髋关节置换术住院患者的静脉血栓栓塞症。

Venous thromboembolism in patients hospitalized for hip joint replacement surgery.

机构信息

Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.

出版信息

Thromb Res. 2020 Jun;190:1-7. doi: 10.1016/j.thromres.2020.03.019. Epub 2020 Mar 27.

DOI:10.1016/j.thromres.2020.03.019

PMID:32247912

Abstract

BACKGROUND

Venous thromboembolism (VTE) is a potentially life-threatening disease. Major transient risk factors include trauma, surgery, and immobilization. Patients undergoing hip joint replacement (HJR) are characterized by a high risk of postoperative VTE, but data on the time trends of VTE rates in this population are sparse.

METHODS

In an analysis of the German nationwide inpatient sample, we included all hospitalizations for elective primary HJR in Germany from 2005 to 2016. Time trends of the surgical procedure, overall death rates, and VTE rates were analysed, and predictors of VTE identified.

RESULTS

Overall, 1,885,839 inpatients with elective primary HJR (59.1% women, 51.4% ≥70 years) were included in the analysis. During hospitalization, VTE was documented in 11,554 (0.6%) patients. While total numbers of primary HJR increased from 145,223 in 2005 to 171,421 in 2016 (β-(slope)-estimate 1818 [95%CI 1083 to 2553], P < 0.001), in-hospital VTE decreased from 1288 (0.9%) to 843 (0.5%) cases (β-estimate -0.71 [95%CI -0.77 to -0.65], P < 0.001), and in-hospital death rate from 0.33% (476 deaths) to 0.29% (498 deaths) (β-estimate -0.11 [95%CI -0.20 to -0.02], P = 0.018). Infections during hospitalization were associated with higher VTE risk than cancer and cardiovascular events. VTE events were independently associated with an increased death risk (OR 15.19 [95%CI 14.19-16.86], P < 0.001).

CONCLUSIONS

While total numbers of HJR increased significantly in Germany between 2005 and 2016, in-hospital rates of VTE decreased from 0.9% to 0.5%. Patients with perioperative VTE had a 15-fold increase of in-hospital death. Cancer, cardiovascular disease and perioperative infections were associated with higher risk for VTE.

摘要

背景

静脉血栓栓塞症（VTE）是一种潜在的危及生命的疾病。主要的短暂风险因素包括创伤、手术和固定。接受髋关节置换术（HJR）的患者术后发生 VTE 的风险很高，但关于该人群中 VTE 发生率的时间趋势的数据很少。

方法

在对德国全国住院患者样本的分析中，我们纳入了 2005 年至 2016 年期间德国所有择期初次 HJR 的住院患者。分析了手术程序、总体死亡率和 VTE 发生率的时间趋势，并确定了 VTE 的预测因素。

结果

共纳入 1885839 例择期初次 HJR 住院患者（59.1%为女性，51.4%≥70 岁）。住院期间，11554 例（0.6%）患者确诊 VTE。虽然初次 HJR 的总数从 2005 年的 145223 例增加到 2016 年的 171421 例（β-（斜率）估计值为 1818[95%CI 1083 至 2553]，P<0.001），但住院期间 VTE 从 1288 例（0.9%）下降到 843 例（0.5%）（β 估计值-0.71[95%CI-0.77 至-0.65]，P<0.001），住院期间死亡率从 0.33%（476 例死亡）下降到 0.29%（498 例死亡）（β 估计值-0.11[95%CI-0.20 至-0.02]，P=0.018）。住院期间感染与 VTE 风险增加相关，而癌症和心血管事件则与 VTE 风险增加无关。VTE 事件与死亡风险增加独立相关（OR 15.19[95%CI 14.19-16.86]，P<0.001）。