Department of Surgery, Section of Endocrine Surgery, University of Wisconsin, Madison, WI, USA.
Surgery. 2010 Dec;148(6):1163-8; discussion 1168-9. doi: 10.1016/j.surg.2010.09.013.
Recent guidelines suggest pharmacologic deep vein thrombosis (DVT) prophylaxis in all patients undergoing major surgical procedures to minimize the risk of postoperative DVT and pulmonary embolism (PE). Pharmacologic DVT prophylaxis perioperatively might increase the risk of bleeding complications. Our goal was to study the risk/benefit ratio of DVT prophylaxis in patients who undergo thyroidectomy and parathyroidectomy.
A review of the ACS NSQIP Database from 2005 to 2007 was performed. The incidence of DVT/PE complications in a cohort of 347,862 patients was compared with the 16,022 patients who underwent a thyroidectomy or parathyroidectomy. We identified risk factors for DVT/PE and developed a surrogate variable to determine the risk for postoperative bleeding.
The risk of DVT/PE complication in the thyroidectomy and parathyroidectomy patients (0.16) was 6 fold less than the entire cohort (0.96) (P < .001). The estimated risk of bleeding requiring a return to the operating room was 1.58%, which is 10-fold greater than the risk of developing a DVT/PE (P < .001).
Patients who underwent thyroidectomy and parathyroidectomy have a low incidence of developing DVT/PE complications and have a significantly greater risk of developing bleeding complications. Hence, we believe that DVT prophylaxis should be done at the discretion of the surgeon in select high-risk patients only.
最近的指南建议在所有接受大手术的患者中使用药物性深静脉血栓形成（DVT）预防措施，以最大程度地降低术后 DVT 和肺栓塞（PE）的风险。围手术期药物性 DVT 预防可能会增加出血并发症的风险。我们的目标是研究接受甲状腺和甲状旁腺切除术的患者中 DVT 预防的风险/获益比。
对 2005 年至 2007 年 ACS NSQIP 数据库进行了回顾。比较了 347862 例患者中 DVT/PE 并发症的发生率与 16022 例接受甲状腺或甲状旁腺切除术的患者。我们确定了 DVT/PE 的危险因素，并制定了一个替代变量来确定术后出血的风险。
甲状腺和甲状旁腺切除术患者的 DVT/PE 并发症风险（0.16）比整个队列（0.96）低 6 倍（P <.001）。需要返回手术室的出血风险估计为 1.58%，比发生 DVT/PE 的风险高 10 倍（P <.001）。
接受甲状腺和甲状旁腺切除术的患者发生 DVT/PE 并发症的风险较低，但发生出血并发症的风险显著增加。因此，我们认为 DVT 预防应根据外科医生的判断，仅在选择的高危患者中进行。
