PREDICTION OF THROMBOEMBOLIC COMPLICATIONS IN NON-CARDIAC SURGERY
Original research article
Published August 27, 2023
Keywords
thromboembolic complications
prediction
non-cardiac surgery
prediction
non-cardiac surgery
How to Cite
Murashko S. S., Pasechnik I. N., Berns S. A. PREDICTION OF THROMBOEMBOLIC COMPLICATIONS IN NON-CARDIAC SURGERY // Kremlin Medicine Journal. 2023. VOL. № 3. С. 8-12.
Abstract
The risk of fatal outcomes in patients with thromboembolic complications determines the importance of timely stratification of these complications. Purpose Evaluation of the effectiveness of predictive models (PM) with clinical predictors of feasibility study. Development of combined (using clinical predictors and laboratory indicators of hemostasis in the perioperative period) PM to determine the likelihood of developing feasibility study. Material and method The study included 174 patients, mean age 62.74±12.1 years, 72.4% men, who underwent various non-cardiac surgical interventions. The majority (89.7%) had one or more comorbidities: cardiovascular disease in 69.5%, diabetes mellitus in 28.4%, cancer in 32.2%. The end points of the study being assessed are thromboembolic complications (TEС). The risk of postoperative complications was assessed using widely accepted and currently recommended prognostic scales and indices, as well as independent prognostic factors. Hemostasis monitoring was performed based on the determination of activated partial thromboplastin time (APTT) and integral thrombodynamic test (TD) on day 1 before surgery, day 1 after surgery, day 3-4, day 5-7 of the postoperative stage. Statistical analysis was performed using the StatTech v. 2.8.4 (developer - Stattech LLC, Russia). Quantitative indicators were assessed for compliance with the normal distribution using the Shapiro-Wilk test or the Kolmogorov-Smirnov test. The construction of a predictive model of the probability of a certain outcome was performed using the method of logistic regression. The accuracy of the developed predictive models (PM) was assessed using ROC analysis with 95% CI. The quality of the obtained PM was determined by the AUC interval. Results. TEC developed in 5 patients (2.9%) during the first 5-6 days after surgery. On the surgical risk scale, the majority of patients (79.9%) had an intermediate risk of developing cardiovascular complications. Considering the high percentage of polymorbid patients among the studied patients, a 10-year survival rate was calculated using the Charlson comorbidity scale - in 32.2% of patients, a survival rate of 21% was predicted. According to the assessment of the physical status of the studied patients, calculated according to the ASA functional state scale, 94% of patients were assigned to groups of persons with moderate or stable severe pathology, without disability. The Caprini scale identified 96.6% of patients in the group of high and very high risk of TEC. When determining the risk of developing hemorrhagic complications according to the recommendations of the Federation of Anesthesiologists and Resuscitators, 92% of patients were classified as high-risk. The ROC analysis performed showed that the prognostic significance of independent risk factors for feasibility study and generally accepted risk scales in the study sample at the preoperative stage was low with insufficient specificity and sensitivity. The predictive value of the generally accepted risk scale of TEC Caprini was low and statistically unreliable. The characteristics of models of medium or good quality in predicting feasibility studies were answered: the presence or absence of cancer, the comorbidity scale, and the duration of the surgical intervention. The dynamics of APTT was statistically significant only after the 1st postoperative day and reflected the effectiveness of the ongoing prophylactic anticoagulant therapy. Among the parameters of the TD test, the clot growth rate and steady-state rate before surgery and clot density on the first day after surgery had the highest correlation with the risk of developing TEC. Using these parameters, combined PM were developed to determine the likelihood of developing a feasibility study.References
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3. Smilowitz N.R. et al. Trends in perioperative venous thromboembolism associated with major noncardiac surgery // TH open. – 2017. – V. 1. – № 02. – P. e82–e91.
4. Klemen N.D. et al. Mortality risk associated with venous thromboembolism: a systematic review and Bayesian meta-analysis // Lancet Haematol. – 2020. – V. 7. – № 8. – P. e583–e593.
5. Pandor A. et al. Risk assessment models for venous thromboembolism in hospitalised adult patients: a systematic review // BMJ open. – 2021. – V. 11. – № 7. – P. e045672.
6. Lawson J.W. et al. Surgery and hemostasis // Curr Opin Hematol. – 2015. – V. 22. – № 5. – P. 420–427.
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8. Pirkle S. et al. Comparing bleeding and thrombotic rates in spine surgery: an analysis of 119 888 patients // Global Spine J. – 2021. – V. 11. – № 2. – P. 161–166.
9. Lipets E.N. et al. Integrated laboratory coagulation tests in hypercoagulation diagnosis and thrombosis risk assessment // Oncogematology. – 2015. – № 10 (3) – P. 73–91. In Russian.
10. Berns S.A. et al. Thrombodynamics as a tool for monitoring the effectiveness of anticoagulant therapy in patients with pulmonary embolism // Complex Issues of Cardiovascular Diseases. – 2020. – V. 9. – № 4. – P. 12–20. In Russian.
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