Thromboembolism after trauma: an analysis of 1602 episodes from the American College of Surgeons National Trauma Data Bank

OBJECTIVE: Venous thromboembolic events (VTE) are potentially preventable causes of morbidity and mortality after injury. We hypothesized that the current clinical incidence of VTE is relatively low and that VTE risk factors could be identified. METHODS: We queried the ACS National Trauma Data Bank for episodes of deep venous thrombosis (DVT) and/or pulmonary embolism (PE). We examined demographic data, VTE risk factors, outcomes, and VTE prophylaxis measures in patients admitted to the 131 contributing trauma centers. RESULTS: From a total of 450,375 patients, 1602 (0.36%) had a VTE (998 DVT, 522 PE, 82 both), for an incidence of 0.36%. Ninety percent of patients with VTE had 1 of the 9 risk factors commonly associated with VTE. Six risk factors found to be independently significant in multivariate logistic regression for VTE were age > or = 40 years (odds ratio [OR] 2.01; 95% confidence interval [CI] 1.74 to 2.32), lower extremity fracture with AIS > or = 3 (OR 1.92; 95% CI 1.64 to 2.26), head injury with AIS > or = 3 (OR 1.24; 95% CI 1.05 to 1.46), ventilator days >3 (OR 8.08; 95% CI 6.86 to 9.52), venous injury (OR 3.56; 95% CI 2.22 to 5.72), and a major operative procedure (OR 1.53; 95% CI 1.30 to 1.80). Vena cava filters were placed in 3,883 patients, 86% as PE prophylaxis, including in 410 patients without an identifiable risk factor for VTE. CONCLUSIONS: Patients who need VTE prophylaxis after trauma can be identified based on risk factors. The use of prophylactic vena cava filters should be re-examined.     

Venous thromboembolism after laparoscopic biliopancreatic diversion with duodenal switch: Analysis of 362 patients

BackgroundVenous thromboembolism (VTE), which manifests as deep venous thrombosis (DVT) or pulmonary embolism (PE), is relatively uncommon after weight loss procedures but has the strong potential to affect patient morbidity and mortality. This type of complication has been studied extensively in more common weight loss procedures, such as Roux-en-Y gastric bypass (RYGB). VTE has not been studied after biliopancreatic diversion with duodenal switch (BPD-DS), a bariatric procedure performed mainly for super morbidly obese patients, who are inherently associated with a higher incidence of co-morbidity. The objective of this study was to review VTE prevalence and identify risk factors associated with the postoperative occurrence of VTE in a collected data set of patients after laparoscopic BPD-DS.MethodsThe database of all patients who underwent laparoscopic BPD-DS between 2006 and 2012 was reviewed. Preoperative clinical information, which included history of VTE, inferior vena cava (IVC) filter placement, operative variables, and postoperative course, were reviewed. All VTE related events that occurred within 90 days postoperatively were collected and analyzed.ResultsOf 362 patients who underwent laparoscopic BPD-DS during the study period, 12 (3.3%) experienced a VTE complication. Eight (2.2%) patients presented with DVT; 4 (1.1%) patients presented with PE. VTE complications were more common in females than males (83.3% versus 16.6%, respectively). Age, body mass index (BMI), and time interval between preoperative and postoperative doses of heparin for DVT prophylaxis did not influence the occurrence of VTE complications. However, operative time (P = .02) and length of hospital stay (P = .0005) were identified as risk factors associated with postoperative VTE complications. No related mortality occurred in this study.ConclusionThe prevalence of VTE after BPD-DS is relatively low and comparable to other weight loss procedures. Overall risk of postoperative VTE after laparoscopic BPD-DS appears to be associated with the length of operation and hospital stay.     

Predictors of Venous Thromboembolism after Colorectal Surgery in a Single Unit

Background: Patients undergoing colorectal surgery are at risk of developing venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). Knowing predictors of VTE could help preventing this life-threatening complication.

