Höing B, Hussain T, Kanaan O, Stuck B A, Mattheis S, Lang S, Hansen S
Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Philipps-Universität Marburg, Marburg, Deutschland.
HNO. 2021 Dec;69(12):961-968. doi: 10.1007/s00106-021-01003-6. Epub 2021 Feb 16.
In the authors' department, a newly implemented clinical algorithm for application of perioperative thrombosis prophylaxis in head and neck surgery recommends restrictive handling of anticoagulants. This retrospective study aims to evaluate the algorithm by comparing incidences of venous thromboembolic events (VTE) and surgical revisions due to postoperative hemorrhage.
Perioperative incidences of deep vein thrombosis and pulmonary embolism as well as surgical revisions due to postoperative hemorrhage after head and neck surgery were determined based on all patients operated in the department over a period of 36 months. The incidences before (group I) and after (group II) implementation of the restrictive algorithm were compared.
A total of 9276 patients were included. The incidences of VTE (0.12%) and surgical revisions due to postoperative hemorrhage (1.4%) were low. Incidences of VTE were non-significantly higher in group II (0.16%) than in group I (0.08%; p > 0.45, chi-square-test). Case analysis revealed that this difference was not due to implementation of the restrictive algorithm. The incidence of surgical revision due to postoperative hemorrhage was identical in the two groups (1.4%).
After restricting the indication for thrombosis prophylaxis, the incidence of VTE or surgical revision due to postoperative hemorrhage did not change significantly. The provided clinical algorithm represents a low-risk and low-cost strategy of perioperative risk stratification.
在作者所在科室，一种新实施的用于头颈部手术围手术期血栓预防的临床算法建议严格控制抗凝剂的使用。这项回顾性研究旨在通过比较静脉血栓栓塞事件（VTE）的发生率和术后出血导致的手术修正率来评估该算法。
基于该科室36个月内所有接受手术的患者，确定头颈部手术后深静脉血栓形成和肺栓塞的围手术期发生率以及术后出血导致的手术修正率。比较了严格算法实施前（I组）和实施后（II组）的发生率。
共纳入9276例患者。VTE的发生率（0.12%）和术后出血导致的手术修正率（1.4%）较低。II组VTE的发生率（0.16%）略高于I组（0.08%），但差异无统计学意义（p>0.45，卡方检验）。病例分析显示，这种差异并非由于严格算法的实施所致。两组术后出血导致的手术修正率相同（1.4%）。
在限制血栓预防指征后，VTE的发生率或术后出血导致的手术修正率没有显著变化。所提供的临床算法代表了一种低风险、低成本的围手术期风险分层策略。
