Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, Los Angeles, California.
Division of Cardiac Surgery, University of California Los Angeles, Los Angeles, California.
Ann Thorac Surg. 2020 Jun;109(6):1804-1810. doi: 10.1016/j.athoracsur.2019.09.055. Epub 2019 Nov 7.
Deep venous thrombosis and pulmonary embolism are life-threatening complications after surgery, warranting prophylaxis. However prophylaxis is not uniformly practiced among cardiac surgical patients. This study aimed to characterize the national incidence, mortality, and costs associated with thromboembolism after cardiac surgery.
The 2005 to 2015 National Inpatient Sample was used to identify all adult patients undergoing coronary artery bypass grafting or valve surgery. International Classification of Disease codes were used to identify patients with deep venous thrombosis and pulmonary embolism.
Of approximately 3 million patients undergoing cardiac surgery, 1.62% developed deep venous thrombosis and 0.38% pulmonary embolism. Those with deep venous thrombosis and pulmonary embolism were more commonly women (33.2% and 36.2 vs 31.2%, P < .001), older (68.1 and 66.0% vs 65.7 years, P < .001), and had a higher Elixhauser comorbidity index (4.0 and 4.7 vs 3.7, P < .001). Deep venous thrombosis and pulmonary embolism were associated with increased mortality (4.95% and 14.8% vs 2.67%, P < .001). After adjustment for baseline differences, deep venous thrombosis was associated with an incremental increase in cost of $12,308, whereas pulmonary embolism was associated with $13,879 cost increase after cardiac surgery. Pulmonary embolism was an independent predictor of mortality (adjusted odds ratio, 3.39; 95% confidence interval, 2.74-4.18).
The mortality and financial burden related to thromboembolism in cardiac surgery are significant. Prophylaxis may be indicated in cardiac surgery patients to improve quality of care and reduce healthcare costs. Future controlled randomized trials investigating the benefit of thromboembolism prophylaxis in cardiac surgery are warranted.
深静脉血栓形成和肺栓塞是心脏手术后危及生命的并发症，需要进行预防。然而，心脏外科患者的预防措施并不统一。本研究旨在描述心脏手术后血栓栓塞的全国发病率、死亡率和相关费用。
使用 2005 年至 2015 年全国住院患者样本，确定所有接受冠状动脉旁路移植术或瓣膜手术的成年患者。使用国际疾病分类代码识别深静脉血栓形成和肺栓塞患者。
约 300 万例心脏手术患者中，1.62%发生深静脉血栓形成，0.38%发生肺栓塞。患有深静脉血栓形成和肺栓塞的患者更常见于女性（33.2%和 36.2%比 31.2%，P<0.001）、年龄较大（68.1%和 66.0%比 65.7 岁，P<0.001）和更高的 Elixhauser 合并症指数（4.0%和 4.7%比 3.7%，P<0.001）。深静脉血栓形成和肺栓塞与死亡率增加相关（4.95%和 14.8%比 2.67%，P<0.001）。在调整了基线差异后，深静脉血栓形成与心脏手术后的成本增加 12308 美元有关，而肺栓塞与成本增加 13879 美元有关。肺栓塞是死亡率的独立预测因素（调整后的优势比，3.39；95%置信区间，2.74-4.18）。
心脏手术后血栓栓塞的死亡率和经济负担是显著的。心脏外科患者可能需要预防以改善护理质量并降低医疗保健成本。未来需要进行控制随机试验来研究心脏外科血栓预防的益处。
