Greaves Spencer W, Holubar Stefan D
1 Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire 2 Medical College of Wisconsin, Milwaukee, Wisconsin 3 Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Dis Colon Rectum. 2015 Aug;58(8):782-91. doi: 10.1097/DCR.0000000000000411.
An important factor in the pathophysiology of venous thromboembolism is blood stasis, thus, preoperative hospitalization length of stay may be contributory to risk.
We assessed preoperative hospital length of stay as a risk factor for venous thromboembolism.
We performed a retrospective review of patients who underwent colorectal operations using univariate and multivariable propensity score analyses.
This study was conducted at a tertiary referral hospital.
Data on patients was obtained from the American College of Surgeons National Surgical Quality Improvement Program 2005-2011 Participant Use Data Files.
Short-term (30-day) postoperative venous thromboembolism was measured.
Our analysis included 242,670 patients undergoing colorectal surgery (mean age, 60 years; 52.9% women); of these, 72,219 (29.9%) were hospitalized preoperatively. The overall rate of venous thromboembolism was 2.07% (1.4% deep vein thrombosis, 0.5% pulmonary embolism, and 0.2% both). On multivariable analysis, the most predictive independent risk factors for venous thromboembolism were return to the operating room (OR, 1.62 (95% CI, 1.44-1.81); p < 0.001) and chronic steroid use (OR, 1.59 (95% CI, 1.41-1.80); p < 0.001); preoperative hospitalization also independently predicted venous thromboembolism (OR, 1.39 (95% CI, 1.28-1.51); p < 0.001), whereas the use of laparoscopy was protective (OR, 0.75 (95% CI, 0.67-0.83); p < 0.001). Propensity score stratification (capped at 7 days, 100 strata, area under the curve = 0.73) indicated that each day of preoperative hospitalization increased the odds of venous thromboembolism (OR, 1.42 (95% CI, 1.32-1.53); p < 0.001). All of the analyses showed a dose-response relationship between preoperative lengths of stay and risk of postoperative venous thromboembolism (p < 0.001). Patients who experienced venous thromboembolism had a higher 30-day mortality rate (3.7% vs 8.9%; p < 0.001).
This study has limited potential generalizability and a retrospective design.
Preoperative hospitalization is an independent risk factor for venous thromboembolism and its associated increase in mortality after colorectal surgery, whereas laparoscopy is a strong protective variable. Further research into preoperative screening for highest-risk patients is indicated.
静脉血栓栓塞病理生理学中的一个重要因素是血流淤滞，因此，术前住院时间可能是导致风险的一个因素。
我们评估术前住院时间作为静脉血栓栓塞的一个风险因素。
我们对接受结直肠手术的患者进行了回顾性研究，采用单变量和多变量倾向评分分析。
本研究在一家三级转诊医院进行。
患者数据来自美国外科医师学会国家外科质量改进计划2005 - 2011年参与者使用数据文件。
测量术后短期（30天）静脉血栓栓塞情况。
我们的分析纳入了242,670例接受结直肠手术的患者（平均年龄60岁；52.9%为女性）；其中，72,219例（29.9%）术前住院。静脉血栓栓塞的总体发生率为2.07%（深静脉血栓形成1.4%，肺栓塞0.5%，两者皆有0.2%）。多变量分析显示，静脉血栓栓塞最具预测性的独立风险因素是返回手术室（比值比，1.62（95%可信区间，1.44 - 1.81）；p < 0.001）和长期使用类固醇（比值比，1.59（95%可信区间，1.41 - 1.80）；p < 0.001）；术前住院也独立预测静脉血栓栓塞（比值比，1.39（95%可信区间，1.28 - 1.51）；p < 0.001），而腹腔镜手术的使用具有保护作用（比值比，0.75（95%可信区间，0.67 - 0.83）；p < 0.001）。倾向评分分层（上限为7天，100层，曲线下面积 = 0.73）表明，术前住院的每一天都会增加静脉血栓栓塞的几率（比值比，1.42（95%可信区间，1.32 - 1.53）；p < 0.001）。所有分析均显示术前住院时间与术后静脉血栓栓塞风险之间存在剂量反应关系（p < 0.001）。发生静脉血栓栓塞的患者30天死亡率更高（3.7%对8.9%；p < 0.001）。
本研究的潜在普遍性有限且为回顾性设计。
术前住院是结直肠手术后静脉血栓栓塞及其相关死亡率增加的一个独立风险因素，而腹腔镜手术是一个强有力的保护变量。有必要对高危患者的术前筛查进行进一步研究。
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