全肩关节置换术中静脉血栓栓塞的危险因素。
Risk factors for venous thromboembolism in total shoulder arthroplasty.
作者信息
Lung Brandon E, Kanjiya Shrey, Bisogno Michael, Komatsu David E, Wang Edward D
机构信息
School of Medicine, Stony Brook University, Stony Brook, NY, USA.
Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA.
出版信息
JSES Open Access. 2019 Sep 11;3(3):183-188. doi: 10.1016/j.jses.2019.07.003. eCollection 2019 Oct.
BACKGROUND
Although venous thromboembolism (VTE) has been studied in lower-extremity arthroplasty, there are few guidelines regarding established risk factors for VTE in total shoulder arthroplasty (TSA). With literature suggesting the VTE rate may be as high as 13%, VTE prevention and risk factors should be considered in preoperative planning.
METHODS
All TSAs from 2011 through 2016 were queried from the National Surgical Quality Improvement Program database. Age, sex, body mass index, American Society of Anesthesiologists class, ethnicity, functional status, comorbidities, discharge destination, surgical indication, length of stay, and operative time were compared between patients with and without 30-day postoperative VTE. Pearson χ and tests were used to assess baseline categorical and continuous variables, respectively. Multivariate logistic regression analysis was conducted to determine associated independent risk factors for VTE.
RESULTS
The analysis included 13,299 patients; VTE developed in 83 patients (0.62%). Patients with VTE were older (72 years vs. 69 years) and had a longer hospital stay (3.5 days vs. 1.9 days). Compared with patients with no VTE, patients with VTE were more likely to undergo TSA for proximal humeral fractures, to be discharged to a rehabilitative center, to have a preoperative albumin level lower than 3.5 g/dL, to undergo non-elective surgery, to have an American Society of Anesthesiologists class of 3 or greater, to have a surgical-site infection develop, and ultimately to need a shoulder reoperation (all < .05). Multivariate logistic regression analysis revealed that hypoalbuminemia (albumin level < 3.5 g/dL), an increased length of stay, and African American ethnicity were independent risk factors for VTE development.
CONCLUSION
Patients with hypoalbuminemia, an increased length of stay, and African American ethnicity are at an increased risk of VTE after shoulder arthroplasty. A high index of suspicion is warranted for elderly patients with fractures who may need preoperative medical optimization.
背景
尽管已经对下肢关节置换术中的静脉血栓栓塞症（VTE）进行了研究，但关于全肩关节置换术（TSA）中VTE既定危险因素的指南却很少。有文献表明VTE发生率可能高达13%，因此在术前规划中应考虑VTE的预防和危险因素。
方法
从国家外科质量改进计划数据库中查询2011年至2016年期间所有的TSA病例。比较术后30天发生VTE和未发生VTE患者的年龄、性别、体重指数、美国麻醉医师协会分级、种族、功能状态、合并症、出院目的地、手术指征、住院时间和手术时间。分别使用Pearson χ检验和t检验评估基线分类变量和连续变量。进行多因素逻辑回归分析以确定VTE的相关独立危险因素。
结果
分析纳入13299例患者；83例（0.62%）发生VTE。发生VTE的患者年龄更大（72岁对69岁），住院时间更长（3.5天对1.9天）。与未发生VTE的患者相比，发生VTE的患者更有可能因肱骨近端骨折接受TSA，出院至康复中心，术前白蛋白水平低于3.5 g/dL，接受非择期手术，美国麻醉医师协会分级为3级或更高，发生手术部位感染，最终需要进行肩关节再次手术（均P<0.05）。多因素逻辑回归分析显示，低白蛋白血症（白蛋白水平<3.5 g/dL）、住院时间延长和非裔美国人种族是VTE发生的独立危险因素。
结论
低白蛋白血症、住院时间延长和非裔美国人种族的患者在肩关节置换术后发生VTE的风险增加。对于可能需要术前医学优化的老年骨折患者，应保持高度怀疑。
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