Abstract：
OBJECTIVE: To assess the safety of preoperative chemoprophylaxis (PEC) in head and neck cancer (HNC) patients undergoing oncologic procedures.
METHODS: Retrospective cohort study.
METHODS: Tertiary academic center.
METHODS: HNC patients with Caprini risk score (CRS) ≥5 who underwent inpatient surgery ≥3 hours between 2015 and 2020 were included. Patients were divided into 2 cohorts, PEC and control, based on whether or not they received a single dose of low molecular weight heparin or unfractionated heparin prior to surgery. The primary endpoint was the 30-day rate of major bleeding events.
RESULTS: A total of 539 patients were included; 427 patients received PEC prior to surgery. The rate of major bleeding was 6.7%. The PEC cohort was more likely to have received concurrent aspirin or ketorolac (225 of 427 patients vs 36 of 112 patients; P = .0002), greater duration of chemoprophylaxis (7.8 vs 5.0 days; P < .0001), have higher CRS (7.2 vs 6.6; P < .0001), longer operative times (596 vs 512 minutes; P < .0001), higher blood loss (265 vs 214 ml; P = .02), and higher bleeding rates when compared to the control (34 of 427 patients; P = .03). On multivariate analysis, only PEC was associated with bleeding (odds ratio, 8.74; 95% confidence interval, 1.15-66.5). The rate of VTE was 1.3% and was not significantly different between cohorts.
CONCLUSIONS: PEC was associated with an increase in bleeding and did not result in lower rates of VTE in patients with HNC. This study highlights the need to determine the optimal regimen of chemoprophylaxis in this patient cohort.
METHODS:
METHODS: Retrospective cohort study.
METHODS: Tertiary academic center.
METHODS: HNC patients with Caprini risk score (CRS) ≥5 who underwent inpatient surgery ≥3 hours between 2015 and 2020 were included. Patients were divided into 2 cohorts, PEC and control, based on whether or not they received a single dose of low molecular weight heparin or unfractionated heparin prior to surgery. The primary endpoint was the 30-day rate of major bleeding events.
RESULTS: A total of 539 patients were included; 427 patients received PEC prior to surgery. The rate of major bleeding was 6.7%. The PEC cohort was more likely to have received concurrent aspirin or ketorolac (225 of 427 patients vs 36 of 112 patients; P = .0002), greater duration of chemoprophylaxis (7.8 vs 5.0 days; P < .0001), have higher CRS (7.2 vs 6.6; P < .0001), longer operative times (596 vs 512 minutes; P < .0001), higher blood loss (265 vs 214 ml; P = .02), and higher bleeding rates when compared to the control (34 of 427 patients; P = .03). On multivariate analysis, only PEC was associated with bleeding (odds ratio, 8.74; 95% confidence interval, 1.15-66.5). The rate of VTE was 1.3% and was not significantly different between cohorts.
CONCLUSIONS: PEC was associated with an increase in bleeding and did not result in lower rates of VTE in patients with HNC. This study highlights the need to determine the optimal regimen of chemoprophylaxis in this patient cohort.
METHODS:
摘要：
目的：评估头颈部肿瘤手术患者术前化学预防（PEC）的安全性。
方法：回顾性队列研究。
方法：高等教育中心。
方法：纳入了在2015年至2020年期间接受住院手术≥3小时的Caprini风险评分（CRS）≥5的HNC患者。患者分为两组，PEC和控制，基于他们在手术前是否接受了单剂量的低分子量肝素或普通肝素。主要终点是30天大出血事件的发生率。
结果：共纳入539例患者；427例患者在手术前接受PEC。大出血率为6.7%。PEC队列更有可能同时接受阿司匹林或酮咯酸（427例患者中的225例vs112例患者中的36例；P=.0002），化学预防持续时间更长（7.8天vs5.0天；P<0.0001），具有较高的CRS（7.2对6.6；P<0.0001），手术时间更长（596对512分钟；P<0.0001），更高的失血量（265对214毫升；P=0.02），与对照组相比，出血率更高（427例患者中有34例；P=0.03）。在多变量分析中，只有PEC与出血相关(比值比，8.74；95%置信区间，1.15-66.5)。VTE的发生率为1.3%，队列之间没有显著差异。
结论：PEC与HNC患者的出血增加相关，并没有降低VTE的发生率。这项研究强调了在该患者队列中确定化学预防的最佳方案的必要性。
方法：
方法：回顾性队列研究。
方法：高等教育中心。
方法：纳入了在2015年至2020年期间接受住院手术≥3小时的Caprini风险评分（CRS）≥5的HNC患者。患者分为两组，PEC和控制，基于他们在手术前是否接受了单剂量的低分子量肝素或普通肝素。主要终点是30天大出血事件的发生率。
结果：共纳入539例患者；427例患者在手术前接受PEC。大出血率为6.7%。PEC队列更有可能同时接受阿司匹林或酮咯酸（427例患者中的225例vs112例患者中的36例；P=.0002），化学预防持续时间更长（7.8天vs5.0天；P<0.0001），具有较高的CRS（7.2对6.6；P<0.0001），手术时间更长（596对512分钟；P<0.0001），更高的失血量（265对214毫升；P=0.02），与对照组相比，出血率更高（427例患者中有34例；P=0.03）。在多变量分析中，只有PEC与出血相关(比值比，8.74；95%置信区间，1.15-66.5)。VTE的发生率为1.3%，队列之间没有显著差异。
结论：PEC与HNC患者的出血增加相关，并没有降低VTE的发生率。这项研究强调了在该患者队列中确定化学预防的最佳方案的必要性。
方法：
