(P 186) ANALYSIS OF FACTORS INFLUENCING POSTOPERATIVE VENOUS THROMBOEMBOLISM FORMATION IN PATIENTS WITH MASSIVE BLOOD LOSS DURING RETROPERITONEAL TUMOR RESECTION

Objective: To evaluate the incidence, associated risk factors, and prognosis of venous thromboembolism (VTE) in patients with massive blood loss undergoing retroperitoneal tumor resection.

Methods: A retrospective cohort study was conducted, including patients who underwent retroperitoneal tumor resection with intraoperative blood loss ≥ 70 ml/kg from January 2016 to March 2022 at Peking University International Hospital.

Results: A total of 1624 patients were included in the database, with 116 patients ultimately analyzed. Postoperative VTE was diagnosed in 27 patients, with an overall incidence of 23%. Among them, 26 cases were lower limb deep vein thrombosis (DVT) and 1 case was pulmonary embolism (PE). The median time from surgery to VTE occurrence was 1 day. Patients in the VTE group were older and had a higher rate of intraoperative vascular manipulation. There were no significant differences between the two groups in terms of the proportion of recurrent patients, blood loss, transfusion volume, usage of prothrombin complex, fibrinogen, operation duration, and anesthesia duration. Multivariate analysis indicated that factors associated with postoperative VTE included age (OR = 1.065, 95% CI: 1.024-1.117, P = 0.004), vascular manipulation (OR = 4.461, 95% CI: 1.339-16.831, P = 0.019), and acute kidney injury (AKI) (OR = 4.666, 95% CI: 1.225-19.451, P = 0.027). A total of 31 patients developed postoperative AKI, with an overall incidence of 27%. The incidence of AKI was significantly higher in the VTE group compared to the non-VTE group, and the AKI stages differed between the groups. There were no significant differences between the two groups in terms of postoperative mechanical ventilation time, ICU length of stay, postoperative hospital stay, total hospital stay, complication grades, and 30-day overall mortality.

Conclusion: Age, intraoperative vascular manipulation, and postoperative AKI are positively correlated with the incidence of postoperative VTE in patients with massive blood loss undergoing retroperitoneal tumor resection.