Methods: We collected data of patients undergoing colorectal surgery at our Unit between 2009 and 2014. Baseline characteristics, type of surgery, and postoperative complications were gathered. A univariate regression analysis was performed with symptomatic VTE as outcome. Pre-, intra-and postoperative clinical factors were separately tested. All variables significantly associated with VTE occurring within three months from the discharge were entered in the final multivariate regression model.

Results: A total of 476 patients were included. Symptomatic VTE occurred in 13 patients (2.7%). Six (46.1%) occurred after hospital discharge. Preoperative variables associated with VTE were: advanced age at surgery (OR 2.3, 95%CI 1.8–5.6), smoking (OR 1.7, 95%CI 1.2–2.5), inflammatory bowel diseases (OR 2.1, 95%CI 1.5–4.3), advanced pelvic malignancies (OR 2.4, 95%CI 2.0-4.2), and obesity (OR 1.5, 95%CI 1.1-2.1). Prolonged pelvic manipulation (OR 1.8, 95%CI 1.1-4.3) and steep Trendelenburg position (OR 2.4, 95%CI 1.9-5.0) were intraoperative predictors of VTE, while stockings significantly reduced the risk (OR 0.8, 95%CI 0.4-0.9). Late mobilization (OR 2.5, 95%CI 2.0-4.6) and septic complications (OR 1.4, 95%CI 1.2-3.7) were postoperative predictors of VTE, whereas anticoagulants administered for at least 3 weeks after discharge were associated with lower VTE risk (OR 0.5, 95%CI 0.2-0.8).

Conclusions: We observed several modifiable predictors of VTE. Patients with > 2 risk factors undergoing colorectal surgery could benefit from a more intensive VTE preventive pathway.     

Venous thromboembolism after laparoscopic cholecystectomy: clinical burden and prevention

Background

The clinical benefit of prophylaxis for venous thromboembolism (VTE) in laparoscopic cholecystectomy is unclear. This study aimed to assess the clinical burden of VTE and the efficacy and safety of antithrombotic prophylaxis during laparoscopic cholecystectomy.

Methods

Data sources and study selection studies were searched in MEDLINE and Embase using the terms “cholecystectomy and venous thrombosis” and “cholecystectomy and venous thromboembolism.” Studies were considered for a systematic review and a metaanalysis if they reported on the methods of antithrombotic prophylaxis and on the incidence of objectively confirmed VTE in patients who had undergone laparoscopic cholecystectomy. Overall, 15 studies of patients who had undergone laparoscopic cholecystectomy were included in the systematic review.

Results

The incidence of VTE was lower after laparoscopic cholecystectomy than after open cholecystectomy [odds ratio (OR), 0.47; 95 % confidence interval (CI), 0.40–0.56]. No statistically significant reduction in VTE was observed in patients receiving heparin prophylaxis after laparoscopic cholecystectomy (OR, 0.86; 95 % CI, 0.12–5.82).

Conclusions

The rate of VTE after laparoscopic cholecystectomy seems to be relatively low. The clinical benefit of heparin prophylaxis for patients undergoing laparoscopic cholecystectomy remains unclear.     

Venous thromboembolism after laparoscopic bariatric surgery for morbid obesity: clinical burden and prevention

