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A Prospective Observational Study to Determine Rate of Thromboprophylaxis in Oncology Patients Undergoing Abdominal or Pelvic Surgery.

ABSTRACT: Venous thromboembolism (VTE) is common in patients with cancer and is a leading cause of death. In addition to the hypercoagulable state associated with malignancy, cancer-related surgery and subsequent immobilization further increase the risk of VTE. Guidelines suggest extended prophylaxis up to 4 weeks with low-molecular-weight heparin (LMWH) in such patients. This study is conducted to determine the proportion of patients receiving thromboprophylaxis among those undergoing surgery for malignant abdominal or pelvic tumor. This prospective, multicenter, observational study included 300 patients (217 [72.3%] were women). Mean age and duration of cancer were 53.2 and 1.2 years, respectively. A total of 162 (54%) patients received thromboprophylaxis of which only pharmacological in 78 [48.1%], only mechanical in 27 [16.7%], and both pharmacological and mechanical in 57 [35.2%] patients. LMWH (128, 79.0%) and graduated compression stockings (74, 45.7%) were the commonly used modalities. VTE prophylaxis was given in only half of the patients. Physician education to increase adherence to international guidelines is very important. Trial Registration No. CTRI/2013/05/003617.

Supplementary information

The online version contains supplementary material available at 10.1007/s13193-021-01281-0.

SUBMITTER: Shrikhande SV

PROVIDER: S-EPMC8272769 | biostudies-literature | 2021 Jun

REPOSITORIES: biostudies-literature

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A Prospective Observational Study to Determine Rate of Thromboprophylaxis in Oncology Patients Undergoing Abdominal or Pelvic Surgery.

Shrikhande Shailesh V SV Verma Manish M

Indian journal of surgical oncology 20210301 2

Venous thromboembolism (VTE) is common in patients with cancer and is a leading cause of death. In addition to the hypercoagulable state associated with malignancy, cancer-related surgery and subsequent immobilization further increase the risk of VTE. Guidelines suggest extended prophylaxis up to 4 weeks with low-molecular-weight heparin (LMWH) in such patients. This study is conducted to determine the proportion of patients receiving thromboprophylaxis among those undergoing surgery for maligna ...[more]

PMID: 34290488

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Project description:BackgroundThere is low-certainty evidence on the impact of extended pharmacological prophylaxis on venous thromboembolism-associated morbidity and mortality. The aim of this study was to determine the efficacy and safety of extended prophylaxis after major abdominopelvic surgery for the prevention of clinically relevant venous thromboembolism after hospital discharge.MethodsCArdiovaSCulAr outcomes after major abDominal surgEry (CASCADE) was a prospective, international, cohort study into which consecutive adult patients undergoing major abdominopelvic surgery were enrolled (January-May 2022). Extended prophylaxis was considered at least 28 days of anticoagulant prescription after surgery. The primary efficacy outcome was clinically relevant venous thromboembolism and the primary safety outcome was clinically relevant bleeding within 30 days after surgery (European Medicines Agency definitions). The independent association of these outcomes with extended prophylaxis was explored using mixed-effects logistic regression and propensity score weighting.ResultsA total of 11 571 patients (median age of 58.0 years; 6399 (55.3%) women) from 29 countries were included. The extended prophylaxis prescription rate was 31.7% (3670 patients). The post-discharge venous thromboembolism and bleeding rates were 0.1% (12 patients) and 0.7% (85 patients) respectively. After weighting, extended prophylaxis was not significantly associated with increased bleeding risk (OR 1.07 (95% c.i. 0.64 to 1.81); P = 0.792) or decreased venous thromboembolism incidence, both in the overall cohort (OR 1.13 (95% c.i. 0.33 to 3.90); P = 0.848) and in a subgroup analysis of patients undergoing complex major surgery and with active cancer (OR: 1.36 (95% c.i. 0.33 to 5.57); P = 0.669).ConclusionIn modern practice, the incidence of postoperative venous thromboembolism is low. Extended prophylaxis appears safe, yet the clinical efficacy remains uncertain. Further work is required to define patients who stand to benefit.

