EVALUATING VENOUS THROMBOEMBOLISM IN PATIENTS WITH METASTATIC BONE DISEASE: ARE WE TREATING PATIENTS WITH APPROPRIATE THROMBOPROPHYLAXIS?
Notice bibliographique
Résumé
Metastatic bone disease (MBD) has a substantial impact on quality of life in cancer patients. Despite the prevalence of MBD, the incidence of post-operative venous thromboembolism (VTE) including pulmonary embolism (PE) and deep vein thrombosis (DVT) remains high and is likely under-reported. Additionally, there is a paucity of guidelines for directing optimal thromboprophylaxis in this high-risk patient population. The primary objective of this study was to evaluate the use of thromboprophylaxis in patients with MBD undergoing orthopaedic surgery. The secondary objectives were to determine the incidence of VTE and identify risk factors for developing VTE post-operatively. We have conducted a retrospective, multicentre cohort study of adult patients presenting for orthopaedic surgery for MBD of the long bones or pelvis across nine hospitals between 2006 and 2021. All VTE events were identified through chart review and were defined as an image-confirmed diagnosis of a DVT or PE. Outpatient prescriptions for post-operative thromboprophylaxis or anticoagulation were obtained from the regional Pharmaceutical Information Network (PIN). The PIN data search included prophylactic and therapeutic dosages for low-molecular weight heparin and direct oral anticoagulants, as well as therapeutic dosages of warfarin prescribed up to 90 days post-operatively. A binomial logistic regression analysis was performed to identify risk factors for developing VTE. A total of 558 patients were included with a median age of 67.3 years and 52.0% of patients were female. Breast, lung, prostate, renal cell carcinoma, and multiple myeloma were the most common primary malignancies (n=461, 82.5%). Lower extremity surgery was more prevalent, with 487 patients (87.3%) undergoing surgery of the femur, tibia, or pelvis. The indication for surgery was a pathologic fracture in 344 patients (61.7%) and an impending fracture in 214 patients (38.4%). The average post-operative length of stay was 10 days (95%CI: 9–12). Median follow-up was 8.0 months (95%CI: 6.8–9.7). Outpatient thromboprophylaxis was prescribed in only 198 patients (35.5%). Median duration of thromboprophylaxis was 30 days (IQR: 10–60). Thirty-four (6.1%) patients were on anticoagulation for chronic medical comorbidities. The incidence of VTE was 5.7% in the entire cohort, and 6.0% in patients undergoing surgery of the lower extremity. There were 24 PEs and 11 DVTs diagnosed. Notably, 10 PEs and six DVTs occurred in patients who were prescribed thromboprophylaxis. VTE was diagnosed a median of nine days post-operative (IQR: 5–36). Lack of outpatient prescription of thromboprophylaxis and a pathologic fracture were identified as risk factors for developing a VTE on logistic regression (p = 0.025 and p = 0.028, respectively) while age, sex, primary malignancy, surgical technique, and fixation strategy were not significant. We have identified low rates of thromboprophylaxis prescribing in patients undergoing orthopaedic surgery for MBD with a high rate of VTE (5.7%). As patients underwent diagnostic investigations for a VTE based on clinical indications, the true rate of VTE may be greater. This research highlights the need for evidence-based guidelines to optimize post-operative protocols and improve patient care in this high-risk population.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».