Babic Bruna, De Roulet Amory, Volpe Anita, Nilubol Naris
Department of Surgery, New York Presbyterian-Queens, Flushing, New York.
Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
J Endocr Soc. 2018 Dec 12;3(2):304-313. doi: 10.1210/js.2018-00278. eCollection 2019 Feb 1.
Patients with Cushing syndrome (CS) have an increased risk for venous thromboembolism (VTE). However, it is unclear whether patients undergoing adrenalectomy for CS are at increased risk for postoperative VTE. The aim of this study was to determine the rate of postoperative VTE in patients undergoing adrenalectomy for CS.
A retrospective analysis of patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent adrenalectomy from 2005 to 2016 was performed. We compared the clinical characteristics and 30-day postoperative VTE occurrence in patients with and without CS.
A total of 4217 patients were analyzed; 2607 (61.8%) were female and 310 (7.4%) had CS. The overall prevalence of postoperative VTE was 1.0% (n = 45). The rates of VTE were higher in patients with CS (2.6% vs 0.9%; = 0.007). In the two groups, CS was associated with younger age, increased body mass index, and diabetes mellitus ( < 0.001). CS was also associated with longer length of operation and longer hospital length of stay ( < 0.001). In the subgroup of patients who had diagnosed VTE, CS was associated with longer length of operation ( < 0.001). Rates of laparoscopic vs open surgery were equivalent between patients with and without CS, and VTE events did not differ. The median time to VTE event was 14.5 days (range, 1 to 23 days) in the CS group and 4 days (range, 2 to 25 days) in the group without CS.
The prevalence of postoperative VTE was increased in patients undergoing adrenalectomy for CS. In patients with CS undergoing adrenalectomy, VTE prophylaxis for 28 days should be considered upon discharge.
库欣综合征（CS）患者发生静脉血栓栓塞症（VTE）的风险增加。然而，因CS接受肾上腺切除术的患者术后发生VTE的风险是否增加尚不清楚。本研究的目的是确定因CS接受肾上腺切除术的患者术后VTE的发生率。
对2005年至2016年在美国外科医师学会国家外科质量改进计划数据库中接受肾上腺切除术的患者进行回顾性分析。我们比较了有和没有CS的患者的临床特征及术后30天VTE的发生情况。
共分析了4217例患者；2607例（61.8%）为女性，310例（7.4%）患有CS。术后VTE的总体发生率为1.0%（n = 45）。CS患者的VTE发生率更高（2.6%对0.9%；P = 0.007）。在两组中，CS与年龄较小、体重指数增加和糖尿病相关（P < 0.001）。CS还与手术时间延长和住院时间延长相关（P < 0.001）。在已诊断VTE的患者亚组中，CS与手术时间延长相关（P < 0.001）。有和没有CS的患者腹腔镜手术与开放手术的比例相当，VTE事件无差异。CS组VTE事件的中位时间为14.5天（范围1至23天），无CS组为4天（范围2至25天）。
因CS接受肾上腺切除术的患者术后VTE的发生率增加。对于因CS接受肾上腺切除术的患者，出院时应考虑进行28天的VTE预防。
