Department of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Clin Orthop Relat Res. 2013 Oct;471(10):3310-6. doi: 10.1007/s11999-013-3073-9. Epub 2013 May 21.
Limited information is available regarding the incidence, risk factors, and optimal prophylaxis in orthopaedic oncology patients, although malignancy and major orthopaedic surgery are associated with an increased pulmonary embolism (PE) risk.
QUESTIONS/PURPOSES: We aimed to investigate the incidence of PE after musculoskeletal tumor surgery in Japanese patients and analyze the potential risk factors for PE.
We retrospectively identified 3750 patients (1981 males, 1769 females) who underwent musculoskeletal tumor surgery during 2007 to 2010 using the Japanese Diagnostic Procedure Combination administrative database. Data collected included sex, age, primary diagnosis, type of surgery, duration of anesthesia, and comorbidities that may affect PE incidence. Univariate logistic regression analyses were performed to examine the relationship of each factor with PE occurrence.
We identified 10 patients with PE during the survey period. A primary malignant bone tumor was associated with a significantly higher risk of PE than a primary malignant soft tissue tumor (odds ratio [OR], 5.58; 95% CI, 1.39-22.42). Bone tumor resection (OR, 7.94; 95% CI, 1.77-35.59) and prosthetic reconstruction (OR, 9.15; 95% CI, 1.52-55.07) were associated with a significantly higher risk of PE than soft tissue tumor resection.
Malignant bone tumors and bone tumor resections have a higher risk of PE than malignant soft tissue neoplasms and soft tissue resections. Both populations might require PE prophylaxis as it is likely that the risk is greater than with other major orthopaedic surgery, but data accumulation should continue, and further investigation should be done to clarify details of the incidence, risk factors, and optimal prophylaxis for PE.
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
尽管恶性肿瘤和重大骨科手术与增加肺栓塞（PE）风险相关，但有关骨科肿瘤患者的发病率、风险因素和最佳预防措施的信息有限。
问题/目的：我们旨在研究日本患者在进行肌肉骨骼肿瘤手术后发生 PE 的发生率，并分析 PE 的潜在风险因素。
我们使用日本诊断程序组合行政数据库，回顾性地确定了 2007 年至 2010 年间接受肌肉骨骼肿瘤手术的 3750 名患者（1981 名男性，1769 名女性）。收集的数据包括性别、年龄、主要诊断、手术类型、麻醉持续时间以及可能影响 PE 发生率的合并症。进行单变量逻辑回归分析以检查每个因素与 PE 发生的关系。
在调查期间，我们发现了 10 例 PE 患者。与原发性恶性软组织肿瘤相比，原发性恶性骨肿瘤与 PE 的发生风险显著相关（优势比[OR]，5.58；95%置信区间[CI]，1.39-22.42）。骨肿瘤切除术（OR，7.94；95%CI，1.77-35.59）和假体重建术（OR，9.15；95%CI，1.52-55.07）与 PE 的发生风险显著相关。
恶性骨肿瘤和骨肿瘤切除术比恶性软组织肿瘤和软组织切除术发生 PE 的风险更高。这两个群体可能都需要 PE 预防，因为风险可能高于其他重大骨科手术，但应继续积累数据，并进一步调查以明确 PE 的发生率、风险因素和最佳预防措施的细节。
二级，预后研究。有关证据水平的完整描述，请参见作者指南。
