Hokenstad Erik D, Habermann Elizabeth B, Glasgow Amy E, Occhino John A
Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
Division of Gynecology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Int Urogynecol J. 2016 Oct;27(10):1525-8. doi: 10.1007/s00192-016-2990-z. Epub 2016 Mar 15.
We sought to determine the incidence of venous thromboembolism (VTE) in patients undergoing surgery for pelvic organ prolapse (POP) based on surgical approach.
The American College of Surgeons National Quality Improvement Program (NSQIP) database was used to select all surgeries performed for POP from 2005 to 2013. CPT-4 codes were grouped based on surgical approach: vaginal (VAG), laparoscopic sacrocolpopexy (LSC), or open abdominal sacrocolpopexy (ASC). Patient demographics, preoperative American Society of Anesthesiologists (ASA) classification system scores, and 30-day postoperative complications were obtained.
Of the 26,103 women who underwent surgery for POP, 21,311 (81.7 %) underwent VAG, 3,346 (12.8 %) LSC, and 1,426 (5.5 %) ASC. VTE occurred in 36 patients (0.17 %) in the VAG group, 8 (0.24 %) in the LSC group, and 9 (0.63 %) in the ASC group. The ASC group had a significantly higher incidence of VTE compared with the VAG group (p < 0.01). Upon multivariate analysis, factors associated with a greater incidence of VTE included BMI greater than 30 kg/m(2) (p = 0.048), ASA score of 3, 4, or 5 (p = 0.027), and length of stay above the 75th percentile (p < 0.01). The procedure group did not retain statistical significance in multivariate modeling.
Venous thromboembolism is rare following surgery for POP. Although differences in VTE rates between procedure groups failed to maintain statistical significance after multivariate analysis, we were able to identify risk factors associated with an increased VTE risk in surgery for POP. Women with obesity, an increased length of stay, or ASA score of 3 or higher are at an increased risk for developing VTE after undergoing surgery for POP.
我们试图根据手术方式确定盆腔器官脱垂（POP）手术患者静脉血栓栓塞（VTE）的发生率。
利用美国外科医师学会国家质量改进计划（NSQIP）数据库选取2005年至2013年期间所有因POP进行的手术。根据手术方式将CPT - 4编码分组：经阴道（VAG）、腹腔镜骶骨阴道固定术（LSC）或开放性腹部骶骨阴道固定术（ASC）。获取患者人口统计学资料、术前美国麻醉医师协会（ASA）分类系统评分以及术后30天并发症情况。
在26103例行POP手术的女性中，21311例（81.7%）接受了VAG手术，3346例（12.8%）接受了LSC手术，1426例（5.5%）接受了ASC手术。VAG组有36例患者（0.17%）发生VTE，LSC组有8例（0.24%），ASC组有9例（0.63%）。ASC组VTE发生率显著高于VAG组（p < 0.01）。多因素分析显示，与VTE发生率较高相关的因素包括体重指数大于30kg/m²（p = 0.048）、ASA评分为3、4或5（p = 0.027）以及住院时间高于第75百分位数（p < 0.01）。手术方式组在多因素模型中未保持统计学显著性。
POP手术后静脉血栓栓塞很少见。尽管多因素分析后各手术方式组之间的VTE发生率差异未保持统计学显著性，但我们能够确定POP手术中与VTE风险增加相关的危险因素。肥胖、住院时间延长或ASA评分为3或更高的女性在接受POP手术后发生VTE的风险增加。