BackgroundThe clinical benefit of prophylaxis for venous thromboembolism (VTE) in laparoscopic bariatric surgery is unclear. Our objective was to assess the clinical burden of VTE after laparoscopic bariatric surgery.MethodsWe performed a systematic review and meta-analysis. Studies were considered for the review if they reported on the methods used for antithrombotic prophylaxis and on the incidence of objectively confirmed VTE in patients who had undergone laparoscopic bariatric surgery.ResultsOverall, 19 studies were included in the analysis. The weighted mean incidence (WMI) of pulmonary embolism was .5% (12 events in 3991 patients, 12 studies; 95% confidence interval [CI] .2–.9%; I² 38%) with unfractionated heparin (5000 UI twice or 3 times daily) or low-molecular-weight heparin (30 mg twice daily or 40 mg once daily). The WMI of major bleeding as originally reported in 7 of these studies was 3.6% (2741 patients; 95% CI .9–7.95; I² 94%). The WMI of screened VTE in 3 high-quality studies with different regimens of heparin prophylaxis was 2.0% (8 events in 458 patients; 95% CI .9–3.5%; I² 0%). The WMI of symptomatic VTE was .6% (4 studies; 7 events in 1328 patients; 95% CI .3–1.1%; I² 0%) and that of major bleeding was 2.0% (95% CI 1.0–3.4%; I² 55%), with weight-adjusted doses of heparin prophylaxis.ConclusionThe rate of VTE after laparoscopic bariatric surgery seems to be relatively low with standard regimens for antithrombotic prophylaxis. The incidence of major bleeding seems to increase using weight-adjusted doses of heparin with no advantage in terms of VTE reduction.     

Risk-adjusted analysis of positive surgical margins following laparoscopic and retropubic radical prostatectomy

OBJECTIVES: To prospectively compare in a contemporary and contemporaneous series the positive surgical margin (PSM) rate between laparoscopic (LRP) and retropubic (RRP) radical prostatectomy at the same institution. METHODS: Between 1 January 2003 and 30 June 2005, 1177 consecutive men with clinically localized adenocarcinoma of the prostate underwent radical prostatectomy at the same institution: 485 laparoscopically and 692 through a retropubic approach. Partin table probability of organ-confined (OC) disease was used as an index of disease aggressiveness: The PSM rate between the two approaches was compared, with adjustment for the OC probability. RESULTS: Overall both surgical approaches had a comparable PSM rate of 11.3% after LRP and 11% after RRP. In a logistic regression analysis adjusting for OC probability, there was no statistically significant difference between LRP and RRP (odds ratio [OR]: 1.156; 95% confidence interval [%95 CI], 0.792, 1.686; p=0.5). There was a statistically significant decrease over time in the rate of PSM for LRP (OR: 0.71 per 100 patients treated; %95 CI, 0.57, 0.89; p=0.003), while that of RRP was unchanged (OR: 1.06 per 100 patients treated; %95 CI, 0.94, 1.21; p=0.3; p=0.002 for interaction between change over time and procedure). CONCLUSIONS: In our institution, laparoscopic and retropubic radical prostatectomy provide comparable PSM rates for patients with clinically localized prostate cancer. The PSM rate over the study period remained unchanged in the RRP experience, indicating a mature and well-established operative technique, while that of LRP underwent a significant decrease, demonstrating that the procedure and therefore the results continued to evolve during the study.     

Thromboembolic complications after total hip replacement

We conducted a retrospective analysis of 1,640 consecutive patients undergoing total hip replacement between 1990 and 1997 under general anesthesia and receiving three different prophylactic regimens. The thromboembolic prophylaxis consisted of low-dose unfractioned heparin (UFH), low-molecular-weight heparin (LMWH), or indobufen (INDO). Postoperatively, occurrence of symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE) was recorded during the first 30 days after surgery and at a routine follow-up visit. Symptomatic DVT was diagnosed in 16 patients (0.9%), while PE occurred in eight patients (0.5%). Patients receiving UFH showed a higher incidence of symptomatic DVT (3.6%) than those patients receiving either LMWH (1.3%) or INDO (0.3%), with an odds ratio for developing symptomatic DVT when receiving UFH versus other treatments of 6.05 (95% confidence intervals [CI95%]: 3.63-10.07) (P=0.001). On the other hand, the diagnosis of PE was more frequently seen in patients receiving cemented hip arthroplasty (2.4%) than in patients receiving uncemented hip arthroplasty (0.34%), with an odds ratio of 3.185 (CI95%: 2.01-5.02)(P=0.05).     

