Incidence of venous thromboembolism and bleeding after pulmonary lobectomy: evaluating the timing for thromboprophylaxis
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Incidence of venous thromboembolism and bleeding after pulmonary lobectomy: evaluating the timing for thromboprophylaxis David Smith2 · Micaela Raices1 · Carolina Diego1 · Drago Julián1 · Juan Montagne2 · Agustín Dietrich2 Accepted: 7 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Venous thromboembolism (VTE) is an important postoperative complication after major lung cancer resective surgery, such as lobectomy. It is recommended to start chemical thromboprophylaxis within the first 12 h following the procedure. Postoperative bleeding is also a relevant complication in patients with predisposing conditions. However, the criterion for classifying a patient as “high risk of bleeding” is not standardized and is left to the expertise of the attending physician or surgeon. We aim to describe the incidence and risk factors for postoperative VTE and hemorrhage after pulmonary lobectomy; and to assess the impact of the timing of thromboprophylaxis on the incidence of postoperative thrombotic or hemorrhagic events. A retrospective observational study of 358 lobectomies performed in a single center was performed, analyzing the rates of postoperative thrombotic and hemorrhagic events and predisposing factors, including postoperative thromboprophylaxis management. Cumulative incidence of VTE was 3.07% (95% CI 1.54–5.43), and early postoperative bleeding was 10.05% (95% CI 7.14–13.64). Underlying pulmonary disease was associated with VTE (p = 0.001) and open approach was associated with hemorrhagic events (p = 0.01). The use of thromboprophylaxis and timing of its initiation were not associated with a higher incidence of events. VTE and postoperative hemorrhage are relevant complications following pulmonary lobectomy. Compliance with VTE prophylaxis guidelines is essential. Even so, a case-by-case risk evaluation of VTE and bleeding remains preferable and safe in order to decide on the most suitable timing of thromboprophylaxis. Keywords Hemorrhage · Prophylaxis · Pulmonary · Surgical procedure · Thromboembolism
Highlights • Venous thromboembolism and bleeding are important
Introduction
the first 12 hours.
According to the American Cancer Society, worldwide, lung cancer remains the leading cause of cancer incidence and mortality, with 2.1 million new lung cancer cases and 1.8 million deaths in 2018, representing close to 1 in 5 (18.4%) cancer deaths [1]. Surgery is the mainstay treatment for early non-small cell lung cancer and, even though sublobar resections are nowadays more common, lobectomy with lymph node resection remains the preferred procedure for most patients with early stage lung cancer [2]. Morbidity rate associated with lobectomy remains at 26.2–36.3% despite considerable advances in surgical techniques, anesthetic techniques and perioperative care, and varies from 10 to 50% in different series, increasing in the elderly [3–5]. One prevalent postoperative
• Cumulative incidence of VTE was 3.07% and early post-
operative bleeding was 10.05%.
• Thromb
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