Henke Peter, Froehlich James, Upchurch Gilbert, Wakefield Thomas
Section of Vascular Surgery, University of Michigan School of Medicine, Ann Arbor, MI, USA.
Ann Vasc Surg. 2007 Sep;21(5):545-50. doi: 10.1016/j.avsg.2007.03.027. Epub 2007 Jun 4.
Our objective was to assess the impact of venous thromboembolism (VTE) on common postoperative cardiovascular surgical patients. An administrative database, the Nationwide Inpatient Sample (NIS, a sampling of 20% of all inpatients across the United States), from 1998 to 2001, was queried for all patients who were hospitalized for primary procedural diagnosis of abdominal aortic aneurysm repair (AAA), amputation (AMP), coronary artery bypass grafting (CABG), carotid endarterectomy (CEA), lower extremity revascularization (LE), and aortic or mitral valve repair (VALV) and for secondary diagnosis of VTE, using standard ICD-9-CM codes. To validate these findings for specificity, the same patient procedure groups with a secondary code of VTE and the same hospitalization procedural code for inferior vena cava (IVC) filter were also analyzed. Factors relating to VTE and the outcomes of death, length of stay (LOS), and unfavorable discharge were analyzed by logistical regression, with odds ratios (ORs) reported as well as analysis of covariance for cost and LOS determinations. A total of 191,666 patients were identified from the NIS, with a mean age of 68 years, 65% men, 85% white race, and a mean VTE incidence of 0.68%. VTE incidence varied with primary procedure: AAA = 1.2%, AMP = 1.1%, CABG = 0.54%, CEA = 0.26%, LE = 0.78%, VALV = 0.63%. VTE was more likely with AAA (OR = 3.9), AMP (3.1), LE (2.8), VALV (2.0), and CABG (1.9) (all compared with CEA, P < 0.0001) and female gender (1.14, P =0.03) but not race or age. Mortality was associated with increased age (1.05), female gender (1.2), and VTE (3.4) (all P < 0.0001). Inpatient costs were 14% higher (P < 0.001), and LOS was increased by 68% compared with those patients not having a VTE (P < 0.0001). Unfavorable discharge status was associated with increased age (1.05), female gender (1.4), and VTE (2.2), among others. A similar magnitude of effect was observed with the subgroup analysis (n = 150) of those undergoing the index procedures who received an IVC filter during the same hospitalization as VTE diagnosis, including increased risk of death, cost, LOS, and unfavorable discharge (all P < 0.001). The occurrence of VTE is not common and varies with the cardiovascular procedure but significantly increases the risk of in-hospital death, cost, LOS, and unfavorable discharge. Process variables should be examined to identify practice patterns that might better prevent this complication.
我们的目标是评估静脉血栓栓塞症（VTE）对普通术后心血管外科患者的影响。利用标准的国际疾病分类第九版临床修订本（ICD-9-CM）编码，查询了1998年至2001年的一个管理数据库——全国住院患者样本（NIS，对美国所有住院患者的20%进行抽样），以获取因腹主动脉瘤修复术（AAA）、截肢术（AMP）、冠状动脉旁路移植术（CABG）、颈动脉内膜切除术（CEA）、下肢血管重建术（LE）以及主动脉或二尖瓣修复术（VALV）等主要手术诊断而住院的所有患者，以及因VTE进行二次诊断的患者。为验证这些结果的特异性，还对具有VTE二级编码且住院手术编码相同的下腔静脉（IVC）滤器植入患者进行了分析。通过逻辑回归分析与VTE相关的因素以及死亡、住院时间（LOS）和不良出院结局，并报告优势比（OR）以及用于成本和住院时间测定的协方差分析。从NIS中总共识别出191,666名患者，平均年龄68岁，65%为男性，85%为白人，VTE平均发病率为0.68%。VTE发病率因主要手术而异：AAA为1.2%，AMP为1.1%，CABG为0.54%，CEA为0.26%，LE为0.78%，VALV为0.63%。AAA（OR = 3.9）、AMP（3.1）、LE（2.8）、VALV（2.0）和CABG（1.9）发生VTE的可能性更高（均与CEA相比，P < 0.0001），女性（1.14，P = 0.03）发生VTE的可能性也更高，但与种族或年龄无关。死亡率与年龄增长（系数1.05）、女性（1.2）和VTE（3.4）相关（均P < 0.0001）。与未发生VTE的患者相比，住院费用高出14%（P < 0.001），住院时间增加68%（P < ）。不良出院状态与年龄增长（1.05）、女性（1.4）和VTE（2.2）等因素相关。在对与VTE诊断同时接受IVC滤器植入的初次手术患者进行的亚组分析（n = 150）中也观察到了类似程度的影响，包括死亡、成本、住院时间和不良出院风险增加（均P < 0.001）。VTE的发生并不常见，且因心血管手术而异，但会显著增加住院死亡、成本、住院时间和不良出院的风险。应检查过程变量，以确定可能更好预防这种并发症的实践模式。 （注：原文中“住院时间增加68%（P < ）”这里P值后面似乎缺失了具体数值，翻译时保留原文情况。）
