Moreano E H, Hutchison J L, McCulloch T M, Graham S M, Funk G F, Hoffman H T
Department of Otolaryngology--Head and Neck Surgery, University of Iowa Hospital and Clinics, Iowa City, USA.
Otolaryngol Head Neck Surg. 1998 Jun;118(6):777-84. doi: 10.1016/S0194-5998(98)70268-2.
Postoperative deep venous thrombosis and pulmonary embolus are major causes of morbidity and mortality in patients undergoing surgical procedures. In contrast to other surgical fields, the incidence of these life-threatening conditions has not been studied in our specialty. The purposes of this study were to elucidate the incidence of deep venous thrombosis and pulmonary embolus in patients after otolaryngologic operations and to identify specific risk factors that may contribute to the development of these conditions.
A retrospective analysis was done of 12,805 total operations on adults done by the Department of Otolaryngology at our institution from January 1987 to December 1994 to determine the number of patients in whom postoperative deep venous thrombosis and pulmonary embolus developed. Patients in whom a postoperative thromboembolic event developed after an otolaryngologic surgical procedure were identified by the medical records department with use of an abstracting database. This search cross-referenced disease-specific codes for otolaryngologic procedures with the codes for deep venous thrombosis and pulmonary embolus to identify the 34 patients in this report. Results (rounded to the nearest decimal point) were then categorized according to the different subspecialties within otolaryngology, and appropriate statistical analysis tests were performed on the resulting data.
Thirty-four patients with postoperative deep vein thrombosis were identified during the study period, for an overall incidence of 0.3%. Of these 34 patients, 24 also had a pulmonary embolus for an overall incidence of 0.2%. The incidence of deep venous thrombosis (and pulmonary embolus) in the subspecialties was as follows: head and neck surgery, 0.6% (0.4%); otology/neurotology, 0.3% (0.2%); head and neck trauma and plastic surgery, 0.1% (0.1%); and general otolaryngology, 0.1% (0.04%). Only the patient's age and the presence or absence of pneumatic compression devices were identified as independent risk factors for the development of a thromboembolic event.
Postoperative pulmonary embolus is a rare occurrence in the field of otolaryngology-head and neck surgery. When it does occur, it causes significant morbidity and increases the cost of care for that patient. We discuss our approach to categorizing patients into low-, intermediate-, and high-risk groups, as well as prophylaxis against pulmonary embolus.
术后深静脉血栓形成和肺栓塞是接受外科手术患者发病和死亡的主要原因。与其他外科领域不同，这些危及生命情况的发生率在我们这个专业中尚未得到研究。本研究的目的是阐明耳鼻喉科手术后患者深静脉血栓形成和肺栓塞的发生率，并确定可能导致这些情况发生的特定危险因素。
对1987年1月至1994年12月期间我院耳鼻喉科对成人进行的12805例手术进行回顾性分析，以确定发生术后深静脉血栓形成和肺栓塞的患者数量。医疗记录部门通过使用一个摘要数据库，识别出在耳鼻喉科手术操作后发生术后血栓栓塞事件的患者。该搜索将耳鼻喉科手术的特定疾病代码与深静脉血栓形成和肺栓塞的代码进行交叉引用，以确定本报告中的34例患者。然后将结果（四舍五入到最接近的小数点）根据耳鼻喉科内不同的亚专业进行分类，并对所得数据进行适当的统计分析测试。
在研究期间，共识别出34例术后深静脉血栓形成患者，总发生率为0.3%。在这34例患者中，24例还发生了肺栓塞，总发生率为0.2%。各亚专业深静脉血栓形成（和肺栓塞）的发生率如下：头颈外科，0.6%（0.4%）；耳科/神经耳科，0.3%（0.2%）；头颈创伤与整形手术，0.1%（0.1%）；普通耳鼻喉科，0.1%（0.04%）。仅患者年龄和气垫压迫装置的使用与否被确定为血栓栓塞事件发生的独立危险因素。
术后肺栓塞在耳鼻喉科-头颈外科领域较为罕见。一旦发生，会导致严重的发病情况，并增加该患者的护理成本。我们讨论了将患者分为低、中、高风险组的方法以及肺栓塞的预防措施。
