%0 Journal Article
%T COMPARATIVE STUDY ON THE IMPACT OF SURGICAL RISK FACTORS IN PATIENTS WITH VENOUS THROMBOEMBOLISM. ANALYSIS OF THE MORTALITY RISK
%A Iulia-Cristina Roca
%A 1
%A Viviana Aursulesei
%A M. Roca
%A Diana Cimpoe£¿u
%J Jurnalul de Chirurgie
%D 2012
%I University of Medicine and Pharmacy, Iasi
%X Background: Accurate and immediate diagnosis of venous thromboembolism (VTE) still remains a difficult challenge for clinicians. Because of the increasing awareness of postoperative VTE, selection of patients who require adequate prophylaxis is of primary importance. Without prophylaxis, the incidence of hospital-acquired deep vein thrombosis (DVT) is approximately 10-40% among surgical patients and 40-60% following major orthopedic surgery. Pulmonary embolism (APE) is a life threatening disease and one of the main causes of in-hospital mortality. Aim:The purpose of this study was to determine the relationship between surgical risk factors and VTE and in-hospital mortality in patients with APE. Methods: We conducted a prospective, cohort study, between January 2004 and December 2010. The patients with VTE, admitted in the Ist Medical Cardiology Clinic, in ¡°St Spiridon¡± University Hospital, Iasi were included. The risk factors analised were: postoperative risk factor in orthopedic surgery, major surgery and gynecologic surgery and additional risk factors: obesity, central venous line, imobilization and neoplasia. To evaluate which risk factors were independent predictors of mortality in VTE, potential confounding variables were chosen using univariate analysis (p < 0.10), and final odds ratio (OR) and 95% confidence interval (CI) were calculated using multiple logistic regression analysis. Results: The cohort consisted of 890 subjects with VTE: 362 with EP and 528 with DVT. The mortality was 21.54% (78 subjects died). From surgical risk factors, orthopedic surgery was most common (5.8% in PE and 6.4% in DVT), followed by general surgery (2.3% in EP and 3.4%DVT) and gynecologic surgery (0.82% in EP patients, 1.13% in DVT). Multivariate analysis showed that an obesity (OR=4.21, CI=2.08-8.53, p=0.0001), imobilisation (OR=3.34, CI=1.18-9.45, p=0,023) and time between admission and death (OR=0.77, CI=0.72-0.83, p<0,0001) were the only significant predictors of mortality VTE. Conclusions: Mortality in patients with VTE and surgical risk factors is high and preoperative screening is important to identify patients at risk of developing clinically significant thromboembolic events.
%K VENOUS THROMBOEMBOLISM
%K PULMONARY EMBOLISM
%K SURGICAL RISK FACTORS
%K MORTALITY
%U http://www.jurnaluldechirurgie.ro/jurnal/docs/jurnal112/art%204%202012%20nr%201.pdf