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术后早期 COVID 感染与代谢和减重手术后静脉血栓栓塞的风险显著增加相关。

Early postoperative COVID infection is associated with significantly increased risk of venous thromboembolism after metabolic and bariatric surgery.

机构信息

Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Department of Surgery, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts.

出版信息

Surg Obes Relat Dis. 2024 Aug;20(8):730-736. doi: 10.1016/j.soard.2024.01.021. Epub 2024 Feb 8.

Abstract

BACKGROUND

Patients who undergo metabolic and bariatric surgery (MBS) are at risk for thromboembolism. Patients are susceptible to coronavirus throughout the perioperative period, which also has a well-known association with thrombotic complications.

OBJECTIVES

To identify and define the association between venous thromboembolism (VTE) and postoperative coronavirus diagnosis in bariatric surgery patients.

SETTING

United States.

METHODS

We conducted a retrospective cohort study using the MBS Accreditation and Quality Improvement Program (MBSAQIP) 2021 database to analyze the incidence of VTE within 30 days of surgery. VTE was a composite variable defined as either postoperative pulmonary embolism or postoperative venous thrombus requiring treatment. Cohorts were stratified by whether the patient was diagnosed with postoperative coronavirus. We created a multivariable logistic regression model to determine the adjusted odds of postoperative VTE based on various factors. Additionally, we conducted subset analyses of sleeve gastrectomy and Roux-en-Y bypass cases, the 2 most frequent bariatric operations in the United States.

RESULTS

Patients diagnosed with postoperative coronavirus were significantly more likely to develop postoperative VTE (1.1% versus .3%, P < .001). In our logistic regression model, the adjusted odds of postoperative VTE for patients with postoperative coronavirus was 3.55 (95% CI: 2.15-5.87, P < .001). For patients who underwent Roux-en-Y bypass, the adjusted odds was even greater at 5.69 (95% CI: 2.76-11.70, P < .001).

CONCLUSIONS

Early postoperative coronavirus infection after MBS is associated with higher odds of postoperative VTE. This persisted on subset analyses of the 2 most common procedures and appeared particularly important for Roux-en-Y bypass. COVID infection after MBS may warrant prolonged VTE prophylaxis.

摘要

背景

接受代谢和减重手术(MBS)的患者存在血栓栓塞风险。患者在围手术期内易感染冠状病毒,而冠状病毒也与血栓并发症密切相关。

目的

确定并定义减重手术患者中静脉血栓栓塞症(VTE)与术后冠状病毒诊断之间的关联。

设置

美国。

方法

我们使用 MBS 认证和质量改进计划(MBSAQIP)2021 数据库进行了一项回顾性队列研究,分析了术后 30 天内 VTE 的发生率。VTE 是一个复合变量,定义为术后肺栓塞或需要治疗的术后静脉血栓。根据患者是否被诊断为术后冠状病毒,对队列进行分层。我们创建了一个多变量逻辑回归模型,以根据各种因素确定术后 VTE 的调整后 odds。此外,我们还对美国最常见的两种减重手术袖状胃切除术和 Roux-en-Y 旁路手术进行了亚组分析。

结果

被诊断为术后冠状病毒的患者发生术后 VTE 的可能性明显更高(1.1%比.3%,P <.001)。在我们的逻辑回归模型中,术后冠状病毒患者发生术后 VTE 的调整后 odds 为 3.55(95%CI:2.15-5.87,P <.001)。对于接受 Roux-en-Y 旁路手术的患者,调整后的 odds 甚至更高,为 5.69(95%CI:2.76-11.70,P <.001)。

结论

MBS 后早期术后冠状病毒感染与术后 VTE 的 odds 增加相关。在两种最常见手术的亚组分析中仍然存在这种情况,对于 Roux-en-Y 旁路手术尤其重要。MBS 后 COVID 感染可能需要延长 VTE 预防。

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