Analysis Of Influencing Factors For Postoperative Venous Thromboembolism Of Inguinal Hernia

Objective:To investigate the risk factors of postoperative venous thrombosis in patients with inguinal hernia.Methods:A retrospective case-control study was conducted.The clinical data of patients with inguinal hernia treated surgically in the Department of Gastrointestinal of the affiliated Hospital of Zun Yi Medical University from January to December 2017 were collected,including 287 males and 63 females,an aged from 15 to 89 years,with a median age of 57 years.Body mass index is(21.47±2.63)kg/m~2.Observation indicators:(1)Baseline characteristics.(2)Surgical data.(3)Postoperative and follow-up VTE.The patients were followed up by outpatient clinic and telephone after operation,and the follow-up period ended in December 2018.The measurement data of normal distribution are represented by Mean±SD,and the measurement data of skewness distribution are represented by M(range).Two independent sample t test and Mann-Whitney U test were used in univariate analysis.Count data are described as absolute numbers and percentages.Comparison between groups was analyzed using the chi-squere test or Fisher exact probability.Rank sum test(Z test)was used for grade data.The binary Logisticregression model was used for multivariate analysis.Results:1.Baseline characteristics:Univariate analysis showed that age,body mass index,cases with preoperative hypertension,Chronic bronchitis,the stable stage of chronic obstructive pulmonary disease(?~2=13.127,9.183,4.388,Fisher,Fisher,P<0.05)were the influencing factors of postoperative VTE.Mulitivariate analysisshowed that age≥65years,BMI≥25 kg/m2,chronic bronchitis and the stable stage of chronic obstructive pulmonary disease were independent risk factors for post-operative VTE of inguinal hernia(Odds ratio 1.078,1.328,0.120,1.045;95%Confidence interval 1.017-1.143,1.002-1.762,0.017-0.851,0.006-0.310,P<0.05).2.Surgical data:In all patients,173 underwent open inguinal hernia surgery including 120 cases with Lichtenstein repair,30 cases with mesh plug repair,23 cases with Bassinirepair.And 177 underwent laparoscopic inguinal hernia surgery including 134 cases with laparoscopic transabdominal preperitoneal prothetic repair,43 cases with laparoscopic totally extroperitonealprothetic repair.Among the 350patients,local anesthesia were performed in 65 cases,intraspinal anesthesia in 52 cases and general anesthesia in 233 cases.In all patients,There were 15 cases occurred VTE,including 13 cases underwent open surgery,Two cases underwent laparoscopic surgery,including 12 cases DVT and 2 cases PE(1 death).Univariate analysis showed that type of operation(?~2=8.694,P<0.05)was influencing factor for postoperative VTE of inguinal hernia.Mulitivariate analysis showed that open surgery was independent risk factors for post-operative VTE of inguinal hernia(Odds ratio 5.770,95%Confidence interval1.015-32.819,P<0.05).3.Postoperative and follow-up VTE:Univariate analysis showed that the compression time of operative area,time to first out-of-bed activities,duration of hospital stay were influencing factors for postoperative VTE of inguinal hernia(Z=-4.690,-5.265,-4.281,P<0.05).Mulitivariate analysis showed that the compression time of operative area≥42hours and time to first out-of-bed activities≥60 hours were independent risk factors for post-operative VTE of inguinal hernia(Odds ratio 1.109,1.027,95%Confidence interval 1.048-1.173,1.008-1.147).The Caprini score of patients with postoperative VTE was higher than that of patients without thrombosis VTE(3 VS 5,P<005).Of the 350 patients,349 completed one-year follow-up.No new VTE occurred during the follow-up period.14 Cases with VTE had no recurrence of VTE within 1 year after health education and reasonable drug treatment.Conclusion:Age≥65years,BMI≥25kg/m~2,cases with chronic bronchitis preoper atively,the stable stage of chronic obstructive pulmonary disease,open surgery,the compression time of operative area≥42hours,time to first out-of-bed a-ctivities≥60 hours,post-operative Caprini score>5 are independent risk fact-ors for post-operative VTE of inguinal hernia.