From the Departments of Obstetrics and Gynecology and Medicine, Columbia University College of Physicians and Surgeons, the Department of Epidemiology, Mailman School of Public Health, Columbia University, and the Herbert Irving Comprehensive Cancer Center, New York, New York.
Obstet Gynecol. 2011 Nov;118(5):978-986. doi: 10.1097/AOG.0b013e31822c952a.
To estimate the use of venous thromboembolism prophylaxis in women undergoing gynecologic surgery and to estimate the patient, physician, and hospital characteristics associated with guideline-based prophylaxis.
A commercial database was used to examine women who underwent major gynecologic surgery from 2000 to 2010. Venous thromboembolism prophylaxis was classified as none, mechanical, pharmacologic, or a combination. Multivariable logistic regression models of factors associated with any prophylaxis and pharmacologic and combination prophylaxis were developed.
We identified a total of 738,150 women who underwent gynecologic surgery. No prophylaxis was given to 292,034 (39.6%) women, whereas 344,068 (46.6%) received mechanical prophylaxis, 40,268 (5.5%) pharmacologic prophylaxis, and 61,780 (8.4%) combination prophylaxis. Use of prophylaxis increased from 53.5% in 2000 to 67.5% in 2010. Prophylaxis was more commonly used in older women, those with Medicare, women with more comorbidities, white women, patients treated at rural hospitals, teaching facilities, and in patients treated by high-volume surgeons and at high-volume centers (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.23-1.27, P<.05 for all). Factors associated with use of pharmacologic prophylaxis included advanced age, white race, noncommercial insurance, later year of diagnosis, greater comorbidity, treatment at large hospitals and urban facilities, and treatment by a high-volume surgeon (OR 1.47, 95% CI 1.44-1.49).
Despite clear recommendations from evidence-based guidelines, venous thromboembolism prophylaxis is underused in women undergoing gynecologic surgery.
评估妇科手术患者中静脉血栓栓塞预防的使用情况，并评估与基于指南的预防相关的患者、医生和医院特征。
使用商业数据库检查了 2000 年至 2010 年间接受主要妇科手术的女性。静脉血栓栓塞预防分为无、机械、药物或联合预防。制定了多变量逻辑回归模型，以评估与任何预防和药物预防及联合预防相关的因素。
我们共确定了 738150 名接受妇科手术的女性。292034 名（39.6%）女性未接受预防治疗，344068 名（46.6%）接受机械预防治疗，40268 名（5.5%）接受药物预防治疗，61780 名（8.4%）接受联合预防治疗。预防治疗的使用率从 2000 年的 53.5%增加到 2010 年的 67.5%。老年患者、医疗保险患者、合并症较多的患者、白人女性、在农村医院、教学医院就诊的患者、接受高容量外科医生治疗的患者以及在高容量中心治疗的患者更常接受预防治疗（比值比[OR] 1.25，95%置信区间[CI] 1.23-1.27，所有 P<.05）。药物预防治疗的相关因素包括年龄较大、白种人、非商业保险、较晚的诊断年份、合并症较多、在大医院和城市医院就诊、由高容量外科医生治疗（OR 1.47，95% CI 1.44-1.49）。
尽管有基于证据的指南的明确建议，但妇科手术患者中静脉血栓栓塞预防的使用率仍然较低。