多模式预防措施对老年关节置换术后静脉血栓栓塞症发生及转归的影响

目的分析采用多模式血栓预防措施后,老年初次髋、膝关节置换术后静脉血栓栓塞症（VTE）的发生和转归情况。 方法回顾性收集2015年1月至2017年6月行初次单侧髋、膝关节置换的老年患者375例（年龄≥60岁）,所有患者均接受抗凝药物、足底小腿静脉气压泵、加强踝泵和早期下地等康复预防以及减少围手术期脱水等多模式血栓预防措施,术后采用彩色多普勒超声检查双侧下肢深静脉血栓（DVT）的发生情况,对有症状患者行肺动脉CT造影排查肺动脉栓塞（PE）。 结果共349名患者获完整随访,随访率92.5%。随访期间无症状性PE,DVT共38例,总发生率为10.9%,均为远端DVT。手术同侧DVT 38例,双侧3例。症状性DVT共27例（27/38,71.1%）,无症状性DVT 11例（11/38,29.0%）。单纯腓肠肌间静脉血栓29例,单条小腿静脉血栓3例,混合静脉血栓6例。接受不同手术方式的患者DVT发生率差别有统计学意义（χ²=0.000,P<0.001）,其中接受全膝关节置换手术患者DVT的发生率为16.3%,显著高于单髁关节置换手术组的4.7%。单纯腓肠肌间静脉血栓未予药物治疗,其他DVT口服利伐沙班抗凝治疗4 w。术后8 w,有26例（26/38,68.4%）血栓完全消融,12例（12/38,31.6%）血栓未完全消融,但所有DVT相关临床表现均消失,无残留血栓后遗症,且无血栓进展或新发PE。 结论采取多模式预防措施后,老年关节置换术后VTE发生率低,且均为远端DVT,经观察或短程抗凝治疗,症状消失并无后遗症。     

Equivalence of DOACS and LMWH for thromboprophylaxis after hip fracture surgery: Systematic review and meta-analysis

BackgroundPatients with hip fractures (HF) have an increased risk of venous thromboembolism (VTE). In elective orthopedic surgery direct oral anticoagulants (DOACs) have proven to be similarly or more effective compared to low molecular weight heparin (LMWH), but DOACs are not yet approved for thromboprophylaxis in trauma patients with HF. The aim of this study was to systematically review the literature comparing the effectiveness of DOACs and LMWH for thromboprophylaxis in trauma patients with surgically treated HF.Materials and MethodsWe searched PubMed, the Cochrane Library, Web of Science, and Embase. The primary outcome was the incidence of VTE (symptomatic and asymptomatic combined). Secondary outcomes were symptomatic VTE; a symptomatic VTE, symptomatic deep venous thrombosis (DVT); symptomatic pulmonary embolism (PE); major, clinically relevant non-major (CRNM), and minor bleeding. Meta-analysis was performed to compare the odds of VTE and secondary outcomes between DOACs and LMWH.ResultsThe search resulted in 738 titles. Five studies matched inclusion criteria. In total, 4748 hip fracture patients were analyzed (DOACs: 2276 patients, LMWH: 2472 patients). The pooled odds ratio for the risk of VTE for DOAC use was 0.52 (95% confidence interval 0.25–1.11, p = 0.09) compared to LMWH. No statistically significant differences between DOAC and LMWH were found for asymptomatic VTE, symptomatic DVT, PE, major or CRNM bleeding, and minor bleeding.ConclusionsMeta-analysis of the literature suggests that DOACs are associated with equivalent effectiveness and safety compared to LMWH.     

