目的:本研究旨在建立和验证一种新的预测模型,用于接受口腔颌面肿瘤同时重建手术的患者的静脉血栓栓塞症(VTE)。
方法:共选取372例患者,和他们的人口统计数据,合并症,病史,实验室变量,术后Caprini评分,围手术期指标,并对程序进行了记录和分析,建立了模型。预测模型显示为列线图。
结果:VTE的发生率为20.7%(77/372)。发现几个因素与VTE显着相关,包括年龄(67vs.56年,P<0.001),术前D-二聚体水平(0.56vs.0.36mg/L,P<0.001),女性患者比例(46.8%vs.33.6%,P=0.032),高血压(33.8%vs.21%,P=0.019)。预测模型由年龄、性别,术前D-二聚体水平,具有良好的辨别能力,曲线下面积(AUC)为0.756,95%置信区间(CI)为0.696-0.816.此外,与2005年(AUC0.646,95%CI=0.578-0.714)和2010年(AUC0.627,95%CI=0.559-0.694)版本的Caprini风险评估模型相比,它显示出良好的诊断性能.对于恶性肿瘤患者,新辅助化疗也是一个独立的危险因素。
结论:这个新的预测模型由三个易于获得的临床变量组成,在预测术后VTE方面显示出良好的诊断性能。
OBJECTIVE: This study aimed to establish and validate a novel predictive model for venous thromboembolism (VTE) in patients undergoing oral and maxillofacial oncological surgery with simultaneous reconstruction.
METHODS: A total of 372 patients were selected, and their demographic data, comorbidities, medical history, laboratory variables, postoperative Caprini scores, perioperative indicators, and procedures were recorded and analyzed to build the model. The predictive model is displayed as a nomogram.
RESULTS: The incidence of VTE was 20.7% (77/372). Several factors were found to be significantly associated with VTE, including age (67 vs. 56 years, P < 0.001), preoperative level of D-dimer (0.56 vs. 0.36 mg/L, P < 0.001), proportion of female patients (46.8% vs. 33.6%, P = 0.032), hypertension (33.8% vs. 21%, P = 0.019). The predictive model was composed of age, gender, and preoperative D-dimer level, with good discriminative ability, as reflected by an area under the curve (AUC) of 0.756, the 95% confidence interval (CI) was 0.696-0.816. Moreover, it showed favorable diagnostic performance compared with both the 2005 (AUC 0.646, 95% CI = 0.578-0.714) and 2010 (AUC 0.627, 95% CI = 0.559-0.694) versions of the Caprini risk assessment model. For patients with malignant tumor, neoadjuvant chemotherapy was also an independent risk factor.
CONCLUSIONS: This novel predictive model consists of three readily available clinical variables that show good diagnostic performance in predicting postoperative VTE.