دورية أكاديمية
Association of the Risk of a Venous Thromboembolic Event in Emergency vs Elective General Surgery.
| العنوان: | Association of the Risk of a Venous Thromboembolic Event in Emergency vs Elective General Surgery. |
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| المؤلفون: | Ross SW; Division of Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina., Kuhlenschmidt KM; Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas., Kubasiak JC; Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas., Mossler LE; Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas., Taveras LR; Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas., Shoultz TH; Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas., Phelan HA; Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas., Reinke CE; Division of Acute Care Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina., Cripps MW; Division of General and Acute Care Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas. |
| المصدر: | JAMA surgery [JAMA Surg] 2020 Jun 01; Vol. 155 (6), pp. 503-511. |
| نوع المنشور: | Comparative Study; Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Medical Association Country of Publication: United States NLM ID: 101589553 Publication Model: Print Cited Medium: Internet ISSN: 2168-6262 (Electronic) Linking ISSN: 21686254 NLM ISO Abbreviation: JAMA Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Chicago, IL : American Medical Association, [2013]- |
| مواضيع طبية MeSH: | Elective Surgical Procedures* , Emergency Treatment*, Postoperative Complications/*epidemiology , Venous Thromboembolism/*epidemiology, Adult ; Aged ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Assessment |
| مستخلص: | Importance: Trauma patients have an increased risk of venous thromboembolism (VTE), partly because of greater inflammation. However, it is unknown if this association is present in patients who undergo emergency general surgery (EGS). Objectives: To investigate whether emergency case status is independently associated with VTE compared with elective case status and to test the hypothesis that emergency cases would have a higher risk of VTE. Design, Setting, and Participants: This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program database from January 1, 2005, to December 31, 2016, for all cholecystectomies, ventral hernia repairs (VHRs), and partial colectomies (PCs) to obtain a sample of commonly encountered emergency procedures that have elective counterparts. Emergency surgeries were then compared with elective surgeries. The dates of analysis were January 1 to 31, 2019. Main Outcomes and Measures: The primary outcome was VTE at 30 days. A multivariable analysis controlling for age, sex, body mass index, bleeding disorder, disseminated cancer, laparoscopy approach, and surgery type was performed. Results: There were 604 537 adults undergoing surgical procedures over 12 years (mean [SD] age, 55.3 [16.6] years; 61.4% women), including 285 847 cholecystectomies, 158 500 VHRs, and 160 190 PCs. The rate of VTE within 30 days was 1.9% for EGS and 0.8% for elective surgery, a statistically significant difference. Overall, 4607 patients (0.8%) had deep vein thrombosis, and 2648 patients (0.4%) had pulmonary embolism. A total of 6624 VTEs (1.1%) occurred in the cohort. As expected, when VTE risk was examined by surgery type, the risk increased with invasiveness (0.5% for cholecystectomy, 0.8% for VHR, and 2.4% for PC; P < .001). On multivariable analysis, EGS was independently associated with VTE (odds ratio [OR], 1.70; 95% CI, 1.61-1.79). Also associated with VTE were open surgery (OR, 3.38; 95% CI, 3.15-3.63) and PC (OR, 1.86; 95% CI, 1.73-1.99). Conclusions and Relevance: In this cohort study, emergency surgery and increased invasiveness appeared to be independently associated with VTE compared with elective surgery. Further study on methods to improve VTE chemoprophylaxis is highly recommended for emergency and more extensive operations to reduce the risk of potentially lethal VTE. |
| التعليقات: | Comment in: JAMA Surg. 2020 Jun 1;155(6):511-512. (PMID: 32347913) Comment in: Anaesthesia. 2022 Jan;77(1):3-6. (PMID: 34738633) |
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| تواريخ الأحداث: | Date Created: 20200430 Date Completed: 20210222 Latest Revision: 20211209 |
| رمز التحديث: | 20231215 |
| مُعرف محوري في PubMed: | PMC7191471 |
| DOI: | 10.1001/jamasurg.2020.0433 |
| PMID: | 32347908 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2168-6262 |
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| DOI: | 10.1001/jamasurg.2020.0433 |