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日本全髋关节置换术患者术前深静脉血栓形成的发生率及危险因素

Preoperative incidence and risk factors of deep vein thrombosis in Japanese patients undergoing total hip arthroplasty.

作者信息

Kaneko Taizo, Nakamura Shinya, Hayakawa Kentaro, Tokimura Fumiaki, Miyazaki Tsuyoshi

机构信息

Department of Orthopaedic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Sakae-cho 35-2, Itabashi-ku, 173-0015, Tokyo, Japan.

出版信息

Eur J Orthop Surg Traumatol. 2023 Oct;33(7):2859-2864. doi: 10.1007/s00590-023-03508-y. Epub 2023 Mar 5.

Abstract

PURPOSE

Preoperative deep vein thrombosis (DVT) is a risk factor for postoperative venous thromboembolism (VTE), causing severe mortality. Early detection of preoperative DVT is essential to prevent postoperative VTE. However, little is known regarding preoperative DVT in patients undergoing major surgery. The present study aimed to determine the incidence and risk factors of preoperative DVT in patients admitted for total hip arthroplasty (THA).

METHODS

From August 2017 to September 2022, 243 patients admitted for THA at our institution were enrolled in this study. Patients medical records and preoperative laboratory data were retrospectively collected. According to the results of lower-limb ultrasonography, patients were divided into either the non-DVT (n = 136) or DVT (n = 43) group. The incidence of DVT and independent risk factors for preoperative DVT were investigated using univariate and multivariate logistic regression analyses.

RESULTS

The mean age was 74.0 ± 8.4 years. Preoperative DVT was diagnosed in 43 of the 243 (17.7%) patients. The risk of DVT was significantly high (p < 0.05) in patients with advanced age, increased D-dimer levels, and malnutrition status, as assessed by the Geriatric Nutritional Risk Index (GNRI). Multivariate analysis showed that advanced age, increased D-dimer level, and malnutrition status assessed by the GNRI were independent risk factors for preoperative DVT.

CONCLUSION

A high incidence of preoperative DVT was observed in patients undergoing THA. Advanced age, increased D-dimer levels, and malnutrition assessed by the GNRI increased the risk of preoperative DVT. Screening high-risk subgroups for preoperative DVT is necessary to prevent postoperative VTE.

摘要

目的

术前深静脉血栓形成(DVT)是术后静脉血栓栓塞症(VTE)的危险因素,可导致严重的死亡率。术前DVT的早期检测对于预防术后VTE至关重要。然而,对于接受大手术患者的术前DVT了解甚少。本研究旨在确定全髋关节置换术(THA)患者术前DVT的发生率及危险因素。

方法

2017年8月至2022年9月,本机构收治的243例行THA的患者纳入本研究。回顾性收集患者的病历和术前实验室数据。根据下肢超声检查结果,将患者分为非DVT组(n = 136)和DVT组(n = 43)。采用单因素和多因素logistic回归分析研究DVT的发生率及术前DVT的独立危险因素。

结果

平均年龄为74.0±8.4岁。243例患者中有43例(17.7%)诊断为术前DVT。根据老年营养风险指数(GNRI)评估,高龄、D-二聚体水平升高和营养不良状态的患者发生DVT的风险显著升高(p < 0.05)。多因素分析显示,高龄、D-二聚体水平升高和经GNRI评估的营养不良状态是术前DVT的独立危险因素。

结论

THA患者术前DVT的发生率较高。高龄、D-二聚体水平升高和经GNRI评估的营养不良会增加术前DVT的风险。筛查术前DVT的高危亚组对于预防术后VTE很有必要。

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