Early warning prevention and control strategies to reduce perioperative venous thromboembolism in patients with gastrointestinal cancer

Table 1 Characteristics of the patients in two groups

Item	Control (n = 128)	Early warning (n = 136)	P value
Sex, n (%)
Male	72 (56.3)	69 (50.7)	0.369
Female	56 (43.8)	67 (49.3)
Age (years), mean ± SD	65.9 ± 11.3	63.4 ± 12.7	0.096
BMI (kg/m2), mean ± SD	21.6 ± 3.3	22.3 ± 4.2	0.108
Education, n (%)			0.263
Junior middle school and below	36 (28.1)	41 (30.2)
Senior high school and technical secondary school	59 (40.1)	50 (36.8)
Junior college and undergraduate and above	33 (25.8)	45 (33.1)
Marital status, n (%)			0.736
Living with a spouse	86 (67.2)	94 (66.9)
Unmarried, widowed or divorced	42 (32.8)	42 (30.9)
Hypertension, n (%)	23 (17.9)	19 (14.0)	0.375
Diabetes, n (%)	18 (14.1)	24 (17.6)	0.402
Hyperlipemia, n (%)	15 (11.7)	18 (13.2)	0.710
Preoperative VTE risk classification, n (%)			0.488
Moderate risk	52 (40.6)	61 (44.9)
High risk	76 (59.4)	75 (55.2)
TNM, n (%)			0.928
I	34 (26.6)	39 (28.7)
II	51 (39.9)	53 (39.0)
III	43 (33.6)	44 (32.4)
Surgical method, n (%)			0.524
Radical resection of gastric cancer	68 (53.1)	70 (51.5)
Radical resection of rectal cancer	42 (32.8)	40 (29.4)
Radical resection of colon cancer	18 (14.1)	26 (19.12)
Operation time (min), mean ± SD	118.5 ± 45.7	121.8 ± 51.9	0.247
Intraoperative blood loss (mL), mean ± SD	85.3 ± 21.6	89.7 ± 23.6	0.076
Length of hospital stay (day), mean ± SD	15.27 ± 2.68	14.69 ± 2.35	0.062

SD: Standard deviation; VTE: Venous thromboembolism; BMI: Body mass index.

Table 2 Comparison of deep vein thrombosis occurrence rate, venous thromboembolism risk assessment rate by nurses, and implementation rate of VTE preventive measures between the two groups

	Control (n = 128)	Early warning (n = 136)	P value
Occurrence of DVT, n (%))	18 (14.1)	9 (6.6)	0.046
Correct rates of VTE risk assessment of nurse evaluation, n (%)	84 (65.6)	118 (86.8)	< 0.001
Standard implementation rate of VTE preventive measures of patients, n (%)	74 (57.8)	109 (80.2)	< 0.001

DVT: Deep vein thrombosis; VTE: Venous thromboembolism.

Table 3 Comparison of coagulation indicators between two groups at different points in time

	Control (n = 128)	Early warning (n = 136)	P value
d-dimer (µg/mL), mean ± SD
Before	0.46 ± 0.20	0.44 ± 0.24	0.473
1 d	1.86 ± 0.96	2.04 ± 1.27	0.197
3 d	3.27 ± 1.85	2.68 ± 1.74	0.008
7 d	2.75 ± 1.82	1.52 ± 1.03	0.000
Prothrombin time (s), mean ± SD
Before	11.3 ± 1.4	11.1 ± 1.0	0.061
1 d	11.5 ± 1.1	11.3 ± 1.2	0.359
3 d	11.7 ± 1.0	11.5 ± 0.9	0.057
7 d	11.2 ± 1.2	11.3 ± 1.0	0.648
Fibrinogen degradation product, mean ± SD
Before	2.54 ± 1.52	2.67 ± 1.36	0.464
1 d	7.26 ± 3.21	6.82 ± 3.29	0.273
3 d	7.69 ± 2.27	5.62 ± 2.11	0.000
7 d	8.16 ± 4.26	4.38 ± 3.04	0.000
Activated partial thromboplastin time (s), mean ± SD
Before	33.1 ± 6.4	32.2 ± 5.7	0.242
1 d	35.6 ± 7.3	35.7 ± 6.6	0.925
3 d	34.6 ± 6.6	32.8 ± 7.3	0.523
7 d	62.3 ± 6.3	32.3 ± 6.6	0.247

SD: Standard deviation.

Table 4 Univariate and Multivariate logistic regression analysis of the occurrence of postoperative deep vein thrombosis of patients with gastrointestinal cancer

	DVT Group (n = 27)	Non-DVT Group (n = 237)	Univariate			Multivariate
			OR	95%CI	P value	OR	95%CI	P value
Age	70.81 ± 7.95	60.17 ± 8.36	1.03	1.04-1.35	0.026	1.083	1.070-3.265	0.032
Gender
Male	16 (59.26)	125 (52.74)	1
Female	11 (40.74)	112 (47.26)	1.30	0. 58-2.93	0.52
BMI	22.56 ± 1.92	21.83 ± 2.51	1.09	0.96-1.23	0.145
Education background
Junior secondary and below	5 (18.52)	72 (30.38)	1
Above junior secondary	22 (81.48)	165 (69.62)	0.52	0.19-1.43	0.371
Marital status
Having a spouse	17 (62.96)	163 (68.78)	1
Unmarried, widowed, or divorced	10 (37.04)	74 (31.22)	0.77	0.33-1.76	0.539
Hypertension, no	17 (62.96)	205 (84.50)	3.77	1.58-8.95	0.002
Diabetes, no	22 (81.48)	200 (84.39)	1.23	0.43-3.45	0.78
Hyperlipidemia, yes	8 (29.63)	25 (10.55)	3.57	1.41-8.99	0.005	1.127	1.139-2.564	0.042
TNM
I, II	6 (22.22)	67 (28.27)	1
III	12 (44.45)	75 (31.65)	0.56	0.25-1.26	0.18
Surgery method
Radical gastrectomy	13 (48.15)	125 (52.74)	1
Radical resection of colorectal cancer	9 (33.33)	73 (30.80)	0.832	0.37-1.81	0.651
Preoperative VTE risk grade
Medium-risk	6 (22.22)	107 (45.15)	1
High risk	21 (77.78)	130 (54.85)	1.12	0.13-0.89	0.023	2.131	1.085-5.178	0.001
Time of operation (min)	128.4 ± 29.47	112.2 ± 35.76	1.07	1.13-1.37	0.024	2.268	2.005-5.546	0.026
Intraoperative bleeding volume (mL)	91.46 ± 17.38	85.25 ± 20.26	1.06	0.48-1.26	0.127
Adoption of early warning prevention, no	18 (66.67)	110 (46.41)	1.28	0.18-1.0	0.046	3.747	1.523-6.956	0.017

OR: Odds ratio; CI: Confidence interval; DVT: Deep vein thrombosis; BMI: Body mass index; VTE: Venous thromboembolism; BMI: Body mass index.

Table 5 Comparison of venous thromboembolism knowledge in nurses before and after implementation

	Before implementation (n = 86)	After implementation (n = 86)	P value
VTE basic knowledge, mean ± SD	20.0 ± 3.7	23.6 ± 4.3	< 0.001
VTE evaluation knowledge, mean ± SD	18.2 ± 4.0	23.4 ± 4.2	< 0.001
VTE prevention knowledge, mean ± SD	22.3 ± 3.4	25.4 ± 2.5	< 0.001
Total score, mean ± SD	62.4 ± 10.1	71.3 ± 11.4	< 0.001

SD: Standard deviation; VTE: Venous thromboembolism.