Project description:BackgroundHernia repairs account for millions of general surgical procedures performed each year worldwide, with a notable shift to outpatient settings over the last decades. As technical possibilities such as smartphones, tablets, and different kinds of probes are becoming more and more available, such systems have been evaluated for applications in various clinical settings. However, there have been few studies conducted in the surgical field, especially in general surgery.ObjectiveWe aimed to assess the feasibility of a tablet-based follow up to monitor activity levels after repair of abdominal wall hernias and to evaluate a possible reduction of adverse events by their earlier recognition.MethodsPatients scheduled for elective surgical repair of minor abdominal wall hernias (eg, inguinal, umbilical, or trocar hernias) were equipped with a telemonitoring system, including a tablet, pulse oximeter, and actimeter, for a monitoring phase of 7 days before and 30 days after surgery. Descriptive statistical analyses were performed.ResultsWe enrolled 16 patients with a mean overall age of 48.75 (SD 16.27) years. Preoperative activity levels were reached on postoperative day 12 with a median of 2242 (IQR 0-4578) steps after plunging on the day of surgery. The median proportion of available activity measurements over the entire study period of 38 days was 69% (IQR 56%-81%). We observed a gradual decrease in the proportion of available data for all parameters during the postoperative course. Six out of ten patients (60%) regained preoperative activity levels within 3 weeks after surgery. Overall, patients rated the usability of the system as relatively easy.ConclusionsTablet-based follow up is feasible after surgical repair of minor abdominal wall hernias, with good adherence rates during the first couple of weeks after surgery. Thus, such a system could be a useful tool to supplement or even replace traditional outpatient follow up in selected general surgical patients.

Project description:BACKGROUND:Major abdominal surgery (MAS) is associated with increased morbidity and mortality. The main objective of our study was to evaluate the predictive value of heart-rate variability (HRV) concerning development of postoperative complications in patients undergoing MAS. The secondary objectives were to identify the relationship of HRV and use of vasoactive drugs during anesthesia, intensive care unit length of stay (ICU-LOS), and hospital length of stay (H-LOS). PATIENTS AND METHODS:Sixty-five patients scheduled for elective MAS were enrolled in a prospective, single-center, observational study. HRV was measured by spectral analysis (SA) preoperatively during orthostatic load. Patients were divided according to cardiac autonomic reactivity (CAR; n=23) and non-cardiac autonomic reactivity (NCAR; n=30). RESULTS:The final analysis included 53 patients. No significant difference was observed between the two groups regarding type of surgery, use of minimally invasive techniques or epidural catheter, duration of surgery and anesthesia, or the amount of fluid administered intraoperatively. The NCAR group had significantly greater intraoperative blood loss than the CAR group (541.7±541.9 mL vs 269.6±174.3 mL, p<0.05). In the NCAR group, vasoactive drugs were used during anesthesia more frequently (n=21 vs n=4; p<0.001), and more patients had at least one postoperative complication compared to the CAR group (n=19 vs n=4; p<0.01). Furthermore, the NCAR group had more serious complications (Clavien-Dindo ≥ Grade III n=6 vs n=0; p<0.05) and a greater number of complications than the CAR group (n=57 vs n=5; p<0.001). Significant differences were found for two specific subgroups of complications: hypotension requiring vasoactive drugs (NCAR: n=10 vs CAR: n=0; p<0.01) and ileus (NCAR: n=11 vs CAR: n=2; p<0.05). Moreover, significant differences were found in the ICU-LOS (NCAR: 5.7±3.5 days vs CAR: 2.6±0.7 days; p<0.0001) and H-LOS (NCAR: 12.2±5.6 days vs CAR: 7.2±1.7 days; p<0.0001). CONCLUSION:Preoperative HRV assessment during orthostatic load is objective and useful for identifying patients with low autonomic physiological reserves and high risk of poor post-operative course.

Dataset Information

A Prospective Observational Study to Determine Rate of Thromboprophylaxis in Oncology Patients Undergoing Abdominal or Pelvic Surgery.

Supplementary information

Publications

A Prospective Observational Study to Determine Rate of Thromboprophylaxis in Oncology Patients Undergoing Abdominal or Pelvic Surgery.

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