Incidence and Risk Factors for Venous Thromboembolic Disease in Podiatric Surgery
Incidence and Risk Factors for Venous Thromboembolic Disease in Podiatric Surgery
复制标题
DOI：
10.1378/chest.08-1631
复制
发表时间：
2009-04-01
期刊：
影响因子：
9.6
通讯作者：
Laxson, Steven E.
中科院分区：
文献类型：
--
作者：
Felcher, Andrew H.;Mularski, Richard A.;Laxson, Steven E.
背景：医疗保健研究和质量机构将预防静脉血栓栓塞 (VTE) 列为患者安全的首要任务；然而，尚无指南或基于人群的研究来指导足部手术患者的管理。我们研究的目的是确定足部手术中术后 VTE 的发生率和危险因素。方法：对 1999 年至 2004 年在太平洋西北地区为超过 485,000 名会员提供服务的大型非营利健康维护组织中接受足部手术的患者进行了 5 年回顾性分析。结果：我们在 7,264 名患者中进行了 16,804 次外科手术，并检测到 22 例有症状的患者术后 VTE。术后 VTE 的总体发生率为 0.30%。三个危险因素与足部手术中的 VTE 显着且独立相关：既往 VIM（发生率，4.6%；相对风险，23.0；p < 0.001）、使用激素替代疗法或口服避孕药（发生率，0.55%；相对风险，4.2；p = 0.01）和肥胖（发生率，0.48%；相对风险，3.0；p = 0.02）。结论：我们发现足部手术中 VTE 的总体风险较低，表明常规预防是没有必要的。然而，对于有 VTE 病史的患者，建议根据风险水平进行围手术期预防。对于具有两种或多种 VTE 危险因素的足病手术患者，应考虑围手术期预防。在前瞻性研究完成之前，足部手术患者的测试建议、指南和护理决策将继续基于回顾性数据、专家共识和临床判断。
Background: The Agency for Healthcare Research and Quality ranks prevention of venous thromboembolism (VTE) as a top priority for patient safety; however, no guidelines or population-based research exist to guide management for podiatric surgery patients. The objective of our study was to determine the incidence and risk factors for postprocedure VTE in podiatric surgery.Methods: A 5-year retrospective analysis of patients undergoing podiatric surgery in a large not-for-profit health maintenance organization serving > 485,000 members in the Pacific Northwest from 1999 to 2004.Results: We identified 16,804 surgical procedures in 7,264 patients and detected 22 symptomatic postprocedure VTEs. The overall incidence of postprocedure VTE was 0.30%. Three risk factors were significantly and independently associated with VTE in podiatiric surgery: prior VIM (incidence, 4.6%; relative risk, 23.0; p < 0.001), use of hormone replacement therapy or oral contraceptives (incidence, 0.55%; relative risk, 4.2; p = 0.01), and obesity, (incidence, 0.48%; relative risk, 3.0; p = 0.02).Conclusions: We identified a low overall risk of VTE in podiatric surgery, suggesting that routine prophylaxis is not warranted. However, for patients with a history of VTE, periprocedure prophylaxis is suggested based on the level of risk. For podiatry surgery patients with two or more risk factors for VTE, periprocedure prophylaxis should be considered. Until a prospective study, is completed testing recommendations, guidelines and care decisions for podiatric surgery patients will continue to be based on retrospective data, expert consensus, and clinical judgment.