Haskins Ivy N, Amdur Richard, Sarani Babak, Vaziri Khashayar
Department of Surgery, The George Washington University, Washington, DC.
Department of Surgery, The George Washington University, Washington, DC.
Surg Obes Relat Dis. 2015 Sep-Oct;11(5):1140-5. doi: 10.1016/j.soard.2014.12.020. Epub 2014 Dec 24.
Venous thromboembolism (VTE) is a major complication of bariatric surgery leading to significant morbidity and mortality. We sought to identify predictive factors that increase the risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) using data from the National Surgical Quality Improvement Program (NSQIP).
Patients undergoing bariatric procedures from 2005-2012 were identified in the NSQIP database. Pretreatment patient characteristics were examined by laparoscopic and open treatment groups using t tests and chi-square regression. Independent associations between patient characteristics and DVT and PE were examined using logistic regression. Logistic regression was also used to examine whether patients who had postprocedure DVT or PE were more likely than those who did not have these events to have additional morbidity and mortality outcomes.
102,869 patients underwent bariatric surgery (96,085 laparoscopic; 6,784 open) from 2005-2012. Preoperative variables associated with increased risk of DVT in laparoscopic bariatric surgery are male gender, higher BMI, congestive heart failure (CHF), and hypertension (HTN). Preoperative variables associated with increased risk of PE in laparoscopic bariatric surgery are male gender, age greater than or equal to 60, higher BMI, African American race, chronic obstructive pulmonary disease (COPD) and CHF. There are no preoperative variables associated with an increased risk of DVT in open bariatric surgery although there is a trend toward significance with CHF. Finally, higher BMI and CHF is associated with an increased risk of PE in open bariatric surgery.
CHF is a significant risk factor for VTE in bariatric surgery. Surgeons should consider aggressive screening and VTE prophylaxis in patients with CHF and other known risk factors to decrease postoperative morbidity from VTE.
静脉血栓栓塞症（VTE）是减肥手术的一种主要并发症，会导致显著的发病率和死亡率。我们试图利用国家外科质量改进计划（NSQIP）的数据，确定增加深静脉血栓形成（DVT）和肺栓塞（PE）风险的预测因素。
在NSQIP数据库中识别出2005年至2012年接受减肥手术的患者。通过t检验和卡方回归，对腹腔镜手术组和开放手术组的术前患者特征进行检查。使用逻辑回归分析患者特征与DVT和PE之间的独立关联。逻辑回归还用于检查术后发生DVT或PE的患者是否比未发生这些事件的患者更有可能出现其他发病率和死亡率结果。
2005年至2012年期间，102,869例患者接受了减肥手术（96,085例腹腔镜手术；6,784例开放手术）。腹腔镜减肥手术中与DVT风险增加相关的术前变量包括男性、较高的体重指数（BMI）、充血性心力衰竭（CHF）和高血压（HTN）。腹腔镜减肥手术中与PE风险增加相关的术前变量包括男性、年龄大于或等于60岁、较高的BMI、非裔美国人种族、慢性阻塞性肺疾病（COPD）和CHF。在开放减肥手术中，没有术前变量与DVT风险增加相关，尽管CHF有显著趋势。最后，较高的BMI和CHF与开放减肥手术中PE风险增加相关。
CHF是减肥手术中VTE的一个重要危险因素。外科医生应考虑对CHF患者和其他已知危险因素进行积极筛查和VTE预防，以降低VTE术后发病率。
