Risk Factors Of Venous Thromboembolism After Da Vinci Robotic Urology Surgery

Research background and purpose:The Da Vinci robotic surgery system is now widely used in urological surgery in clinical practice,we found that the number of patients with postoperative venous thromboembolism（VTE）has also increased.This article aims to explore the independent risk factors that affect the occurrence of postoperative VTE,establish a risk prediction model,and intervene early,so as to reduce the occurrence and further development of VTE.Materials and methods:This article retrospectively studied 35 patients with venous thromboembolism who underwent Da Vinci robotic surgery in the urology department of the First Bethune Hospital of Jilin University from May 2020 to December 2021,and included them in the VTE group.70 patients in the control group were randomized in a ratio of1 to 2.They had the same hospitalization time,suffered from the same disease,and underwent the same surgery,but without postoperative venous thromboembolism.Complete clinical data such as general data,VTE-related data,preoperative lab test indicators,and surgery-related data were collected,and SPSS25.0 software system was used for statistical analysis.Result:Among the 35 patients included in the VTE group,29 patients（82.86%）were asymptomatic;30 patients（85.71%）occurred in the intermuscular vein of the lower extremity,and 24 patients had onset on the 3rd to 5th day after surgery,accounting for68.57%.Univariate analysis showed that age,BMI（Body mass index）,postoperative time in bed,previous surgical history,history of hypertension,history of other medical diseases（heart,lung,liver,brain,kidney and other major organ disease）,PT（Prothrombin time）,PTR（Prothrombin time ratio）,FBG（Fibrinogen）,intraoperative infusion volume（ml）,Caprini thrombosis assessment scale exist a statistical difference between the two groups.Multivariate logistic regression analysis showed that age,postoperative time in bed,previous surgical history,and Caprini score were independent risk factors for VTE after Da Vinci robotic surgery in urology.Drawing the ROC curve,the area of age factor was the largest,indicating that it has a better diagnostic value.Prediction model Logit（P）= ln[P/（1-P）]=0.089×age+0.737×days in bed+1.517×history of previous surgery+1.274×Caprini score-19.989（age and days in bed are actual values,such as year,day.Past surgical history,yes = 1,no = 0.Caprini score,less than 5 points = 0,5-10 points = 1,more than 10 points = 2）.The overall accuracy of the model was 88.6%,the sensitivity was 0.771,and the specificity was0.957.Conclusion:1.3-5 days after operation is the most common incidence period of venous thromboembolism after Da Vinci robotic urology surgery.The most common thrombosis occurs in the intermuscular vein of the lower extremity,and most of them are asymptomatic.2.The occurrence of postoperative venous thromboembolism is affected by many factors.Among them,advanced age,long postoperative bed rest,previous operation history,and high Caprini thrombosis risk score are independent risk factors for postoperative VTE.Strengthen perioperative management for high-risk patients to reduce the incidence of VTE.3.The risk prediction model obtained in this study has a sensitivity of 0.771,a specificity of 0.957,and an overall accuracy rate of 88.6% for internal verification,which can provide some reference for clinical work.