Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; The Royal College of Surgeons in Ireland, Dublin, Ireland.
Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Wayne State University, Detroit, Michigan, USA.
World Neurosurg. 2022 May;161:e531-e545. doi: 10.1016/j.wneu.2022.02.069. Epub 2022 Feb 20.
Traumatic brain injury (TBI) is a risk factor for venous thromboembolism (VTE). The risk of VTE after decompressive craniectomy (DC) and its effects on the outcomes are unknown. We assessed the incidence of VTE, associated risk factors, and effects on the outcomes.
Using the National Inpatient Sample database, the hospitalizations of patients aged ≥18 years with a severe TBI diagnosis from 2004 to 2014 were extracted. The outcome was discharge status without mortality. Multivariable logistic and linear regressions were used.
Of the 349,165 TBI hospitalizations, 23,813 (6.82%) had undergone DC and 14,175 (4.06%) had developed VTE. The VTE incidence was higher after DC compared with no DC (6.14% vs. 3.91%; P < 0.0001). DC (odds ratio [OR], 1.29; P < 0.005) was an independent predictor for the development of VTE. Age (OR, 1.26; P < 0.005), chronic lung disease (OR, 1.58; P < 0.05), electrolyte imbalance (OR, 1.43; P < 0.05), liver disease (OR, 0.10; P < 0.05), urinary tract infection (OR, 1.56; P < 0.05), pneumonia (OR, 2.03; P < 0.0001), and sepsis (OR, 1.57; P < 0.05) were significantly associated with the development of VTE. Obesity (OR, 2.09; P > 0.05) and spine injury (OR, 2.03; P > 0.05) showed a trend toward significance. VTE was associated with worse discharge outcomes (OR, 1.40; P < 0.05), longer lengths of stay (OR, 1.01; P < 0.00001), and higher costs (P < 0.0001).
Our study showed an independent association between DC and an increased risk of VTE for patients with severe TBI. The development of VTE after DC increased the proportion of poor outcomes, prolonged the length of stay, and increased the hospitalization costs. Older patients with obesity, an electrolyte imbalance, chronic lung disease, spine injury, and infections were at a greater risk of VTE after DC. These risk factors could help in considering VTE prophylaxis for these patients.
创伤性脑损伤（TBI）是静脉血栓栓塞症（VTE）的一个危险因素。去骨瓣减压术（DC）后 VTE 的发生风险及其对结局的影响尚不清楚。我们评估了 VTE 的发生率、相关危险因素及其对结局的影响。
利用国家住院患者样本数据库，提取 2004 年至 2014 年期间年龄≥18 岁、严重 TBI 诊断的住院患者。结局为无死亡率的出院状态。采用多变量逻辑和线性回归。
在 349165 例 TBI 住院患者中，23813 例（6.82%）接受了 DC，14175 例（4.06%）发生了 VTE。与未行 DC 相比，行 DC 后 VTE 的发生率更高（6.14% vs. 3.91%；P<0.0001）。DC（比值比[OR]，1.29；P<0.005）是 VTE 发生的独立预测因素。年龄（OR，1.26；P<0.005）、慢性肺部疾病（OR，1.58；P<0.05）、电解质失衡（OR，1.43；P<0.05）、肝脏疾病（OR，0.10；P<0.05）、尿路感染（OR，1.56；P<0.05）、肺炎（OR，2.03；P<0.0001）和脓毒症（OR，1.57；P<0.05）与 VTE 的发生显著相关。肥胖（OR，2.09；P>0.05）和脊柱损伤（OR，2.03；P>0.05）则显示出与 VTE 相关的趋势。VTE 与较差的出院结局（OR，1.40；P<0.05）、更长的住院时间（OR，1.01；P<0.00001）和更高的费用（P<0.0001）相关。
本研究显示，严重 TBI 患者行 DC 后与 VTE 风险增加独立相关。DC 后发生 VTE 增加了预后不良的比例，延长了住院时间，并增加了住院费用。年龄较大、肥胖、电解质失衡、慢性肺部疾病、脊柱损伤和感染的患者行 DC 后发生 VTE 的风险更高。这些危险因素有助于考虑对这些患者进行 VTE 预防。