全膝关节置换术后静脉血栓栓塞症危险因素的Meta分析

目的通过Meta分析总结全膝关节置换术后静脉血栓栓塞症的危险因素,为临床识别和预防全膝关节置换术后静脉血栓栓塞症提供循证医学的根据。 方法检索PUBMED、EMBASE、Cochrane library、中国知网(CKNI)等数据库建库至2018年6月关于全膝关节置换术后发生静脉血栓栓塞症的临床研究。排除研究对象为非成人的文献及结局指标与静脉血栓不相关的文献。由2位研究者独立进行资料提取和质量评估,采用RevMan 5.3软件进行Meta分析。 结果最终共纳入23篇文献,累计病例775 294例,其中10 325例静脉血栓,平均发生率(18.29±0.23)%。Meta分析结果显示,年龄≥ 70岁[OR ＝0.92,95%CI(0.87,0.97),I² ＝33%,P ＝0.0030]、年龄≥ 80岁[OR ＝0.85,95%CI(0.76,0.96),I² ＝68%,P ＝0.0090]、术中止血带的使用[OR＝2.14,95%CI(1.36,3.38),I² ＝0%,P ＝0.0010]是全膝关节置换术后发生静脉血栓栓塞症的危险因素,差异有统计学意义(P < 0.05)。女性[OR ＝0.95,95%CI(0.85,1.05),I² ＝59%,P ＝0.32]、尼格罗人种[OR＝0.40, 95%CI(0.11,1.48),I²＝99%, P＝0.1700]、高血压[OR＝1.46,95%CI(0.87,2.45),I² ＝91%,P ＝0.1500]、糖尿病[OR ＝1.11,95%CI(0.90,1.37),I² ＝68%,P ＝0.3300]、类风湿性关节炎[OR ＝0.78,95%CI(0.38,1.56),I² ＝89%,P ＝0.4800]、翻修[OR ＝1.14,95%CI(0.18,7.25),I² ＝88%,P ＝0.8900]、下肢静脉曲张[OR ＝1.30,95%CI(0.83,2.04),I² ＝29%,P ＝0.2500]、肿瘤[OR ＝1.11,95%CI(0.32,3.92),I² ＝91%,P ＝0.8700]、心脏疾病[OR ＝1.19,95%CI(0.37,2.89),I² ＝98%,P ＝0.9600]、肝肾疾病[OR ＝1.19,95%CI(0.84,1.67),I² ＝0%,P ＝0.3200]不是全膝关节置换术后发生静脉血栓栓塞症的危险因素,差异无统计学意义(P > 0.05)。 结论年龄≥ 70岁、年龄≥ 80岁、术中止血带的使用是全膝关节置换术后发生静脉血栓栓塞症的高危险因素,临床医护人员应更加关注以上相关危险因素,以预防全膝关节置换术后静脉血栓栓塞症的发生。     

Heparin prophylaxis and the risk of venous thromboembolism after robotic-assisted laparoscopic prostatectomy

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? The incidence of deep venous thrombosis (DVT) in major urological surgery has decreased over time with the introduction of pharmacological prophylaxis, early mobilization, and the use of sequential mechanical compression devices. We examined the value of heparin prophylaxis in robotic assisted laparoscopic prostatectomy (RALP), where the risk of DVT is already low. The rate of thromboemolic events within 30 days was 0.6% in this series. Heparin did not influence estimated blood loss, haematrocrit change, or length of stay. The incidence of thromboembolism is low after RALP, which may obviate the use of heparin prophylaxis. However, its use appears to be safe and does not affect surgical outcomes.

OBJECTIVE

? The incidence of venous thromboembolism (VTE) after robotic‐assisted laparoscopic prostatectomy (RALP) in patients receiving perioperative heparin prophylaxis was compared with those who did not receive such prophylaxis.

MATERIALS AND METHODS

? Between July 2007 to February 2010, a total of 307 RALPs were performed at our institution by two surgeons. A total of 187 patients operated on by surgeon 1 received perioperative heparin prophylaxis, whereas 120 patients operated on by surgeon 2 did not receive any. ? All demographic, clinical and pathological data were prospectively recorded, whereas the incidence of venous thromboembolism within 30 days of the operation was retrospectively reviewed. Evaluation for potential VTE was based on clinical symptoms.

