Trends in Perioperative Venous Thromboembolism Associated with Major Noncardiac Surgery.
Trends in Perioperative Venous Thromboembolism Associated with Major Noncardiac Surgery.
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DOI：
10.1055/s-0037-1605360
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发表时间：
2017-07
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影响因子：
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通讯作者：
Berger JS
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作者：
Smilowitz NR;Gupta N;Guo Y;Maldonado TS;Eikelboom JW;Goldhaber SZ;Bangalore S;Berger JS
静脉血栓栓塞症（VTE）是非心脏手术常见的血管并发症。 方法：我们使用美国大型入院数据库，评估了围手术期院内静脉血栓栓塞的发病率、管理和结局的国家趋势。 从国家住院患者样本中确定了2005年至2013年接受重大非心脏手术的年龄≥ 45岁的患者。院内围手术期VTE定义为下肢深静脉血栓形成（DVT）或肺栓塞（PE），并随时间评估其发生率。以人口统计学和合并症作为协变量，建立多变量回归模型，以估计调整后的比值比（aOR）。 结果在9，431，442例符合纳入标准的住院患者中进行了重大非心脏手术，99，776例患者（1，057/100，000）发生了围手术期VTE，对应于应用样本权重后的年发病率为53，000。 随着时间的推移，每10万例手术的围手术期VTE增加了135（95%置信区间[CI]：107-163），从2005年的925例降至2013年的1，060例（趋势p <0.001; aOR [2013 vs. 2005]：1.22，95% CI：1.19-1.26），由于非致死性VTE发生率增加（从2005年的840例[每10万例手术]到2013年的987例;趋势p <0.001）。围手术期VTE最常发生在接受胸外科手术（2.0%）和血管外科手术（1.8%）的患者中。VTE患者的死亡率高于无VTE患者（aOR：3.12，95%CI：3.05-3.20）。 结论在接受大型非心脏手术的≥45岁患者中，围手术期VTE发生率约为1%，随着时间的推移，非致死性VTE的发生率逐渐增加。
Background Venous thromboembolism (VTE) is a common vascular complication of noncardiac surgery. Methods We evaluated national trends in perioperative in-hospital VTE incidence, management, and outcomes using a large database of hospital admissions from the United States. Patients aged ≥ 45 years undergoing major noncardiac surgery from 2005 to 2013 were identified from the National Inpatient Sample. In-hospital perioperative VTE was defined as lower extremity deep vein thrombosis (DVT) or pulmonary embolism (PE), and the incidence was evaluated over time. Multivariable regression models with demographics and comorbidities as covariates were generated to estimate adjusted odds ratios (aOR). Results Major noncardiac surgery was performed in 9,431,442 hospitalizations that met inclusion criteria, and perioperative VTE occurred in 99,776 patients (1,057 per 100,000), corresponding to an annual incidence of ≈53,000 after applying sample weights. Over time, perioperative VTE per 100,000 surgeries increased by 135 (95% confidence interval [CI]: 107–163), from 925 in 2005 to 1,060 in 2013 ( p for trend <0.001; aOR [for 2013 vs. 2005]: 1.22, 95% CI: 1.19–1.26), due to increases in nonfatal VTE rates (from 840 [per 100,000 surgeries] in 2005 to 987 in 2013; p for trend <0.001). Perioperative VTE occurred most frequently in patients undergoing thoracic (2.0%) and vascular surgery (1.8%). Mortality was higher in patients with VTE than those without VTE (aOR: 3.12, 95% CI: 3.05–3.20). Conclusion Perioperative VTE occurs in approximately 1% of patients ≥45 years undergoing major noncardiac surgery, with increasing incidence of nonfatal VTE over time.