White Richard H, Zhou Hong, Romano Patrick S
Division of General Medicine, University of California, Davis, California, USA.
Thromb Haemost. 2003 Sep;90(3):446-55. doi: 10.1160/TH03-03-0152.
There have been no comprehensive studies that have compared the incidence of symptomatic VTE over a spectrum of different urgent or elective surgical procedures. In this study we determined the incidence of symptomatic venous thromboembolic events (VTE) within a 3 month period after 76 different surgical procedures. Using a large administrative data-base, we analyzed 1,653,275 cases that underwent one of 76 selected surgical procedures between January 1, 1992 and September 30, 1996. The principal outcomes were venous thrombosis or pulmonary embolism, during either the initial hospitalization or a re-hospitalization for VTE within 91 days of the date of surgery. Predictors of VTE were analyzed using logistic regression. Overall, VTE was diagnosed in 13,533 cases (0.8%, 95% CI = 0.7-0.9%) and of these, 5049 (37%, 95% CI = 36-38%) had pulmonary embolism. Predictors of VTE included: advancing age (OR=1.1 per 5 year increment in age, 95% CI =1.1-1.1), Latino ethnicity (OR = 0.9, 95% CI = 0.8-0.9), Asian/Pacific Islander ethnicity (OR = 0.5, 95% CI = 0.4-0.6), presence of a malignancy (OR = 1.7, 95% CI = 1.6-1.8) and prior VTE (OR = 6.2, 95% CI = 5.5-7.0). High-risk procedures that had an incidence of symptomatic VTE of approximately 2 to 3% included invasive neurosurgery, total hip arthroplasty, major vascular surgery and radical cystectomy. Fifty-six percent of all VTE events diagnosed within 91 days of surgery occurred after discharge. The findings of this study provide a basis for categorizing different surgical procedures as low, intermediate, high and very high risk for VTE. Because of the high incidence of VTE diagnosed after hospital discharge, further studies of extended thromboprophylaxis appear warranted.
目前尚无全面研究比较不同紧急或择期手术中症状性静脉血栓栓塞症（VTE）的发生率。在本研究中，我们确定了76种不同手术后3个月内症状性静脉血栓栓塞事件（VTE）的发生率。利用一个大型管理数据库，我们分析了1992年1月1日至1996年9月30日期间接受76种选定手术之一的1,653,275例病例。主要结局是在初次住院期间或手术后91天内因VTE再次住院期间发生的静脉血栓形成或肺栓塞。使用逻辑回归分析VTE的预测因素。总体而言，13,533例病例被诊断为VTE（0.8%，95%可信区间=0.7 - 0.9%），其中5049例（37%，95%可信区间=36 - 38%）患有肺栓塞。VTE的预测因素包括：年龄增长（年龄每增加5岁，OR = 1.1，95%可信区间=1.1 - 1.1）、拉丁裔种族（OR = 0.9，95%可信区间=0.8 - 0.9）、亚裔/太平洋岛民种族（OR = 0.5，95%可信区间=0.4 - 0.6）、存在恶性肿瘤（OR = 1.7，95%可信区间=1.6 - 1.8）和既往VTE（OR = 6.2，95%可信区间=5.5 - 7.0）。症状性VTE发生率约为2%至3%的高风险手术包括侵入性神经外科手术、全髋关节置换术、大血管手术和根治性膀胱切除术。在手术后91天内诊断出的所有VTE事件中，56%发生在出院后。本研究结果为将不同手术分类为VTE的低、中、高和极高风险提供了依据。由于出院后诊断出的VTE发生率较高，进一步研究延长血栓预防似乎是必要的。