RESULTS

? Cohorts were comparable with respect to PSA, clinical stage, preoperative Gleason score, body mass index, smoking status, pathological stage, path Gleason score and margin status. A total of two thromboemoblic events occurred (0.6%) within 30 days of surgery (one in each arm of the study). ? Heparin prophylaxis did not influence estimated blood loss (P= 0.076) or haematocrit change from preoperative levels (P= 0.378). Length of stay was comparable between the two groups (1.4 vs 1.3 days; P= 0.159).

CONCLUSION

? The incidence of thromboembolism is low after RALP, which may obviate the need for heparin prophylaxis. However, its use is safe and does not impact surgical outcomes. Larger series are needed to confirm the results obtained in the present study.     

Extended thromboprophylaxis reduces incidence of postoperative venous thromboembolism in laparoscopic bariatric surgery

BackgroundVenous thromboembolism (VTE) after laparoscopic bariatric surgery is a significant cause of morbidity and mortality. The objective of the present study was to study the incidence of symptomatic VTE in extended thromboprophylaxis regimens using dalteparin at an independent hospital in England, United Kingdom.MethodsA prospective database of all patients undergoing bariatric surgery was retrospectively analyzed. All patients underwent VTE prophylaxis regimen using perioperative and extended postoperative low-molecular-weight heparin (dalteparin 2500 IU preoperatively, followed by 5000 IU daily postoperatively). The treatment period was 1 week for laparoscopic gastric banding or 3 weeks for all other procedures. Inferior vena cava filters were used in selected patients with thrombophilia, a history of pulmonary embolism, or >1 episode of deep vein thrombosis. The endpoint was the incidence of symptomatic VTE.ResultsA total of 735 patients underwent laparoscopic bariatric surgery, all of whom received dalteparin. The postoperative VTE incidence was 0%. The 30-day and 90-day all-cause mortality rate was 0%. A total of 3 adverse bleeding events occurred.ConclusionAn extended VTE prophylaxis regimen using low-molecular-weight heparin is simple and effective and was associated with a low incidence of bleeding complications.     

A Prospective Cohort Study of Symptomatic Venous Thromboembolic Events in Foot and Ankle Trauma: The Need for Stratification in Thromboprophylaxis?

The incidence of venous thromboembolic (VTE) events (deep vein thrombophlebitis [DVT] or pulmonary embolism [PE]) in foot and ankle trauma has been low, and the risk/benefit ratio associated with chemoprophylaxis is controversial. We compared the 90-day incidence of VTE events in 3 cohorts: group 1, tendo-Achillis (TA) ruptures managed with full weightbearing in a walker boot; group 2, ankle fractures immobilized non-weightbearing in a below-the-knee cast; and group 3, ankle fractures managed surgically, followed by non-weightbearing in a below-the-knee cast. Data were extracted from 2 prospectively collected trust databases for acute TA ruptures and ankle fractures. VTE risk was assessed using a U.K. national assessment tool. Chemoprophylaxis was prescribed for high-risk patients. The 90-day incidence of symptomatic VTE events was drawn from a trust-wide radiology database. In group 1 (n?=?291), the incidence of VTE events was 4.8% (11 [3.8%] DVT, 3 [1.0%] PE) at a mean of 16.1?±?6.8 days. In group 2 (n?=?227), the incidence of VTE events was 2.2% (5 [2.2%] DVT) at a mean of 33.4?±?11.3 days. In group 3 (n?=?199), the incidence of VTE events was 3.0% (5 [2.5%] DVT, 1 [0.5%] PE) at a mean of 37.2?±?14.2 days. Patients with symptomatic VTE events presented significantly earlier after acute TA rupture compared with after ankle fracture (p?=?.002). We found the overall incidence of VTE events in foot and ankle trauma was low, with a relatively greater incidence of symptomatic VTE events, which occurred earlier, in acute TA ruptures compared with ankle fractures.     

