From the Divisions of Gynecologic Oncology and Gynecologic Surgery, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York; and the Herbert Irving Comprehensive Cancer Center, New York, New York.
Obstet Gynecol. 2011 Jun;117(6):1367-1374. doi: 10.1097/AOG.0b013e31821bdd16.
To examine the risk of venous thromboembolism and the use of venous thromboembolism prophylaxis in women undergoing laparoscopic hysterectomy.
Results of women recorded in a health outcomes, resource utilization, and quality database from 2003 to 2007 who underwent laparoscopic hysterectomy were analyzed. The rate and predictors of venous thromboembolism as well as patterns of venous thromboembolism prophylaxis were examined. Multivariable logistic regression models were developed to determine the incidence of venous thromboembolism and use of any prophylaxis, as well as pharmacologic prophylaxis.
Among 60,013 women, a total of 579 (1.0%) venous thromboembolism events were noted. Venous thromboembolism was diagnosed in 2.1% of women aged 60 years or older and in 2.3% of those with cancer. Women older than 60 years (OR 1.64, 95% CI 1.19-2.26) and with more medical comorbidities (OR 3.07, 95% CI 2.23-4.23) were most likely to have a venous thromboembolism develop. A total of 23,562 (39.3%) patients received no venous thromboembolism prophylaxis, 29,288 (48.8%) received mechanical prophylaxis, and 7,163 (11.9%) received pharmacologic prophylaxis. Women aged 60 years or older (OR 1.56, 95% CI 1.41-1.73), women with more medical comorbidities (OR 1.93, 95% CI 1.71-2.17), those with cancer (OR 3.08, 95% CI 2.75-3.45), and patients treated by high-volume surgeons (OR 1.42, 95% CI 1.33-1.52) were more likely to receive pharmacologic prophylaxis.
Whereas patients undergoing laparoscopic hysterectomy are overall at low risk for venous thromboembolism, older women, those with medical comorbidities, and women with cancer are at substantial risk. Venous thromboembolism prophylaxis is highly variable and often not utilized.
探讨腹腔镜子宫切除术患者发生静脉血栓栓塞症的风险及静脉血栓栓塞症预防措施的应用。
分析 2003 年至 2007 年健康结局、资源利用和质量数据库中记录的接受腹腔镜子宫切除术的女性患者的结果。研究了静脉血栓栓塞症的发生率和预测因素以及静脉血栓栓塞症预防措施的模式。采用多变量逻辑回归模型确定静脉血栓栓塞症的发生率以及任何预防措施和药物预防措施的应用。
在 60013 名女性患者中，共发现 579 例（1.0%）静脉血栓栓塞症事件。60 岁及以上女性静脉血栓栓塞症的诊断率为 2.1%，癌症患者为 2.3%。年龄超过 60 岁的女性（OR 1.64，95%CI 1.19-2.26）和合并更多合并症的女性（OR 3.07，95%CI 2.23-4.23）最有可能发生静脉血栓栓塞症。共有 23562 名（39.3%）患者未接受静脉血栓栓塞症预防措施，29288 名（48.8%）接受机械预防措施，7163 名（11.9%）接受药物预防措施。60 岁及以上的女性（OR 1.56，95%CI 1.41-1.73）、合并更多合并症的女性（OR 1.93，95%CI 1.71-2.17）、癌症患者（OR 3.08，95%CI 2.75-3.45）和由高容量外科医生治疗的患者（OR 1.42，95%CI 1.33-1.52）更有可能接受药物预防措施。
尽管接受腹腔镜子宫切除术的患者总体上发生静脉血栓栓塞症的风险较低，但老年女性、合并合并症的女性和患有癌症的女性风险较高。静脉血栓栓塞症预防措施差异较大，且通常未得到充分利用。
