Lewin Grant M, Gelfond Allison L, Crumm Erin G, Patel Parit A
Department of Surgery, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Ill.
Section of Plastic and Reconstructive Surgery, The University of Chicago Medicine and Biological Sciences.
Plast Reconstr Surg Glob Open. 2022 Jun 23;10(6):e4393. doi: 10.1097/GOX.0000000000004393. eCollection 2022 Jun.
Venous thromboembolism (VTE), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major complication in plastic surgery; however, there is a paucity of evidence about the incidence of VTE in the craniofacial subpopulation. We investigated the incidence and risk factors for VTE in the adult craniofacial trauma population.
This retrospective review identified patients from the 2016 and 2017 Healthcare Cost and Utilization Project's National Inpatient Sample with a diagnosis for an initial encounter of a facial fracture. International Classification of Disease codes identified patients with DVT or PE. Groups were identified: adult craniofacial patients with and without a VTE diagnosis. The groups were analyzed to determine risk factors for developing a VTE during inpatient admissions.
A total of 203,240 patients were identified based on a diagnosis for an initial encounter of a facial fracture. Among those, 3350 (1.65%) were diagnosed with a DVT and 1455 (0.72%) with a PE. Risk factors for VTE were male sex ( = 0.011), longer hospital stay ( = 0.000), and higher Elixhauser comorbidity index ( = 0.000). Additionally, PE was an independent predictor of mortality [odds ratio (OR), 2.129] but DVT was not (OR, 1.148). Cranial and frontal fractures were independently associated with an increase in DVT (OR, 2.481) and PE (OR, 1.489).
This study demonstrates that craniofacial trauma patients are at risk for VTE and should be risk-stratified for chemoprophylaxis therapy. Further studies in thromboembolism prophylaxis for facial fractures are warranted as the data are limited.
静脉血栓栓塞症(VTE),特别是深静脉血栓形成(DVT)和肺栓塞(PE),是整形外科的一种主要并发症;然而,关于颅面亚组中VTE发病率的证据很少。我们调查了成年颅面创伤人群中VTE的发病率和危险因素。
这项回顾性研究确定了2016年和2017年医疗成本和利用项目国家住院样本中首次诊断为面部骨折的患者。国际疾病分类代码确定了患有DVT或PE的患者。确定了两组:有和没有VTE诊断的成年颅面患者。对这些组进行分析,以确定住院期间发生VTE的危险因素。
根据首次诊断为面部骨折,共确定了203240名患者。其中,3350名(1.65%)被诊断为DVT,1455名(0.72%)被诊断为PE。VTE的危险因素为男性(P = 0.011)、住院时间较长(P = 0.000)和较高的埃利克斯豪泽合并症指数(P = 0.000)。此外,PE是死亡率的独立预测因素[比值比(OR),2.129],但DVT不是(OR,1.148)。颅骨和额骨骨折与DVT(OR,2.481)和PE(OR,1.489)的增加独立相关。
本研究表明,颅面创伤患者有发生VTE的风险,应进行风险分层以进行化学预防治疗。由于数据有限,有必要对面部骨折的血栓栓塞预防进行进一步研究。