外科手术改进项目静脉血栓栓塞症措施与术后事件之间的关联。
Association between Surgical Care Improvement Program venous thromboembolism measures and postoperative events.
机构信息
The Center for Surgical, Medical Acute Care Research and Transitions, Birmingham Veterans Administration Hospital, Birmingham, AL 35294, USA.
出版信息
Am J Surg. 2012 Nov;204(5):591-7. doi: 10.1016/j.amjsurg.2012.07.006. Epub 2012 Aug 17.
BACKGROUND
In 2006, the Surgical Care Improvement Program (SCIP) implemented measures to reduce venous thromboembolism (VTE). There are little data on whether these measures reduce VTE rates. This study proposed to examine associations between SCIP-VTE adherence and VTE rates.
METHODS
SCIP-VTE adherence for 30,531 surgeries from 2006 to 2009 was linked with VA Surgical Quality Improvement Program data. Patient demographics, comorbidities, and surgical characteristics associated with VTE were summarized. VTE rates were compared by SCIP-VTE adherence. Multivariable logistic regression was used to model VTE by adherence, adjusting for multiple associated factors.
RESULTS
Of 30,531 surgeries, 89.9% adhered to SCIP-VTE; 1.4% experienced VTE. Logistic regression identified obesity, smoking, functional status, weight loss, emergent status, age older than 64 years, and surgical time as associated with VTE. SCIP-VTE was not associated with VTE (1.4% vs 1.33%; P = .3), even after adjustment.
CONCLUSIONS
This study identified several important risk factors for VTE but found no association with SCIP-VTE adherence.
背景
2006 年，外科手术改进计划（SCIP）实施了一系列措施来降低静脉血栓栓塞症（VTE）的发生。目前关于这些措施是否能降低 VTE 发生率的数据较少。本研究旨在探究 SCIP-VTE 依从性与 VTE 发生率之间的关系。
方法
将 2006 年至 2009 年间 30531 例手术的 SCIP-VTE 依从性与 VA 手术质量改进计划数据相关联。总结与 VTE 相关的患者人口统计学、合并症和手术特征。根据 SCIP-VTE 依从性比较 VTE 发生率。采用多变量逻辑回归模型根据依从性来拟合 VTE，同时调整多个相关因素。
结果
在 30531 例手术中，89.9%符合 SCIP-VTE 要求；1.4%发生 VTE。逻辑回归确定肥胖、吸烟、功能状态、体重减轻、紧急状态、年龄大于 64 岁和手术时间与 VTE 相关。即使经过调整，SCIP-VTE 与 VTE 也没有关联（1.4%与 1.33%；P=0.3）。
结论
本研究确定了几个 VTE 的重要危险因素，但未发现与 SCIP-VTE 依从性相关。
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