Identifying patients at high risk for venous thromboembolism requiring treatment after outpatient surgery.
Identifying patients at high risk for venous thromboembolism requiring treatment after outpatient surgery.
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DOI：
10.1097/sla.0b013e3182519ccf
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发表时间：
2012-06
影响因子：
9
通讯作者：
Kheterpal S
中科院分区：
文献类型：
--
作者：
Pannucci CJ;Shanks A;Moote MJ;Bahl V;Cederna PS;Naughton NN;Wakefield TW;Henke PK;Campbell DA;Kheterpal S
确定门诊手术后需要治疗的30天VTE事件的独立预测因素。越来越多的外科手术在门诊进行。门诊手术后需要治疗的静脉血栓栓塞（VTE）的发生率尚不清楚。使用2005-2009年美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库进行的前瞻性观察性队列研究。纳入了接受门诊手术或手术后23小时观察的成人患者。主要结局指标为30天需要治疗的VTE。患者被随机分配到推导（N= 173，501）或验证（N= 85，730）队列。Logistic回归分析了30天VTE的独立危险因素。创建加权风险指数并应用于验证队列。分层分析按风险水平检查了30天VTE。30-整个队列的VTE日发病率为0.15%。独立风险因素包括当前妊娠（调整的比值比（OR）7.80，p=0.044），活动性癌症（OR 3.66，p=0.005），年龄41-59岁（OR 1.72，p=0.008），年龄≥60岁（OR 2.48，p<0.001），体重指数≥40（OR 1.81，p=0.015），手术时间≥120分钟（OR 1.69，p=0.027），关节镜手术（OR 5.16，p<0.001）、隐股交界处手术（OR 13.20，p<0.001）和不涉及大隐静脉的静脉手术（OR 15.61，p<0.001）。加权风险指数确定了低风险（0.06%）和最高风险（1.18%）患者之间30天VTE的20倍变化。30-可以使用加权风险指数量化门诊手术后的日间VTE风险。风险指数确定了30天VTE发生率为1.18%的高风险患者亚组。
To identify independent predictors of 30-day VTE events requiring treatment after outpatient surgery. An increasing proportion of surgical procedures are performed in the outpatient setting. The incidence of venous thromboembolism (VTE) requiring treatment after outpatient surgery is unknown. Prospective observational cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005–2009. Adult patients who had outpatient surgery or surgery with subsequent 23-hour observation were included. The main outcome measure was 30-day VTE requiring treatment. Patients were randomly assigned to derivation (N=173,501) or validation (N=85,730) cohorts. Logistic regression examined independent risk factors for 30-day VTE. A weighted risk index was created and applied to the validation cohort. Stratified analyses examined 30-day VTE by risk level. 30-day incidence of VTE for the overall cohort was 0.15%. Independent risk factors included current pregnancy (adjusted odds ratio (OR) 7.80, p=0.044), active cancer (OR 3.66, p=0.005), age 41–59 (OR 1.72, p=0.008), age ≥60 (OR 2.48, p<0.001), body mass index ≥40 (OR 1.81, p=0.015), operative time ≥120 minutes (OR 1.69, p=0.027), arthroscopic surgery (OR 5.16, p<0.001), sapheno-femoral junction surgery (OR 13.20, p<0.001), and venous surgery not involving the great saphenous vein (OR 15.61, p<0.001). The weighted risk index identified a 20-fold variation in 30-day VTE between low (0.06%) and highest risk (1.18%) patients. 30-day VTE risk after outpatient surgery can be quantified using a weighted risk index. The risk index identifies a high-risk subgroup of patients with 30-day VTE rates of 1.18%.