Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2022; 10(10): 3035-3046
Published online Apr 6, 2022. doi: 10.12998/wjcc.v10.i10.3035
Early warning prevention and control strategies to reduce perioperative venous thromboembolism in patients with gastrointestinal cancer
Yun Lu, Feng-Ying Chen, Lan Cai, Chun-Xia Huang, Xue-Fang Shen, Li-Qin Cai, Xiao-Ting Li, Yong-Yan Fu, Juan Wei
Yun Lu, Xue-Fang Shen, Juan Wei, The Fifth Ward of Surgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, Jiangsu Province, China
Feng-Ying Chen, Lan Cai, Chun-Xia Huang, Xiao-Ting Li, Yong-Yan Fu, Department of Nursing, Traditional Chinese Medicine Hospital of Kunshan, Kunshan 215300, Jiangsu Province, China
Li-Qin Cai, The Fourth Ward of Surgery, Traditional Chinese Medicine Hospital of Kunshan, Kunshan 215300, Jiangsu Province, China
Author contributions: Lu Y and Chen FY and Shen XF carried out the studies, participated in collecting data, and drafted the manuscript; Li XT and Cai LQ and Fu YY performed the statistical analysis and critically for important intellectual content; Huang CX, Li XT, and Lu Y participated in acquisition, analysis, or interpretation of data and drafted the manuscript; All authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Kunshan Traditional Chinese Medicine Hospital of Jiangsu Province Affiliated to Nanjing University of Traditional Chinese Medicine (#2017063).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: This study was registered at the China Clinical Trial Registry (registration number: ChiCTR2100044555).
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xue-Fang Shen, MBBS, Doctor, The Fifth Ward of Surgery, Kunshan Hospital of Traditional Chinese Medicine, No. 189 Chaoyang Road, Kunshan 215300, Jiangsu Province, China. 13913262392@163.com
Received: September 3, 2021
Peer-review started: September 3, 2021
First decision: December 1, 2021
Revised: December 23, 2021
Accepted: February 20, 2022
Article in press: February 20, 2022
Published online: April 6, 2022
Processing time: 207 Days and 3.7 Hours
Abstract
BACKGROUND

Venous thromboembolism (VTE) is a major cause of unexpected and perioperative in-hospital deaths. It is characterized by high morbidity, high mortality, high misdiagnosis rate, and high missed diagnosis rates. VTE is a common postoperative complication in cancer patients. VTE is preventable, and early identification of risk factors leading to VTE and appropriate early preventive actions can reduce its occurrence and mortality. Presently, there is no uniform standard for the prevention and control of VTE in clinical practice, and hospitals in China lack mature and effective protocols for the assessment, prevention, and treatment of VTE.

AIM

To explore whether an early warning program could influence the occurrence of deep vein thrombosis (DVT) postoperatively.

METHODS

This is a comparative retrospective cohort study, which enrolled patients who underwent laparotomic or laparoscopic gastrointestinal tumor resection for gastrointestinal cancer between January 2016 and December 2019. Patients were divided into a control group and an early warning group depending on whether or not the early warning program was implemented. A venous thromboembolism prevention and control team was established. The outcomes included the occurrence of DVT, the correct rate of VTE assessment, the coagulation indicators, and the mastery of VTE knowledge by the nurses.

RESULTS

A total of 264 patients were included in this study, with 128 patients in the control group and 136 patients in the early warning group. The occurrence rate of DVT in the early warning group was 6.6% (9/136), compared with 14.1% (18/128) in the control group (P < 0.05). The correct rates of VTE risk assessment by the nurses and standard implementation rate of VTE preventive measures were 86.8% vs 65.6% and 80.2% vs 57.8% in early warning and control groups, respectively (all P < 0.001). The independent factors associated with postoperative DVT occurrence were age (OR = 1.083, 95%CI: 1.070-3.265, P = 0.032), Hyperlipidemia (OR = 1.127, 95%CI: 1.139-2.564, P = 0.042), preoperative high VTE risk (OR = 2.131, 95%CI: 1.085-5.178, P = 0.001), time of operation (OR = 2.268, 95%CI: 2.005-5.546, P = 0.026) and not adoption of early warning prevention (OR = 3.747, 95%CI: 1.523-6.956, P = 0.017).

CONCLUSION

The early warning strategy was independently associated with the decreasing occurrence of VTE, and it might be suitable for protection from VTE in patients undergoing gastrointestinal cancer surgery.

Keywords: Venous thromboembolism; Gastrointestinal cancer; Perioperative period; Early warning; Prevention and control

Core Tip: Presently, there is no uniform standard for the prevention and control of venous thromboembolism (VTE) in clinical practice, and hospitals in China lack mature and effective protocols for the assessment, prevention, and treatment of VTE. An early warning strategy was independently associated with the decreasing occurrence of VTE, and it might be suitable for protection from VTE in patients undergoing gastrointestinal cancer surgery.