An Approach to Venous Thromboembolism Prophylaxis in Laparoscopic Roux-en-Y Gastric Bypass Surgery

Background: Venous thromboembolism (VTE) prophylaxis regimens for laparoscopic Roux-en-Y gastric bypass (LRYGBP) have not been adequately addressed in the literature. This study presents the results of our prophylactic regimen in LRYGBP at a tertiary care hospital. Methods: A retrospective review of 255 morbidly obese patients undergoing LRYGBP between March 2000 and February 2003 was conducted. Patients received preoperative subcutaneous heparin (SQH) (5000u or 7500u) and every 8 hours thereafter during hospitalization. Sequential compression devices (SCD) were utilized during and after surgery unless ambulating. Early ambulation was enforced. Results: 255 patients underwent LRYGBP, with 5 (1.9%) converted to open.Average preoperative weight and body mass index (BMI) were 138 kg and 50, respectively. Operative time averaged 174 minutes. Average length of stay was 2.2 days. 9 patients (3.6%) had a prior history of deep venous thrombosis/pulmonary embolism (DVT/PE), one of whom had a DVT/PE postoperatively. 2 patients developed DVT/PE within 30 days. Overall DVT/PE incidence was 1.2%. There were 6 postoperative bleeding episodes (2.4%). Conclusion: This regimen provides excellent prophylaxis against VTE in the hospital setting.     

Does thromboprophylaxis reduce symptomatic venous thromboembolism in patients with below knee cast treatment for foot and ankle trauma? A systematic review and meta-analysis

Background

Our aim was to determine the evidence for thromboprophylaxis for prevention of symptomatic venous thromboembolism (VTE) in adults with foot or ankle trauma treated with below knee cast or splint. Our secondary aim was to report major bleeding events.

Pediatric orthopaedic lower extremity trauma and venous thromboembolism

Purpose

Research on venous thromboembolism events (VTE), such as deep venous thrombosis (DVT) and pulmonary embolism (PE), in pediatric orthopaedic trauma patients is sparse. We describe the incidence in the USA of VTE associated with pediatric lower extremity orthopaedic trauma, and characterize injury patterns and VTE treatment methods.

Methods

The Pediatric Health Information System (PHIS) was queried from 2004 to 2013 using ICD-9 codes for lower extremity fractures (pelvis, femur, tibia, ankle, foot) and dislocations (hip, knee, ankle, subtalar) and VTE. Records were queried for age, diagnoses, and VTE treatment.

Results

During the study period 285,611 clinical encounters reported lower extremity trauma. Of those, 167 patients were simultaneously coded with VTE (99 DVT, 50 PE, 18 combined DVT/PE), to give an incidence of VTE associated with pediatric lower extremity trauma of 0.058 %. Patients were from 39 centers, with an average age of 12.9 years (range 0–19). There were 249 fractures and 21 dislocations, with 25 (15 %) patients sustaining more than one lower extremity injury. The most common fracture locations were the femur/femoral neck (95), tibia/ankle (92), and pelvis (44). 72 % (121/167) of patients were treated with anticoagulation medication, of which the most common was low-molecular-weight heparin (111/167, 66 %).

Conclusions

The incidence of VTE events associated with lower extremity orthopaedic trauma is 0.058 %. Adolescents and polytrauma patients with injuries of the femur/femoral neck, tibia/ankle, and pelvis are more commonly affected. Low-molecular-weight heparin is commonly used to treat VTE in pediatric and adolescent patients.     

Incidence of venous thromboembolism after spine surgery

Background  

The incidence of venous thromboembolism (VTE) has varied among studies of patients undergoing elective spine surgery. This may be because of differences in prophylaxis for VTE and differences in methods of observation. Furthermore, some studies have reported symptomatic deep vein thrombosis (DVT) or pulmonary thromboembolism (PE), whereas others have included asymptomatic DVT or PE, making comparisons difficult. Therefore, the objective of this study was to determine the incidence of symptomatic and asymptomatic PE in patients undergoing elective spine surgery and to evaluate therapeutic methods for these conditions.     

