Mukherjee Debraj, Lidor Anne O, Chu Kathryn M, Gearhart Susan L, Haut Elliott R, Chang David C
Department of Surgery, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 610, Baltimore, MD 21287, USA.
J Gastrointest Surg. 2008 Nov;12(11):2015-22. doi: 10.1007/s11605-008-0600-1. Epub 2008 Jul 31.
Venous thrombolism (VTE) is a significant cause of morbidity for surgical patients. Comparative risk across major procedures is unknown.
Retrospective analysis of the Nationwide Inpatient Sample (2001-2005) was conducted. Eight surgeries were identified: bariatric surgery, colorectal surgery, esophagectomy, gastrectomy, hepatectomy, nephrectomy, pancreatectomy, splenectomy. Age < 18, patients with multiple major surgeries, and those admitted for treatment of VTE were excluded. Primary outcome was occurrence of VTE. Independent variables included age, gender, race, Charlson score, hospital teaching status, elective procedures, cancer/metastasis, trauma, and year.
Patients, 375,748, were identified, 5,773 (1.54%) with VTE. Overall death rate was 3.97%, but 13.34% after VTE. Unadjusted rate (0.35%) and adjusted risk for VTE were lowest among bariatric patients. On multivariate analysis, highest risk for VTE was splenectomy (odds ratio 2.69, 95% CI 2.03-3.56). Odds ratio of in-hospital mortality following VTE was 1.84 (1.65-2.05), associated with excess stay of 10.88days and $9,612 excess charges, translating into $55 million/year nationwide.
Highest risk for VTE was associated with splenectomy, lowest risk with bariatric surgery. Since bariatric patients are known to have greater risk for this complication, these findings may reflect better awareness/prophylaxis. Further studies are necessary to quantify effect of best-practice guidelines on prevention of this costly complication.
静脉血栓栓塞症（VTE）是外科手术患者发病的重要原因。主要手术的相对风险尚不清楚。
对全国住院患者样本（2001 - 2005年）进行回顾性分析。确定了八种手术：减肥手术、结直肠手术、食管切除术、胃切除术、肝切除术、肾切除术、胰腺切除术、脾切除术。排除年龄<18岁、接受多次大手术的患者以及因VTE入院治疗的患者。主要结局是VTE的发生。自变量包括年龄、性别、种族、查尔森评分、医院教学状况、择期手术、癌症/转移、创伤和年份。
共纳入375748例患者，其中5773例（1.54%）发生VTE。总体死亡率为3.97%，但VTE后为13.34%。减肥手术患者的VTE未调整发生率（0.35%）和调整后风险最低。多因素分析显示，VTE风险最高的是脾切除术（比值比2.69，95%可信区间2.03 - 3.56）。VTE后院内死亡的比值比为1.84（1.65 - 2.05），住院时间延长10.88天，费用增加9612美元，全国每年总计5500万美元。
VTE风险最高与脾切除术相关，最低与减肥手术相关。由于已知减肥手术患者发生这种并发症的风险更高，这些发现可能反映了更好的认识/预防措施。需要进一步研究来量化最佳实践指南对预防这种高成本并发症的效果。
