Jaffer Amir K, Barsoum Wael K, Krebs Viktor, Hurbanek Jason G, Morra Nariman, Brotman Daniel J
Department of General Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Mayo Clin Proc. 2005 Jun;80(6):732-8. doi: 10.1016/S0025-6196(11)61526-7.
To determine whether longer duration of anesthesia predisposes patients undergoing orthopedic surgery to venous thromboembolism (VTE).
We conducted a secondary analysis of a retrospective case-control study that examined risk factors for postoperative VTE in postmenopausal women. We matched women aged 50 years and older with radiographically confirmed postoperative VTE (cases) by age, surgeon, year of surgery, and surgical joint (knee vs hip) with women without postoperative VTE (controls). Duration of anesthesia, operative variables, demographic data, comorbid illnesses, and laboratory data were determined by medical record review.
Eighty-eight cases were matched with 181 controls. Duration of anesthesia of 3.5 hours or longer (corresponding to the upper tertile of patients) was strongly associated with postoperative VTE compared with a shorter duration of anesthesia (odds ratio, 3.58; 95% confidence Interval, 2.11-6.16; P < .001). This relationship was maintained after controlling for multiple covariates with propensity score methods, Including type of arthroplasty, route of anesthesia, type of antithrombotic prophylaxis, and surgical approach. In multivariate analysis, the Important predictors of VTE included anesthesia duration of 3.5 hours or longer, type of antithrombotic prophylaxis, revision (vs primary) arthroplasty, and allogeneic blood transfusion.
We found a marked association between the duration of anesthesia and postoperative VTE in patients undergoing Joint arthroplasty. Although it is possible that unmeasured intraoperative variables account for this relationship, we suggest that duration of anesthesia may be an important risk factor for postoperative VTE after orthopedic surgery.
确定骨科手术患者麻醉时间延长是否会使其易患静脉血栓栓塞症（VTE）。
我们对一项回顾性病例对照研究进行了二次分析，该研究调查了绝经后女性术后VTE的危险因素。我们将年龄在50岁及以上、经影像学证实有术后VTE的女性（病例组）与年龄、外科医生、手术年份和手术关节（膝关节与髋关节）相匹配的无术后VTE的女性（对照组）进行配对。通过查阅病历确定麻醉时间、手术变量、人口统计学数据、合并疾病和实验室数据。
88例病例与181例对照相匹配。与较短麻醉时间相比，麻醉时间达3.5小时或更长（对应患者的上三分位数）与术后VTE密切相关（优势比，3.58；95%置信区间，2.11 - 6.16；P < .001）。在用倾向评分法控制多个协变量后，这种关系依然存在，这些协变量包括关节成形术类型、麻醉途径、抗血栓预防类型和手术入路。在多变量分析中，VTE的重要预测因素包括麻醉时间达3.5小时或更长、抗血栓预防类型、翻修（相对于初次）关节成形术和异体输血。
我们发现关节置换术患者的麻醉时间与术后VTE之间存在显著关联。尽管可能存在未测量的术中变量导致这种关系，但我们认为麻醉时间可能是骨科手术后术后VTE的一个重要危险因素。