腹部外科病人术后症状性静脉血栓栓塞症多中心临床流行病学研究

目的探讨腹部外科病人术后症状性静脉血栓栓塞症(VTE)的流行病学特点。方法回顾性分析上海交通大学医学院附属第九人民医院、滁州市第一人民医院、郑州大学第二附属医院、上海市奉贤区奉城医院4家医院自2015-01-01—2019-06-30期间就诊于普通外科,入院后行腹部外科手术的病人共计24336例相关临床资料,并观察术后14 d内发生VTE事件的情况。结果VTE事件发生率为0.89%(216/24336),其中,深静脉血栓形成(DVT)发生率0.75%(183/24336),肺动脉栓塞(PE)发生率0.35%(86/24336)。男性VTE事件发生率为0.85%(123/14443),女性为0.94%(93/9893),男女VTE事件发生率差异无统计学意义(χ^2=2.15,P>0.05)。DVT病人常见的症状是下肢肿胀177例(96.72%),疼痛104例(56.83%),浅静脉曲张36例(19.67%)。PE病人常见的症状是呼吸困难和气促77例(89.53%),胸痛55例(63.95%)。DVT易累及左下肢;混合型最多见,左、右下肢分别为61.11%(88/144)和52.11(37/71)。PE病人最常见低危组病人45例(52.32%)。常见的VTE危险因素包括:年龄≥40岁208例(96.30%),手术时间>45 min 139例(64.35%),恶性肿瘤病史99例(45.83%)。主要的腹部外科手术类型是消化道恶性肿瘤手术105例(48.61%),胆囊切除术73例(33.80%)。腹腔镜手术(1.61%,179/11123)较开放手术(0.28%,37/13213)VTE事件发生率低(χ^2=45.56,P<0.05)。VTE相关病人的病死率为0.10%(25/24336)。结论腹部外科病人术后VTE发生率已经明显降低,医生应当根据其流行病学特点,早期发现,早期诊断和早期预防干预,避免严重不良事件的发生。     

Venous thromboembolism during combat operations: a 10-y review

Background

This article examines the incidence of venous thromboembolism (VTE) in combat wounded, identifies risk factors for pulmonary embolism (PE), and compares the rate of PE in combat with previously reported civilian data.

Methods

A retrospective review was performed of all U.S. military combat casualties in Operation Enduring Freedom and Operation Iraqi Freedom with a VTE recorded in the Department of Defense Trauma Registry from September 2001 to July 2011. The Military Amputation Database of all U.S. military amputations during the same 10-y period was also reviewed. Demographic data, injury characteristics, and outcomes were evaluated.

Results

Among 26,634 subjects, 587 (2.2%) had a VTE. This number included 270 subjects (1.0%) with deep venous thrombosis (DVT), 223 (0.8%) with PE, and 94 (0.4%) with both DVT and PE. Lower extremity amputation was independently associated with PE (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.07–2.69). A total of 1003 subjects suffered a lower extremity amputation, with 174 (17%) having a VTE. Of these, 75 subjects (7.5%) were having DVT, 70 (7.0%) were having PE, and 29 (2.9%) were found to have both a DVT and a PE. Risk factors found to be independently associated with VTE in amputees were multiple amputations (OR, 2; 95% CI, 1.35–3.42) and above the knee amputation (OR, 2.11; 95% CI, 1.3–3.32).

Conclusions

Combat wounded are at a high risk for thromboembolic complications with the highest risk associated with multiple or above the knee amputations.     

急性下肢深静脉血栓形成患者并发肺栓塞的危险因素研究

目的 研究急性下肢深静脉血栓形成(deep vein thrombosis,DVT)患者并发肺栓塞(pul-monary embolism,PE)的危险因素.方法 回顾性分析新疆医科大学第一附属医院血管甲状腺外科2015年1月至2020年1月的312例急性下肢DVT患者资料,应用Logistic回归分析合并PE的危险因...