Bekelis Kimon, Labropoulos Nicos, Coy Shannon
Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
Neurosurgery. 2017 May 1;80(5):787-792. doi: 10.1093/neuros/nyw129.
The association of operative duration with the risk of venous thromboembolism (VTE) has not been quantified in neurosurgery.
To investigate the association of surgical duration for several neurosurgical procedures and the incidence of VTE.
We performed a retrospective cohort study involving patients who underwent neurosurgical procedures from 2005 to 2012 and were registered in the American College of Surgeons National Quality Improvement Project registry. In order to control for confounding, we used multivariable regression models, and propensity score conditioning.
During the study period, there were 94 747 patients, who underwent neurosurgical procedures, and met the inclusion criteria. Of these, 1358 (1.0%) developed VTE within 30 days postoperatively. Multivariable logistic regression demonstrated an association of longer operative duration with higher 30-day incidence of VTE (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.19-1.25). Compared with procedures of moderate duration (third quintile, 40-60th percentile), patients undergoing the longest procedures (>80th percentile) had higher odds (OR, 3.15; 95% CI, 2.49-3.99) of developing VTE. The shortest procedures (<20th percentile) were associated with a decreased incidence of VTE (OR, 0.51; 95% CI, 0.27-0.76) in comparison to those of moderate duration. The same associations were present in propensity score-adjusted models, and models stratified by subgroups of cranial, spinal, peripheral nerve, and carotid procedures.
In a cohort of patients from a national prospective surgical registry, increased operative duration was associated with increased incidence of VTE for neurosurgical procedures. These results can be used by neurosurgeons to inform operative management, and to stratify patients with regard to VTE risk.
神经外科手术持续时间与静脉血栓栓塞症（VTE）风险之间的关联尚未得到量化。
研究几种神经外科手术的手术持续时间与VTE发生率之间的关联。
我们进行了一项回顾性队列研究，纳入了2005年至2012年接受神经外科手术并登记在美国外科医师学会国家质量改进项目登记处的患者。为了控制混杂因素，我们使用了多变量回归模型和倾向评分调整。
在研究期间，有94747例患者接受了神经外科手术并符合纳入标准。其中，1358例（1.0%）在术后30天内发生了VTE。多变量逻辑回归显示，手术持续时间越长，30天VTE发生率越高（优势比[OR]，1.22；95%置信区间[CI]，1.19 - 1.25）。与中等持续时间的手术（第三五分位数，第40 - 60百分位数）相比，接受最长手术（>第80百分位数）的患者发生VTE的几率更高（OR，3.15；95% CI，2.49 - 3.99）。与中等持续时间的手术相比，最短手术（<第20百分位数）与VTE发生率降低相关（OR，0.51；95% CI，0.27 - 0.76）。在倾向评分调整模型以及按颅脑、脊柱、周围神经和颈动脉手术亚组分层的模型中也存在相同的关联。
在一个来自国家前瞻性手术登记处的患者队列中，神经外科手术的手术持续时间增加与VTE发生率增加相关。这些结果可供神经外科医生用于指导手术管理，并对患者的VTE风险进行分层。
