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

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.