Carruthers Thomas N, Farber Alik, Rybin Denis, Doros Gheorghe, Eslami Mohammad H
Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston, MA, USA Division of Vascular Surgery, Department of Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston, MA, USA.
Vasc Endovascular Surg. 2014 Oct-Nov;48(7-8):482-90. doi: 10.1177/1538574414561226. Epub 2014 Dec 8.
To evaluate patient characteristics, practice patterns, and outcomes for patients treated for chronic venous insufficiency (CVI).
Chronic venous insufficiency is a common problem treated using open or endovascular methods by physicians from a number of surgical and nonsurgical specialties.
Patients treated for CVI in the American College of Surgeons National Surgical Quality Improvement Program data set (2005-2011) were identified. Analyses were based on open surgical treatment (open surgery of varicose vein [OSVV]) versus endovenous ablation (EVA), specialty of treating surgeon, and by the presence of venous ulceration (VU). Preoperative patient characteristics and intraoperative measures were examined, and multivariate logistic regression analyses were performed for the postoperative outcomes of superficial surgical site infection (sSSI) and deep venous thrombosis (DVT).
A total of 4366 patients were identified. Patients undergoing EVA were older (53.3 vs 51.8 years; P < .001), had higher body mass index (BMI; 29.9 vs 29.0; P < .001), and more commonly presented with VU (20.9% vs 13.3%; P < .001). Vascular surgeons were more likely than general surgeons to treat patients with VU (17.0% vs 13.4%; P = .017). Patients with VU had higher BMI (32.2 vs 28.8; P < .001), were older (57.9 vs 51.4 years; P < .001), and more likely to be diabetic (9.0% vs 4.7%; P < .001). Factors associated with sSSI were OSVV (adjusted odds ratio [AOR] 2.56; 95% confidence interval [CI] 1.19-5.50; P = .016), obesity (AOR 2.16; 95% CI 1.10-4.24; P = .025), and VU (AOR 2.56; 95% CI 1.19-5.50; P = .016). Patients undergoing OSVV had significantly lower odds of DVT when compared to EVA (AOR 0.52; 95% CI 0.28-0.97; P = .040).
The OSVV, obesity, and VU increase the odds of sSSI after procedures treating CVI. Patients in these categories should be monitored closely for signs of infection in the perioperative period. Patients undergoing EVA have higher odds of postoperative DVT, suggesting that routine screening after EVA for DVT may be justified.
评估慢性静脉功能不全（CVI）患者的特征、治疗模式及治疗结果。
慢性静脉功能不全是一个常见问题，许多外科和非外科专业的医生采用开放或血管腔内治疗方法对其进行治疗。
在美国外科医师学会国家外科质量改进计划数据集（2005 - 2011年）中确定接受CVI治疗的患者。分析基于开放手术治疗（大隐静脉曲张开放手术[OSVV]）与静脉内消融（EVA）、治疗外科医生的专业以及是否存在静脉溃疡（VU）。检查术前患者特征和术中指标，并对浅表手术部位感染（sSSI）和深静脉血栓形成（DVT）的术后结果进行多因素逻辑回归分析。
共确定4366例患者。接受EVA治疗的患者年龄更大（53.3岁对51.8岁；P < 0.001），体重指数（BMI）更高（29.9对29.0；P < 0.001），且更常伴有VU（20.9%对13.3%；P < 0.001）。血管外科医生比普通外科医生更有可能治疗伴有VU的患者（17.0%对13.4%；P = 0.017）。伴有VU的患者BMI更高（32.2对28.8；P < 0.001），年龄更大（57.9岁对51.4岁；P < 0.001），且更有可能患糖尿病（9.0%对4.7%；P < 0.001）。与sSSI相关的因素有OSVV（调整优势比[AOR] 2.56；95%置信区间[CI] 1.19 - 5.50；P = 0.016）、肥胖（AOR 2.16；95% CI 1.10 - 4.24；P = 0.025）和VU（AOR 2.56；95% CI 1.19 - 5.50；P = 0.016）。与EVA相比，接受OSVV治疗的患者发生DVT的几率显著更低（AOR 0.52；95% CI 0.28 - 0.97；P = 0.040）。
OSVV、肥胖和VU会增加CVI治疗术后发生sSSI的几率。应对这些类型的患者在围手术期密切监测感染迹象。接受EVA治疗的患者术后发生DVT的几率更高，这表明对EVA术后进行DVT常规筛查可能是合理的。
