前交叉韧带重建术后有症状静脉血栓栓塞的发生率及危险因素
Incidence and risk factors for symptomatic venous thromboembolism following anterior cruciate ligament reconstruction.
作者信息
Forlenza Enrico M, Parvaresh Kevin C, Cohn Matthew R, Lavoie-Gagne Ophelie, Khazi Zain M, Lu Yining, Cregar William, Forsythe Brian
机构信息
Rush University Medical Center, 1611 W Harrison St, Chicago, IL, 60612, USA.
Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2022 May;30(5):1552-1559. doi: 10.1007/s00167-021-06583-y. Epub 2021 May 10.
PURPOSE
To determine the incidence of symptomatic venous thromboembolism (VTE) following anterior cruciate ligament (ACL) reconstruction using a large national database and to identify corresponding independent risk factors.
METHODS
The Humana administrative claims database was reviewed for patients undergoing ACL reconstruction from 2007 to 2017. Patient demographics, medical comorbidities, as well as concurrent procedures were recorded. Postoperative incidence of VTE was measured by identifying symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) at 30 days, 90 days, and 1 year postoperatively. Univariate analysis and binary logistic regression were performed to determine independent risk factors for VTE following surgery.
RESULTS
A total of 11,977 patients were included in the study. The incidence of VTE was 1.01% (n = 120) and 1.22% (n = 146) at 30 and 90 days, respectively. Analysis of VTE events within the first postoperative year revealed that 69.6% and 84.3% of VTEs occurred within 30 and 90 days of surgery, respectively. Logistic regression identified age ≥ 45 (odds ratio [OR] = 1.88; 95% confidence interval [CI] 1.32-2.68; p < 0.001), inpatient surgery (OR = 2.07; 95% CI 1.01-4.24; p = 0.045), COPD (OR = 1.51; 95% CI 1.02-2.24; p = 0.041), and tobacco use (OR = 1.75; 95% CI 1.17-2.62; p = 0.007), as well as concurrent PCL reconstruction (OR = 3.85; 95% CI 1.71-8.67; p = 0.001), meniscal transplant (OR = 17.68; 95% CI 3.63-85.97; p < 0.001) or osteochondral allograft (OR = 15.73; 95% CI 1.79-138.43; p = 0.013) as independent risk factors for VTE after ACL reconstruction.
CONCLUSIONS
The incidence of symptomatic postoperative VTE is low following ACL reconstruction, with the majority of cases occurring within 90 days of surgery. Risk factors include age ≥ 45, inpatient surgery, COPD, tobacco use and concurrent PCL reconstruction, meniscal transplant or osteochondral allograft.
LEVEL OF EVIDENCE
III.
目的
利用一个大型国家数据库确定前交叉韧带（ACL）重建术后有症状静脉血栓栓塞症（VTE）的发生率，并确定相应的独立危险因素。
方法
回顾了2007年至2017年在Humana接受ACL重建手术患者的行政索赔数据库。记录患者的人口统计学资料、合并症以及同期手术情况。通过识别术后30天、90天和1年时有症状的深静脉血栓形成（DVT）和肺栓塞（PE）来测量VTE的术后发生率。进行单因素分析和二元逻辑回归以确定术后VTE的独立危险因素。
结果
该研究共纳入11977例患者。VTE的发生率在术后30天和90天分别为1.01%（n = 120）和1.22%（n = 146）。对术后第一年内的VTE事件分析显示，分别有69.6%和84.3%的VTE发生在术后30天和90天内。逻辑回归确定年龄≥45岁（比值比[OR]=1.88；95%置信区间[CI]1.32 - 2.68；p<0.001）、住院手术（OR = 2.07；95%CI 1.01 - 4.24；p = 0.045）、慢性阻塞性肺疾病（COPD）（OR = 1.51；95%CI 1.02 - 2.24；p = 0.041）、吸烟（OR = 1.75；95%CI 1.17 - 2.62；p = 0.007），以及同期后交叉韧带（PCL）重建（OR = 3.85；95%CI 1.71 - 8.67；p = 0.001）、半月板移植（OR = 17.68；95%CI 3.63 - 85.97；p<0.001）或骨软骨异体移植（OR = 15.73；95%CI 1.79 - 138.43；p = 0.013）为ACL重建术后VTE的独立危险因素。
结论
ACL重建术后有症状的术后VTE发生率较低，大多数病例发生在术后90天内。危险因素包括年龄≥45岁、住院手术、COPD、吸烟以及同期PCL重建、半月板移植或骨软骨异体移植。
证据级别
III级。
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