Nuevos factores de riesgo de tromboembolismo venoso después de la resección transuretral de tumor vesical: modelos de regresión multivariable escalonada y LASSO basados en datos de reclamaciones de seguros de EE. UU.

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas Pub Date : 2025-05-01 DOI:10.1016/j.acuro.2025.501738

J. Łaszkiewicz , F. del Giudice , S. Li , W. Krajewski , Ł. Nowak , T. Szydełko , S. Basran , E. De Berardinis , D. Carino , R. Corvino , V. Santerelli , M. Ferro , B. Rocco , M.C. Sighinolfi , F. Crocetto , B. Barone , F. Dinacci , R. Pichler , J.D. Subiela , B. Pradere , B.I. Chung

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引用次数: 0

Abstract

Introduction and Objectives

Transurethral resection of the bladder tumor (TURBT) is a standard procedure in bladder cancer (BC), which is associated with low risk of venous thrombo-embolism (VTE). The aim of this study was to find the predictors of postoperative VTE in patients undergoing TURBT for BC.

Materials and Methods

In this retrospective cohort analysis, patients aged ≥18 years with BC diagnosis undergoing TURBT were identified in the Merative® Marketscan® Research de-identified databases in 2007-2021. Patients with prior VTE events were excluded. Preoperative diagnostic codes and outpatient prescriptions present in at least 1% of the cohort were recorded (205 variables). Then, logistic regressions were performed including each variable separately, all variables together, as well as variables selected by stepwise and Least Absolute Shrinkage and Selection Operator (LASSO) selection methods. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated.

Results

In total, 132,425 patients were included in this study, with 1,959 (1.5%) individuals diagnosed with postoperative VTE. Various malignant neoplasms diagnosed before BC were significant risk factors of postoperative VTE, with aOR reaching up to 2.26 (95% CI: 1.96-2.61). Another strong predictor of VTE was a diagnosis of nephritis, nephrotic syndrome, and nephrosis (aOR: 1.67; 95% CI: 1.48-1.87 stepwise; aOR: 1.65; 95% CI: 1.46-1.85 LASSO). Also, patients with diseases of the urinary system, non-specific symptoms, diseases of the respiratory system, anemias, and other cardiovascular diseases were associated with increased VTE risk. Regarding drugs, antidiabetic agents and gastrointestinal drugs reduced the probability of VTE.

Conclusions

Numerous preoperative factors have influence on the risk of VTE after TURBT. These findings might facilitate the clinical decision about the implementation of thromboprophylaxis in the appropriate patients.

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经尿道膀胱肿瘤切除后静脉血栓栓塞的新风险因素：分级多变量回归模型和基于美国保险索赔数据的LASSO哦。

前言与目的经尿道膀胱肿瘤切除术（turt）是膀胱癌（BC）的标准手术，与静脉血栓栓塞（VTE）的低风险相关。本研究的目的是寻找行TURBT治疗BC患者术后静脉血栓栓塞的预测因素。材料和方法在这项回顾性队列分析中，年龄≥18岁的BC诊断接受TURBT的患者在2007-2021年的Merative®Marketscan®Research去识别数据库中被识别出来。排除既往有静脉血栓栓塞事件的患者。记录了至少1%队列患者的术前诊断代码和门诊处方（205个变量）。然后，分别对每个变量进行logistic回归，对所有变量进行logistic回归，对逐步回归和最小绝对收缩和选择算子（LASSO）选择方法选择的变量进行logistic回归。计算校正优势比（aOR）和95%可信区间（CI）。结果本研究共纳入132425例患者，其中1959例（1.5%）被诊断为术后静脉血栓栓塞。BC前诊断的各种恶性肿瘤是术后静脉血栓栓塞的重要危险因素，aOR高达2.26 （95% CI: 1.96 ~ 2.61）。静脉血栓栓塞的另一个强预测因子是肾炎、肾病综合征和肾病的诊断(aOR: 1.67；95% CI: 1.48-1.87；优势:1.65;95% ci: 1.46-1.85套索)。此外，患有泌尿系统疾病、非特异性症状、呼吸系统疾病、贫血和其他心血管疾病的患者与静脉血栓栓塞风险增加有关。在药物方面，抗糖尿病药物和胃肠道药物降低了静脉血栓栓塞的可能性。结论术前多种因素影响TURBT术后静脉血栓栓塞的发生。这些发现可能有助于在适当的患者中实施血栓预防的临床决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Actas urologicas espanolas UROLOGY & NEPHROLOGY-

CiteScore

1.90

自引率

0.00%

发文量

审稿时长

46 days

期刊介绍： Actas Urológicas Españolas is an international journal dedicated to urological diseases and renal transplant. It has been the official publication of the Spanish Urology Association since 1974 and of the American Urology Confederation since 2008. Its articles cover all aspects related to urology. Actas Urológicas Españolas, governed by the peer review system (double blinded), is published online in Spanish and English. Consequently, manuscripts may be sent in Spanish or English and bidirectional free cost translation will be provided.