University Lille, CHU Lille, EA 2694, Santé publique: épidémiologie et qualité des soins, Lille, France.
University Lille, Inserm, CHU Lille, U995, Lille Inflammation Research International Center, Lille, France.
JAMA Surg. 2019 Dec 1;154(12):1126-1132. doi: 10.1001/jamasurg.2019.3742.
The risk of postoperative pulmonary embolism has been reported to be highest during the first 5 weeks after surgery. However, how long the excess risk of postoperative pulmonary embolism persists remains unknown.
To assess the duration and magnitude of the late postoperative risk of pulmonary embolism among cancer-free middle-aged patients by the type of surgery.
DESIGN, SETTING, AND PARTICIPANTS: Case-crossover analysis to compute the respective risks of pulmonary embolism after 6 types of surgery using data from a French national inpatient database, which covers a total of 203 million inpatient stays over an 8-year period between 2007 and 2014. Participants were cancer-free middle-aged adult patients (aged 45 to 64) with a diagnosis of a first pulmonary embolism.
Hospital admission for surgery. Surgical procedures were classified into 6 types: (1) vascular surgery, (2) gynecological surgery, (3) gastrointestinal surgery, (4) hip or knee replacement, (5) fractures, and (6) other orthopedic operations.
Diagnosis of a first pulmonary embolism.
A total of 60 703 patients were included (35 766 [58.9%] male; mean [SD] age, 56.6 [6.0] years). The risk of postoperative pulmonary embolism was elevated for at least 12 weeks after all types of surgery and was highest during the immediate postoperative period (1 to 6 weeks). The excess risk of postoperative pulmonary embolism ranged from odds ratio (OR), 5.24 (95% CI, 3.91-7.01) for vascular surgery to OR, 8.34 (95% CI, 6.07-11.45) for surgery for fractures. The risk remained elevated from 7 to 12 weeks, with the OR ranging from 2.26 (95% CI, 1.81-2.82) for gastrointestinal operations to 4.23 (95% CI, 3.01-5.92) for surgery for fractures. The risk was not clinically significant beyond 18 weeks postsurgery for all types of procedures.
The risk of postoperative pulmonary embolism is elevated beyond 6 weeks postsurgery regardless of the type of procedure. The persistence of this excess risk suggests that further randomized clinical trials are required to evaluate whether the duration of postoperative prophylactic anticoagulation should be extended and to define the optimal duration of treatment with regard to both the thrombotic and bleeding risks.
据报道，手术后的肺栓塞风险在手术后的前 5 周内最高。然而，术后肺栓塞的额外风险持续多长时间仍不清楚。
通过手术类型评估无癌症的中年患者术后晚期肺栓塞的持续时间和程度。
设计、设置和参与者：病例交叉分析，使用法国国家住院数据库中的数据，计算 6 种手术类型后肺栓塞的各自风险，该数据库涵盖了 2007 年至 2014 年 8 年间的 2.03 亿次住院记录。参与者为无癌症的中年成年患者（年龄 45 至 64 岁），患有首次肺栓塞的诊断。
因手术住院。手术程序分为 6 类：（1）血管手术，（2）妇科手术，（3）胃肠手术，（4）髋关节或膝关节置换术，（5）骨折，以及（6）其他骨科手术。
首次肺栓塞的诊断。
共纳入 60703 例患者（35766 例[58.9%]为男性；平均[标准差]年龄为 56.6[6.0]岁）。所有类型的手术后至少 12 周内存在术后肺栓塞的风险增加，并且在术后即刻期间（1 至 6 周）风险最高。术后肺栓塞的额外风险范围从血管手术的比值比（OR）5.24（95%CI，3.91-7.01）到骨折手术的 OR8.34（95%CI，6.07-11.45）。风险从第 7 周到第 12 周仍然升高，OR 范围从胃肠手术的 2.26（95%CI，1.81-2.82）到骨折手术的 4.23（95%CI，3.01-5.92）。对于所有类型的手术，术后 18 周后风险无临床意义。
无论手术类型如何，手术后 6 周后肺栓塞的风险都会增加。这种额外风险的持续存在表明，需要进一步进行随机临床试验，以评估是否应延长术后预防性抗凝的持续时间，并确定血栓形成和出血风险方面的最佳治疗持续时间。
