减肥外科手术前期化疗预防和术后出血之间的关联
Joseph E Sanchez1,2, Audra Reiter1,2, Catherine S Valukas1,2
1Northwestern Quality Improvement, Research, & Education in Surgery, Northwestern University Feinberg School of Medicine, 675 N. St. Clair St. Suite 21-100, Chicago, IL, 60611, USA.
Surgical endoscopy
|September 28, 2024
概括
在减肥手术后的手术前静脉血栓塞栓症 (VTE) 预防增加了出血风险,但没有减少VTE事件. 对所有患者来说,选择性使用VTE化学预防可能比常规管理更合适.
科学领域:
- 腹部外科 腹部外科
- 血管外科 血管外科
- 药理学 药理学是指药理学的学科.
背景情况:
- 静脉血栓塞栓症 (VTE) 预防在减肥手术后是标准的,但最佳策略仍然不清楚.
- 实践在四家医院之间有所不同,这促使对VTE预防方案进行分析.
- 这项研究旨在评估不同预防策略对出血和静脉瘤发作率的影响.
研究的目的:
- 评估不同静脉瘤预防策略与术后出血和静脉瘤发生之间的关联.
- 为了确定是否常规的手术前静脉瘤化学预防与增加的出血或减少静脉瘤事件有关.
- 为减肥手术患者提供最佳VTE预防方案.
主要方法:
- 分析了在2018-2021年期间接受袖子胃切除术 (SG) 或Roux-en-Y胃绕道 (RYGB) 的成年患者.
- 患者根据手术前的化疗预防的使用进行了分层.
- 结果包括手术后出血 (输血或重新手术) 和静脉瘤发作事件,使用双变量和多变量逻辑回归分析.
主要成果:
- 总共包括了2145次腹手术,93.1%的患者在三个医院接受了手术前的静脉瘤预防,而在一个医院的患者只有0.1%.
- 在接受手术前预防的患者中,术后出血显著增加 (3.7%对1.1%,p<0.01).
- 手术前预防 (OR 3.54) 和RYGB独立地与出血增加有关;VTE发病率在两组之间没有显著差异 (0.6%对0.2%,p=0.26).
结论:
- 在减肥手术中进行手术前的VTE预防与术后出血增加有关,但没有相应减少VTE事件.
- 这些发现挑战了所有腹部外科手术患者的VTE化疗预防的常规使用.
- 选择性的VTE预防方法,而不是普遍的方法,可能更合适.
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