Kopelman Zachary A, Baker Tieneka M, Aden James K, Ramirez Christina I
Department of Gynecologic Surgery and Obstetrics, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA.
Department of Obstetrics and Gynecology, New Mexico Veterans Affairs Health Care System, Albuquerque, NM 87131, USA.
Mil Med. 2024 May 18;189(5-6):1106-1113. doi: 10.1093/milmed/usad064.
Hysterectomy is the most common major gynecologic procedure performed in the USA. Surgical complications, such as venous thromboembolism (VTE), are known risks that can be mitigated by preoperative risk stratification and perioperative prophylaxis. Based on recent data, the current post-hysterectomy VTE rate is found to be 0.5%. Postoperative VTE significantly impacts health care costs and patients' quality of life. Additionally, for active duty personnel, it can negatively impact military readiness. We hypothesize that the incidence of post-hysterectomy VTE rates will be lower within the military beneficiary population because of the benefits of universal health care coverage.
The Military Health System (MHS) Data Repository and Management Analysis and Reporting Tool was used to conduct a retrospective cohort study of postoperative VTE rates within 60 days of surgery among women who underwent a hysterectomy at a military treatment facility between October 1, 2013, and July 7, 2020. Patient demographics, Caprini risk assessment, preoperative VTE prophylaxis, and surgical details were obtained by chart review. Statistical analysis was performed using the chi-squared test and Student t-test.
Among the 23,391 women who underwent a hysterectomy at a military treatment facility from October 2013 to July 2020, 79 (0.34%) women were diagnosed with VTE within 60 days of their surgery. This post-hysterectomy VTE incidence rate (0.34%) is significantly lower than the current national rate (0.5%, P < .0015). There were no significant differences in postoperative VTE rates with regard to race/ethnicity, active duty status, branch of service, or military rank. Most women with post-hysterectomy VTE had a moderate-to-high (4.29 ± 1.5) preoperative Caprini risk score; however, only 25% received preoperative VTE chemoprophylaxis.
MHS beneficiaries (active duty personnel, dependents, and retirees) have full medical coverage with little to no personal financial burden for their health care. We hypothesized a lower VTE rate in the Department of Defense because of universal access to care and a presumed younger and healthier population. The postoperative VTE incidence was significantly lower in the military beneficiary population (0.34%) compared to the reported national incidence (0.5%). Additionally, despite all VTE cases having moderate-to-high preoperative Caprini risk scores, the majority (75%) received only sequential compression devices for preoperative VTE prophylaxis. Although post-hysterectomy VTE rates are low within the Department of Defense, additional prospective studies are needed to determine if stricter adherence to preoperative chemoprophylaxis can further reduce post-hysterectomy VTE rates within the MHS.
子宫切除术是美国最常见的大型妇科手术。手术并发症，如静脉血栓栓塞（VTE），是已知风险，可通过术前风险分层和围手术期预防来减轻。根据最近的数据，目前子宫切除术后VTE发生率为0.5%。术后VTE会显著影响医疗成本和患者生活质量。此外，对于现役人员，它会对军事战备产生负面影响。我们假设，由于全民医保覆盖的益处，军事受益人群中子宫切除术后VTE发生率会更低。
使用军事卫生系统（MHS）数据存储库以及管理分析与报告工具，对2013年10月1日至2020年7月7日期间在军事治疗机构接受子宫切除术的女性术后60天内的VTE发生率进行回顾性队列研究。通过病历审查获取患者人口统计学信息、卡普里尼风险评估、术前VTE预防措施及手术细节。使用卡方检验和学生t检验进行统计分析。
在2013年10月至2020年7月期间于军事治疗机构接受子宫切除术的23391名女性中，79名（0.34%）女性在术后60天内被诊断为VTE。该子宫切除术后VTE发生率（0.34%）显著低于当前全国发生率（0.5%，P < 0.0015）。术后VTE发生率在种族/族裔、现役状态、军种或军衔方面无显著差异。大多数子宫切除术后发生VTE的女性术前卡普里尼风险评分为中到高（4.29 ± 1.5）；然而，只有25%的女性接受了术前VTE化学预防。
MHS受益人（现役人员、家属和退休人员）享有全面医疗覆盖，几乎无需承担个人医疗费用负担。我们假设国防部的VTE发生率较低是因为全民可及医疗服务以及假定人群更年轻、更健康。与报告的全国发生率（0.5%）相比，军事受益人群中术后VTE发生率显著更低（0.34%）。此外，尽管所有VTE病例术前卡普里尼风险评分为中到高，但大多数（75%）仅接受了序贯加压装置进行术前VTE预防。尽管国防部内子宫切除术后VTE发生率较低，但仍需要更多前瞻性研究来确定更严格遵守术前化学预防措施是否能进一步降低MHS内子宫切除术后VTE发生率。
