Parmontree Porntip, Ketprathum Phanuwat, Ladnok Teeraphat, Meeaium Supanut, Thanaratsiriworakul Thanyaras, Sonhorm Ukrit
Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand.
Pharmacy Department, Bangkok Hospital Pattaya, Chonburi, Thailand.
Ann Med Surg (Lond). 2022 Apr 14;77:103628. doi: 10.1016/j.amsu.2022.103628. eCollection 2022 May.
Venous thromboembolism (VTE) has a major effect on morbidity and mortality in neurosurgical patients. However, identifying risk factors that may be useful in practice is a challenge. The purpose of this study was to investigate the incidence and determine the predictors of VTE in patients undergoing neurosurgery.
This retrospective, single-center cohort study was conducted on adult patients admitted to a private hospital for a primary elective neurosurgical procedure between January 2015 and December 2020. Univariate analysis was used to examine clinical factors, and multivariable regression analysis was used to identify predictors of VTE. The area under the receiver-operating characteristic (AUROC) curve demonstrated the fitting model and discrimination power.
A total of 350 patients who underwent neurological surgery were identified. There were 26 patients (7.4%) with VTE. The final predictors were found to be statistically significant in the multivariate binary logistic regression analysis, including non-Asian populations (p value < 0.001, odds ratio [OR]: 6.11, 95% confidence interval [CI] = 2.20-16.89), lack of postoperative ambulation (p value = 0.009, OR: 9.25, 95% CI = 1.17-48.83), and septic shock complication (p value = 0.001, OR: 5.36, 95% CI = 1.46-19.62). The AUROC was 0.708 (95% CI 0.61-0.80).
Although the incidence of VTE in patients receiving neurosurgery is minimal, it is also higher in non-Asian patients, those who lack of postoperative ambulation, and patients with septic shock complications. This approach may be useful to predict thromboembolism in neurosurgical patients. External validation of the prognostic model requires more investigation.
静脉血栓栓塞症（VTE）对神经外科患者的发病率和死亡率有重大影响。然而，识别在实际应用中可能有用的风险因素是一项挑战。本研究的目的是调查神经外科手术患者VTE的发生率并确定其预测因素。
本回顾性单中心队列研究针对2015年1月至2020年12月期间因原发性择期神经外科手术入住私立医院的成年患者进行。采用单因素分析检查临床因素，并使用多变量回归分析识别VTE的预测因素。受试者操作特征（AUROC）曲线下面积显示了拟合模型和判别能力。
共确定了350例接受神经外科手术的患者。有26例（7.4%）发生VTE。在多变量二元逻辑回归分析中，最终的预测因素具有统计学意义，包括非亚洲人群（p值<0.001，比值比[OR]：6.11，95%置信区间[CI]=2.20-16.89）、术后缺乏活动（p值=0.009，OR：9.25，95%CI=1.17-48.83）和感染性休克并发症（p值=0.001，OR：5.36，95%CI=1.46-19.62）。AUROC为0.708（95%CI 0.61-0.80）。
虽然接受神经外科手术患者的VTE发生率很低，但在非亚洲患者、术后缺乏活动的患者以及有感染性休克并发症的患者中发生率也较高。这种方法可能有助于预测神经外科患者的血栓栓塞。预后模型的外部验证需要更多研究。
