Imberti Davide, Ivaldo Nicola, Murena Luigi, Paladini Paolo, Castagna Alessandro, Barillari Giovanni, Guerra Enrico, Fama Giuseppe, Castoldi Filippo, Marelli Bruno, Pierfranceschi Matteo Giorgi, Camporese Giuseppe, Dentali Francesco, Porcellini Giuseppe
Ospedale di Piacenza, Piacenza, Italy.
Casa di Cura Villa Igea, Acqui Terme (AL), Italy.
Thromb Res. 2014 Aug;134(2):273-7. doi: 10.1016/j.thromres.2014.05.014. Epub 2014 May 15.
Limited informations are available about venous thromboembolic (VTE) complications and thromboprophylaxis use after shoulder surgery. The primary end-point of the study was to determine the incidence of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) within 90days after shoulder surgery. Risk factors for VTE and thromboprophylaxis practices were also studied.
RECOS is a prospective multicenter registry of consecutive patients undergoing shoulder surgery recruited in nine hospitals in Italy. Cumulative rates of VTE were estimated according to the Kaplan-Meier method; a Cox regression model was used to calculate adjusted hazard ratio (HR) and 95% confidence interval (CI) for some variables that were identified as risk factors for VTE.
From June 2009 to June 2011 1366 patients (males 54.4%; mean age 55,65±15.3years) were enrolled. The surgical procedures were: arthroscopy (71.9%), hemiarthroplasty (17.2%) total replacement (8.9%), fixation for proximal humeral fracture (2%). After 90days, the incidence of symptomatic VTE was 0.66% (95CI% 0.2-1.12). Mean age was significantly higher in patient with than in patients without VTE (67,1+/3.49years vs 55,6+/-0,42years, respectively; p=0.024). Duration of surgery>60minutes (HR:10.99; 95CI% 1.26-95.89; p=0.030) was found as independent risk factor for VTE, while cancer, medical disease, venous insufficiency and previous VTE were not. Pharmacological thromboprophylaxis was prescribed in 33.5% (n=457) of the patients, in 95.8% of whom for a duration >10days.
The risk of symptomatic VTE in patients undergoing shoulder surgery is low. The potential need for thromboprophylaxis should be based on a case by case evaluation.
关于肩部手术后静脉血栓栓塞（VTE）并发症及血栓预防措施应用的信息有限。本研究的主要终点是确定肩部手术后90天内症状性深静脉血栓形成（DVT）和肺栓塞（PE）的发生率。同时也研究了VTE的危险因素及血栓预防措施的应用情况。
RECOS是一项对意大利9家医院连续接受肩部手术患者的前瞻性多中心登记研究。采用Kaplan-Meier方法估计VTE的累积发生率；使用Cox回归模型计算一些被确定为VTE危险因素的变量的调整后风险比（HR）和95%置信区间（CI）。
2009年6月至2011年6月，共纳入1366例患者（男性占54.4%；平均年龄55.65±15.3岁）。手术方式包括：关节镜手术（71.9%）、半关节置换术（17.2%）、全关节置换术（8.9%）、肱骨近端骨折内固定术（2%）。90天后，症状性VTE的发生率为0.66%（95%CI 0.2-1.12）。VTE患者的平均年龄显著高于无VTE患者（分别为67.1±3.49岁和55.6±0.42岁；p=0.024）。手术时间>60分钟（HR：10.99；95%CI 1.26-95.89；p=0.030）被发现是VTE的独立危险因素，而癌症、内科疾病、静脉功能不全和既往VTE则不是。33.5%（n=457）的患者接受了药物性血栓预防，其中95.8%的患者预防时间>10天。
肩部手术患者发生症状性VTE的风险较低。血栓预防的潜在需求应基于个案评估。
