Risk factor analysis for early development of calf muscular vein thrombosis after thoracic surgery:a prospective observational study

Abstract

Abstract Background: Venous thromboembolism is a common complication after thoracic surgery. The early development of calf muscular vein thrombosis (CMVT) after thoracic surgery is not well understood. The purpose of our study was to find the incidence and risk factors of early CMVT after thoracic surgery. Methods: We performed a prospective observational study in patients who received thoracic surgery from December 2021 to January 2023. The patients were assigned to either the CMVT or non-CMVT group based on their early postoperative lower extremity venous Doppler ultrasound results. The clinical characteristics of CMVT patients and non-CMVT patients would be compared and analyzed.Multivariate logistic regression analysis was conducted to identify independent risk factors associated with CMVT development. The area under the receiver operating characteristic curve was also calculated. Results: A total of 745 patients were included in the final analysis, with 185 (24.8%) and 560 (75.2%) patients in the CMVT and non-CMVT groups, respectively. In the CMVT group, 7 (3.8%) and 87 (47.1%) patients had concurrent proximal deep vein thrombosis and bilateral lower extremity thrombosis, respectively.Multivariate logistic regression analysis showed that age (OR = 1.092, 95% CI = 1.064–1.120, P = 0.000), Caprini score (moderate and high risks) (OR = 2.029, 95% CI = 1.276–3.227, P= 0.003), non-anticoagulation (OR = 1.859, 95% CI = 1.147–3.013, P = 0.012), operative duration >135 minutes (OR = 1.697, 95% CI = 1.135–2.538, P= 0.010), and postoperative day 1 D-dimer level (OR = 1.342, 95% CI = 1.232–1.462, P = 0.000) were independent risk factors for early postoperative CMVT. The receiver operating characteristic curve analysis showed that the areas under the curve for age and postoperative day 1 D-dimer were 0.715 (cut off value of 58.5) and 0.781 (cut off value of 1.445), respectively. Conclusions: The incidence of early CMVT after thoracic surgery was 24.8%. Nearly half of the CMVT patients had bilateral involvement. The risk of early CMVT was reduced after perioperative anticoagulation prophylaxis. In addition, older age, moderate and high Caprini risk score, operative time >135 minutes, and high postoperative day 1 D-dimer level were independent risk factors for the early development of CMVT after thoracic surgery.