A nomogram model for predicting lower extremity deep vein thrombosis after gynecologic laparoscopic surgery: a retrospective cohort study

Abstract

Objective To investigate the risk factors associated with lower extremity deep vein thrombosis (LEDVT) and to establish a predictive model for patients who undergo gynecologic laparoscopic surgery. Methods A review of clinical data was conducted on patients who underwent gynecologic laparoscopic surgery between November 1, 2020, and January 31, 2022. Patients who developed LEDVT after surgery were included as the observation group, while the control group comprised patients who did not experience complications. Multivariate forward stepwise logistic regression models were used to identify independent risk factors associated with LEDVT. A nomogram model was then developed based on these risk factors. Results A total of 659 patients underwent gynecologic laparoscopic surgery during the study period, and 52 (7.89%) of these patients developed postoperative LEDVT. Multivariate logistic regression analysis showed that older age (adjusted OR, 1.085; 95% CI [1.034–1.138]; P < 0.05), longer operation duration (adjusted OR, 1.014; 95% CI [1.009–1.020]; P < 0.05), shorter activated partial thromboplastin time (APTT) (adjusted OR, 0.749; 95% CI [0.635–0.884]; P < 0.05), higher D-dimer (adjusted OR, 4.929; 95% CI [2.369–10.255]; P < 0.05), higher Human Epididymis Protein 4 (HE4) (adjusted OR, 1.007; 95% CI [1.001–1.012]; P < 0.05), and history of hypertension (adjusted OR, 3.732; 95% CI [1.405–9.915]; P < 0.05) were all independent risk factors for LEDVT in patients who underwent gynecologic laparoscopic surgery. A nomogram model was then created, which had an area under the curve of 0.927 (95% CI [0.893–0.961]; P < 0.05), a sensitivity of 96.1%, and a specificity of 79.5%. Conclusions A nomogram model that incorporates information on age, operation duration, APTT, D-dimer, history of hypertension, and HE4 could effectively predict the risk of LEDVT in patients undergoing gynecologic laparoscopic surgery, potentially helping to prevent the development of this complication.

Keywords

• Gynecological surgery
• Laparoscopy
• Lower extremity deep vein thrombosis
• Risk factors
• Nomogram model