| Objective To investigate incidence and fatality in perioperative patients with VTE for pharmacological prophylaxis in orthopedics surgery and analyze characteristics and risk factors of VTE,in order to provide reasonable suggestions on screening and prophylaxis for perioperative patients with the risk of VTE.Methods 33914 patient data in orthopedics surgery was collected from General Hospital of Ningxia Medical University during January 1,2011 to December 31,2018(8years).Patients who had been in the use of anticoagulant drugs,confirmed for venous thromboembolism preoperatively,underwent two or more operations within 1 month,complicated with coronary heart disease,chronic obstructive pulmonary disease,active tuberculosis,nephrotic syndrome or inflammatory bowel disease were excluded.Eventually27500 patients were enrolled in this study,of 367 patients diagnosed with VTE as the case group,the other the control group.The incidence and mortality of perioperative VTE as well as risk factors were further analyzed by SPSS software.Results The proportion of perioperative anticoagulation in the department of orthopedic from January 1,2011 to December 31,2018 was 26.38%,30.15%,28.13%,37.12%,38.39%,42.81%,44.68%,and 50.73%,respectively.99.73% of patients were treated with LMWH for major anticoagulation.A total of 367 cases from 2011 to 2018 were found with the diagnosis of VTE.The number of patients with perioperative VTE is 62,51,33,54,49,40,50 and 28 respectively,as years by the corresponding VTE incidence was 2.08%,1.86%,1.04%,1.70%,1.24%,1.15%,1.12% and 0.78%.Compared 2015-2018(the last four years)with 2011-2014(the first four years),there were significantly increased(30.52% vs 44.05%,P < 0.0001)in prophylaxis anticoagulation.The incidence of VTE(1.66% vs 1.08%,P < 0.0001),DVT(1.51% vs 1.06%,P=0.001),and PE(0.24% vs 0.10%,P < 0.0001)was decreased relevant to the pro four years.There was no significant difference in the proportion of perioperative deaths between the two groups(0.07% vs 0.03%,P=0.265),while the number of PE-related deaths in the last four years decreased regarding the previous ones(87.50% vs 20.00%,P=0.032).Among the 367 patients diagnosed with VTE,of 345 with DVT,of 42 with PTE,and 20 with DVT complicated PTE.The average onset time of perioperative VTE was 2.82±2.09 days,in which 37.6% of the patients occurred 24 hours and 61% occurred 48 hours after the operation.Analyze the case and control group,it was found that gender,age ? 65,anesthesia selection,the application of anticoagulant drugs,timing of anticoagulant and complicated with malignant tumor or infection was statistically difference between the two groups(P <0.05);After binary Logistic regression,it was demonstrated that female(OR 1.92,95%CI1.54-2.39),age?65 years old(OR 3.52,95%CI 2.82-4.38),with malignant tumor(OR 5.628,2.93-10.80)and infection(OR 3.63,95%CI 2.09-6.32)were independent risk factors for the occurrence of VTE in the perioperative orthopedics.The duration of anticoagulants after surgery(OR 0.45,95%CI 0.34-0.59)was a protective factor for the occurrence of perioperative VTE.Conclusion The proportion of pharmacological prophylaxis in the perioperative orthopedics was increased gradually,while the incidence of VTE and the fatality related to PE decreased,which indicates that the pharmacological prophylaxis is a very important way to prevent VTE.Female,age ?65 years and complicated with malignant tumor or infection isan independent risk factor for the occurrence of VTE during the perioperative period.The incidence and mortality of VTE can be reduced by the pharmacological prophylaxis during the perioperative period in orthopedics surgery. |
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