Analysis of Venous Thromboembolism Risk in Patients Undergoing Craniotomy
Analysis of Venous Thromboembolism Risk in Patients Undergoing Craniotomy
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DOI：
10.1016/j.wneu.2015.06.033
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发表时间：
2015-11-01
影响因子：
2
通讯作者：
Jahromi, Babak S.
中科院分区：
文献类型：
--
作者：
Algattas, Hanna;Kimmell, Kristopher T.;Jahromi, Babak S.
目的：开颅术会造成术后静脉血栓栓塞（VTE）的风险，但抗凝治疗在该患者人群中的效用尚不清楚。我们试图确定风险因素预测静脉血栓栓塞在患者接受craniotomy.METHODS：美国外科医师学会国家外科质量改进项目（ACS-NSQIP）数据库进行审查，接受开颅手术的患者。分析数据库提供的临床因素与VTE的相关性。结果：从2011-2012年共确定了10，477例接受开颅手术的成人患者。VTE发生率为3.2%（肺栓塞[PE]为1.3%;深静脉血栓形成[DVT]为2.4%）。一些因素在单变量分析中是显著的，并且一个子集在多变量分析后仍然存在。根据这些变量的存在，为患者分配了一个风险评分。较高的风险评分预测VTE风险，以及从手术到出院的时间和死亡率的增加。受试者工作特征曲线显示，评分的曲线下面积（0.719）显著预测VTE风险。该模型对我们类似的分析2006-2010年NSQIP数据进行了验证，并表现出可比findings.CONCLUSIONS：开颅术后静脉血栓栓塞的风险可以量化一个简单的风险评分，增加风险因素赋予静脉血栓栓塞的风险增加。根据风险评分，可以确定开颅术后可从抗凝治疗中获益的患者子集。
OBJECTIVES: Craniotomy poses a risk for postoperative venous thromboembolism (VTE), but the utility of anticoagulation in this patient population is unclear. We sought to identify risk factors predictive of VTE in patients undergoing craniotomy.METHODS: The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database was reviewed for patients undergoing craniotomy. Clinical factors provided by the database were analyzed for association with VTE.RESULTS: A total of 10,477 adult patients who underwent craniotomy from 2011-2012 were identified. The rate of VTE was 3.2% (pulmonary embolism [PE] was 1.3%; deep vein thrombosis [DVT] was 2.4%). Several factors were significant in univariate analysis, and a subset persisted after multivariate analysis. Patients were assigned a risk score on the basis of the presence of those variables. Higher risk scores were predictive of VTE risk, as well as increasing time from surgery to discharge and mortality. A receiver operating characteristics curve revealed a significant area under the curve (0.719) for scores being predictive of VTE risk. The model was validated against our similar analysis of 2006-2010 NSQIP data and demonstrated comparable findings.CONCLUSIONS: The risk of postoperative VTE after craniotomy can be quantified by a simple risk score, with increasing risk factors conferring increased risk of VTE. On the basis of risk scoring, a subset of patients who would benefit from anticoagulation post craniotomy may be identified.