Krych Aaron J, Sousa Paul L, Morgan Joseph A, Levy Bruce A, Stuart Michael J, Dahm Diane L
Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A..
Arthroscopy. 2015 Nov;31(11):2112-8. doi: 10.1016/j.arthro.2015.04.091. Epub 2015 Jun 20.
To (1) determine the incidence of symptomatic venous thromboembolic events (VTEs) after knee arthroscopy and arthroscopy-assisted procedures at a single institution and (2) determine associated risk factors for VTEs in these patients.
The records of patients who underwent knee arthroscopy at a single institution between 1988 and 2008 were reviewed. Chemoprophylaxis was not routinely used. Confirmed VTEs occurring within 4 weeks after the index arthroscopy procedure were included. A 2:1 matched control group was generated to include patients in whom knee arthroscopy was performed by the same surgeon either on the same day or immediately before each case resulting in a VTE. Preoperative and perioperative data were collected with respect to demographic data, medical history, medications, and surgical and anesthesia data. Univariate and multivariate analyses were performed.
During the study period, 12,595 patients underwent knee arthroscopy. Among these patients, 43 cases of VTEs (35 deep venous thromboses [DVTs], 5 pulmonary embolisms [PEs], and 3 DVTs that progressed to PEs) occurred, resulting in an incidence of 0.30% (95% confidence interval [CI], 0.22% to 0.41%) for DVT, 0.06% (95% CI, 0.03% to 0.12%) for PE, and 0.34% (95% CI, 0.25% to 0.46%) for VTEs overall. Factors associated with an elevated risk of symptomatic postoperative VTEs included a history of malignancy (P = .01; odds ratio [OR], 6.3), a history of VTEs (P = .02; OR, 5.2), or the presence of more than 2 classic risk factors for VTEs (P = .01; OR, 13.6).
In this study, symptomatic VTEs were rare and occurred infrequently, with an incidence of 0.34% (95% CI, 0.25% to 0.46%), after knee arthroscopy and arthroscopy-assisted cases in the absence of routine chemoprophylaxis. Patients with a history of VTEs, a history of malignancy, or 2 or more classic risk factors are at increased risk of VTEs after knee arthroscopy, and chemoprophylaxis should be considered in these select patients.
Level III, case-control study.
（1）确定在单一机构中，膝关节镜检查及关节镜辅助手术术后有症状的静脉血栓栓塞事件（VTE）的发生率；（2）确定这些患者发生VTE的相关危险因素。
回顾了1988年至2008年间在单一机构接受膝关节镜检查的患者记录。未常规使用化学预防措施。纳入在初次关节镜检查术后4周内确诊的VTE。生成一个2:1匹配对照组，包括由同一位外科医生在同一天或导致VTE的每例病例之前立即进行膝关节镜检查的患者。收集术前和围手术期关于人口统计学数据、病史、用药情况以及手术和麻醉数据。进行单因素和多因素分析。
在研究期间，12595例患者接受了膝关节镜检查。在这些患者中，发生了43例VTE（35例深静脉血栓形成[DVT]、5例肺栓塞[PE]以及3例进展为PE的DVT），DVT的发生率为0.30%（95%置信区间[CI]，0.22%至0.41%），PE的发生率为0.06%（95%CI，0.03%至0.12%），总体VTE的发生率为0.34%（95%CI，0.25%至0.46%）。与术后有症状的VTE风险升高相关的因素包括恶性肿瘤病史（P = 0.01；比值比[OR]，6.3）、VTE病史（P = 0.02；OR，5.2）或存在超过2个VTE的经典危险因素（P = 0.01；OR，13.6）。
在本研究中，在未进行常规化学预防的情况下，膝关节镜检查及关节镜辅助病例术后有症状的VTE很少见且发生率低，为0.34%（95%CI，0.25%至0.46%）。有VTE病史、恶性肿瘤病史或2个或更多经典危险因素的患者在膝关节镜检查后发生VTE的风险增加，对于这些特定患者应考虑进行化学预防。
III级，病例对照研究。
