Department of Internal Medicine, Hospital Carlos Haya, Málaga, Spain.
Thromb Haemost. 2011 Apr;105(4):610-5. doi: 10.1160/TH10-10-0645. Epub 2010 Dec 21.
The impact of venous thromboembolism (VTE) and bleeding in patients undergoing major joint surgery has not been thoroughly studied. The Spanish National Discharge Database during the years 2005-2006 was used to assess the frequency and clinical impact of VTE and bleeding after elective total knee (TKA) or hip (THA) arthroplasty. Of 58,037 patients undergoing TKA, 0.18% (95% confidence interval [CI]: 0.15-0.22) were diagnosed with pulmonary embolism (PE), 0.57% (95% CI: 0.51-0.63) with deep-vein thrombosis (DVT), 1.20% (95% CI: 1.12-1.30) had bleeding complications, and 0.09% (95% CI: 0.07-0.12) died. Of 54 patients who died, 20.4% (95% CI: 10.7-35.4) had been diagnosed with PE, 3.70% (95% CI: 0.63-11.7) with DVT, and 13.0% (95% CI: 5.67-25.6) had bled. Of 31,769 patients undergoing elective THA, 0.23% (95% CI: 0.18-0.29) were diagnosed with PE, 0.44% (95% CI: 0.37-0.52) with DVT, 1.21% (95% CI: 1.10-1.34) bled, and 0.16% (95% CI: 0.12-0.21) died. Of 52 patients who died, 13.5% (95% CI: 6.08-24.8) had been diagnosed with PE, and 9.61% (95% CI: 3.52-21.3) had bled. On multivariable analysis, PE (odds ratio [OR]: 157; 95% CI: 75-328), DVT (OR: 6.3; 95% CI: 1.5-27) and bleeding (OR: 8.5; 95% CI: 3.6-20) were independent predictors for death after TKA. After THA, only PE (OR: 65; 95% CI: 26-160) and bleeding (OR: 6.4; 95% CI: 2.3-17) predicted the risk for death. Bleeding, DVT, and PE, arising after TKA were all independent predictors for death. Their increase in risk was, however, substantially higher for PE. After THA, only PE and bleeding independently predicted death.
静脉血栓栓塞症（VTE）和出血对接受大关节手术的患者的影响尚未得到充分研究。本研究使用 2005-2006 年西班牙国家出院数据库，评估了择期全膝关节（TKA）或髋关节（THA）置换术后 VTE 和出血的频率和临床影响。在 58037 例行 TKA 的患者中，0.18%（95%置信区间 [CI]：0.15-0.22）被诊断为肺栓塞（PE），0.57%（95%CI：0.51-0.63）为深静脉血栓形成（DVT），1.20%（95%CI：1.12-1.30）发生出血并发症，0.09%（95%CI：0.07-0.12）死亡。在 54 例死亡患者中，20.4%（95%CI：10.7-35.4）被诊断为 PE，3.70%（95%CI：0.63-11.7）为 DVT，13.0%（95%CI：5.67-25.6）为出血。在 31769 例行择期 THA 的患者中，0.23%（95%CI：0.18-0.29）被诊断为 PE，0.44%（95%CI：0.37-0.52）为 DVT，1.21%（95%CI：1.10-1.34）出血，0.16%（95%CI：0.12-0.21）死亡。在 52 例死亡患者中，13.5%（95%CI：6.08-24.8）被诊断为 PE，9.61%（95%CI：3.52-21.3）为出血。多变量分析显示，PE（比值比 [OR]：157；95%CI：75-328）、DVT（OR：6.3；95%CI：1.5-27）和出血（OR：8.5；95%CI：3.6-20）是 TKA 后死亡的独立预测因素。THA 后，只有 PE（OR：65；95%CI：26-160）和出血（OR：6.4；95%CI：2.3-17）预测死亡风险。TKA 后发生的出血、DVT 和 PE 均为死亡的独立预测因素。然而，PE 的风险增加幅度要高得多。THA 后，只有 PE 和出血独立预测死亡。
