Amaral Cristina, Guimarães Pereira Luís, Moreto Ana, Sá Ana Carolina, Azevedo Ana
Serviço de Anestesiologia, Centro Hospitalar de São João, Porto, Portugal.
Serviço de Anestesiologia, Centro Hospitalar de São João, Porto, Portugal.
Rev Port Cardiol. 2017 Sep;36(9):609-616. doi: 10.1016/j.repc.2016.11.007. Epub 2017 Sep 1.
Venous thromboembolism, risk of which is increased in surgical patients, is a preventable cause of morbidity and death. The primary objective of this study was to estimate the incidence of symptomatic postoperative venous thromboembolism in adults at a tertiary university hospital, overall and by surgical specialty. The secondary objective was to analyze severity of and mortality from thromboembolic events.
We performed a retrospective study to identify cases of in-hospital postoperative venous thromboembolism, encoded by the International Classification of Diseases, Ninth Revision, according to the Joint Commission International criteria. Adult patients admitted for surgery in 2008-2012 were included.
Among 67 635 hospitalizations, 90 cases of postoperative symptomatic venous thromboembolism were identified, corresponding to an incidence of 1.33/1000 admissions (95% confidence interval [CI] 1.1-1.6/1000). Neurosurgery had the highest risk (4.07/1000), followed by urological surgery and general surgery (p<0.001). There were 50 cases of pulmonary embolism, 11 of which were fatal. Of the 90 cases, 12.2% occurred under neuraxial anesthesia and 55.1% in patients with American Society of Anesthesiology III physical status. At least 37.7% of patients with events received a prophylactic dose of injectable anticoagulant postoperatively. The overall risk decreased from 2008 to 2012. Venous thromboembolism-associated mortality during hospitalization was 21.1% (95% CI 13.6-30.4).
The incidence of postoperative symptomatic venous thromboembolism was 1.33/1000. Neurosurgery showed the greatest risk. Mortality was 21.1%.
静脉血栓栓塞是发病率和死亡率的一个可预防原因，手术患者发生静脉血栓栓塞的风险会增加。本研究的主要目的是评估一家三级大学医院成年患者术后有症状静脉血栓栓塞的发生率，包括总体发生率以及按外科专业分类的发生率。次要目的是分析血栓栓塞事件的严重程度和死亡率。
我们进行了一项回顾性研究，根据国际联合委员会标准，通过《国际疾病分类（第九版）》编码来确定住院术后静脉血栓栓塞病例。纳入2008年至2012年因手术入院的成年患者。
在67635例住院病例中，确定了90例术后有症状静脉血栓栓塞病例，发生率为1.33/1000例住院（95%置信区间[CI]1.1 - 1.6/1000）。神经外科风险最高（4.07/1000），其次是泌尿外科手术和普通外科手术（p<0.001）。有50例肺栓塞病例，其中11例死亡。在90例病例中，12.2%发生在神经轴麻醉下，55.1%发生在麻醉医师协会身体状况分级为III级的患者中。至少37.7%发生事件的患者术后接受了预防性剂量的注射用抗凝剂。总体风险从2008年到2012年有所下降。住院期间静脉血栓栓塞相关死亡率为21.1%（95%CI 13.6 - 30.4）。
术后有症状静脉血栓栓塞的发生率为1.33/1000。神经外科显示出最大风险。死亡率为21.1%。
