PDF(Pubmed)
Abstract：
Background Surgery is a major transient risk factor for venous thromboembolism (VTE). However, the impact of major surgery as a VTE trigger has been scarcely investigated using a case-crossover design. Aim To investigate the role of major surgery as a trigger for incident VTE in a population-based case-crossover study while adjusting for other concomitant VTE triggers. Methods We conducted a case-crossover study with 531 cancer-free VTE cases derived from the Tromsø Study cohort. Triggers were registered during the 90 days before a VTE event (hazard period) and in four preceding 90-day control periods. Conditional logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for VTE according to major surgery and after adjustment for other VTE triggers. Results Surgery was registered in 85 of the 531 (16.0%) hazard periods and in 38 of the 2,124 (1.8%) control periods, yielding an OR for VTE of 11.40 (95% CI: 7.42-17.51). The OR decreased to 4.10 (95% CI: 2.40-6.94) after adjustment for immobilization and infection and was further attenuated to 3.31 (95% CI: 1.83-5.96) when additionally adjusted for trauma, blood transfusion, and central venous catheter. In a mediation analysis, 51.4% (95% CI: 35.5-79.7%) of the effect of surgery on VTE risk could be mediated through immobilization and infection. Conclusions Major surgery was a trigger for VTE, but the association between surgery and VTE risk was in part explained by other VTE triggers often coexisting with surgery, particularly immobilization and infection.
摘要：
背景手术是静脉血栓栓塞（VTE）的主要短暂性危险因素。然而,几乎没有使用病例交叉设计研究大手术作为VTE触发因素的影响.目的研究在一项基于人群的病例交叉研究中，在调整其他伴随的VTE触发因素的同时，大手术作为VTE事件触发因素的作用。方法我们进行了一项病例交叉研究，其中531例无癌VTE病例来自Tromsø研究队列。在VTE事件发生前90天（危险期）和前四个90天的控制期内记录了触发因素。根据大手术和调整其他VTE触发因素后，使用条件逻辑回归以95％置信区间（CI）估算VTE的比值比（OR）。结果在531个危险期中的85个（16.0％）和2,124个（1.8％）对照期中的38个中进行了手术登记，VTE的OR为11.40（95%CI：7.42-17.51）。校正固定和感染后，OR降至4.10（95％CI：2.40-6.94），另外校正创伤后，OR进一步减弱至3.31（95％CI：1.83-5.96），输血,和中心静脉导管.在调解分析中，51.4％（95％CI：35.5-79.7％）的手术对VTE风险的影响可能是通过固定和感染介导的。结论大手术是VTE的触发因素,但手术和VTE风险之间的关联部分解释为其他VTE触发因素通常与手术共存，特别是固定和感染。
