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bioRxiv · 10.64898/2026.11.04.764430

Hypoxemia is an Independent Risk Factor for Perioperative Thrombosis at High Altitude: A Retrospective Study of 11,084 Patients

Jin, Y. Y.·Wu, Y.·Ma, S.·Xiang, L.·Peng, C.·He, Z.
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Abstract

Objective Perioperative thrombosis occurs at a significantly higher rate at high altitudes compared to low altitudes, severely threatening the safety of surgical patients. This study aims to determine the independent risk factors for perioperative thrombosis in high-altitude environments, providing a scientific basis for early clinical screening and targeted intervention. Methods Clinical data from 11,084 surgical patients were retrospectively analyzed. Patients were categorized into thrombosis and non-thrombosis groups based on the occurrence of postoperative thrombosis. Baseline characteristics, operative variables, and laboratory indicators were collected, encompassing 21 potential risk factors including arterial partial pressure of oxygen (PaO2). Univariate analysis and multivariate logistic regression (forward stepwise likelihood ratio method) were performed using SPSS 27.0 to identify independent risk factors for perioperative thrombosis. The predictive performance of the model was evaluated using receiver operating characteristic (ROC) curves, decision curve analysis (DCA), calibration plots, and nomograms. Results Of the 11,084 patients, 1,631 (14.7%) developed thrombosis. Univariate analysis showed that varicose veins, hemoglobin levels, Preoperative hospital stay, body mass index (BMI), D-dimer, partial pressure of oxygen, and interleukin-6 were significantly associated with thrombosis (P < 0.05). Multivariate logistic regression identified varicose veins,Preoperative hospital stay, elevated BMI, erythrocytosis, elevated D-dimer, hypoxemia, and elevated interleukin-6 as independent risk factors for thrombosis (P < 0.05). The predictive model demonstrated strong discrimination, with an area under the curve (AUC) of 0.862 (95% CI: 0.848-0.876), a sensitivity of 0.790, and a specificity of 0.773. Among the individual risk factors, hypoxemia exhibited the highest diagnostic performance, yielding an AUC of 0.732 and a sensitivity of 0.763. Conclusion The incidence of perioperative thrombosis at high altitudes is elevated, with hypoxemia serving as an independent predictor beyond traditional risk factors. Clinical management should prioritize correcting pre- and postoperative hypoxic states. Furthermore, implementing individualized prophylaxis that accounts for other risk factors such as multiple surgeries, advanced age, anemia, and coagulation-fibrinolysis system abnormalities is crucial to mitigating thrombotic risk.

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Jin, Y. Y., Wu, Y., Ma, S., Xiang, L., Peng, C., He, Z.. 2026-11-05. Hypoxemia is an Independent Risk Factor for Perioperative Thrombosis at High Altitude: A Retrospective Study of 11,084 Patients. https://doi.org/10.64898/2026.11.04.764430

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