of disease,underlying diseases,surgical approach,surgical technique,duration of surgery,blood volume after surgery,and proportion of pregnancy or puerperium were compared between two groups.Multivariate logistic regression analysis was conducted to identify the influencing factors of VTE in the perisurgical period of gynecological surgery.Results(1)In VTE group,17 patients with a postsurgical Caprini score of ≥5 were subjected to immediate bilateral lower limb ultrasonography,revealing the formation of intrasurgical DVT,and they were found no PE during their hospitalization after immobilization of both lower limbs and individualized anticoagulation therapy.The other 40 patients were subjected to physical therapy after surgery and subsequent individualized anticoagulation therapy 6 to 12 h after surgery to prevent DVT formation.Nine patients with elevated D-dimer level and symptoms of PE during physical therapy were confirmed as PE by bilateral lower limb ultrasonography and CT pulmonary angiography.Twenty patients during physical therapy and 11 during anticoagulation therapy experienced elevated D-dimer level and were diagnosed with DVT by bilateral lower limb ultrasonography.(2)In VTE group,the proportions of age ≥60 years(29.82％),malignant/borderline ovarian tumors(57.89％),hypertension(38.60％),diabetes(31.58％),hysterectomy(42.11％),hysterectomy+lymph node dissection(47.37％),open abdominal surgery(38.60％),surgical duration ≥180 min(56.14％),and postsurgical hypovolemia(21.05％)in VTE group were higher than those in control group(13.16％,21.93％,17.54％,17.54％,34.21％,21.93％,21.93％,22.81％,9.65％)(x2=0.011,20.354,9.090,4.331,21.622,21.622,5.296,18.838,4.245;all P values＜0.05),while the body mass index and pregnancy or puerperium proportion had no significant differences between two groups(P＞0.05).(3)Malignant/borderline ovarian tumors(OR=9.313,95％CI:3.673-23.630,P＜0.001),open abdominal surgery(OR=15.269,95％CI:4.035-57.771,P＜0.001),hysterectomy+lymph node dissection(OR=2.831,95％CI:1.053-7.601,P=0.039),and surgical duration ≥180 min(OR=26.576,95％CI:6.949-101.691,P＜0.001)were the risk factors of VTE in the perisurgical period of gynecological surgery.Conclusions The patients with malignant/borderline ovarian tumors,open abdominal surgery,hysterectomy+lymph node dissection,and duration of surgery ≥ 180 min have an increased risk of VTE in the perisurgical period of gynecological surgery.Immediate postsurgical thromboembolic risk assessment,and immobilization plus individualized anticoagulation therapy for those with intrasurgical DVT,contribute to the prevention of PE.
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