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首页> 外文期刊>Journal of orthopaedic trauma >The Incidence of Venous Thromboembolism Following Pelvic and Lower Extremity Trauma Despite Adherence to Modern Prophylactic Protocols
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The Incidence of Venous Thromboembolism Following Pelvic and Lower Extremity Trauma Despite Adherence to Modern Prophylactic Protocols

机译：骨盆和下肢创伤后静脉血栓栓塞的发病率尽管依赖于现代预防型方案

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Objectives: Describe the incidence of venous thromboembolism (VTE) in patients with pelvic and lower extremity long bone trauma in the setting of modern prophylaxis. Design: Retrospective health-system database study. Setting: Multi-center health care system. Patients: Database query from 2010 to 2017 identified 11,313 adult trauma patients who received open reduction internal fixation of pelvic, acetabular, femoral neck, or intertrochanteric fractures, or received intramedullary nailing (IMN) of the femoral or tibial shaft. Patients with incomplete prophylaxis, prior history of VTE, coagulopathy, or concomitant lower extremity fracture were excluded. Intervention: Mechanical and chemical VTE prophylaxis following pelvic or lower extremity fracture fixation. Main Outcome Measurements: VTE rates. Results: The overall VTE rate was 0.82% [0.39% deep venous thromboses (DVT); 0.43% pulmonary emboli (PE)]. By procedure, pelvic open reduction and internal fixation (ORIF) and femoral IMN had the highest VTE rates 1.70% (0.98% DVT; 0.78% PE) and 1.33% (0.75% DVT; 0.58% PE), whereas tibial IMN had the lowest incidence of VTE 0.34% (0.17% DVT; 0.17% PE). Among hip fractures, femoral neck ORIF had a VTE rate of 0.98% (0.59% DVT; 0.39% PE), whereas intertrochanteric ORIF had lower rates of 0.59% (0.20% DVT; 0.39% PE). Conclusions: Despite adherence to modern VTEp protocols, nonpreventable VTE occur in 0.82% of pelvic and lower extremity orthopaedic trauma patients. Incidence ranged between 0.34% and 1.70% depending on injury/fixation method with the highest rate observed in pelvis ORIF followed by femoral IMN. In the era of pay for quality performance, it is important for health systems and auditing agencies to reconcile the difference between preventable and nonpreventable VTEs.
机译：目的：描述现代预防患者骨盆和下肢长骨创伤患者静脉血栓栓塞（VTE）的发病率。设计：回顾性健康系统数据库研究。设置：多中心保健系统。患者：2010年至2017年的数据库查询鉴定了11,313名接受骨盆，髋臼，股骨颈或股骨颈部骨折的开放式内固定，或接受股骨或胫骨轴的髓内钉（IMN）的腹腔内固定。患有不完全预防的患者，vTE，凝血病或伴随的下肢骨折的现有病史。干预：在骨盆或下肢断裂固定后机械和化学VTE预防。主要结果测量：VTE率。结果：总VTE率为0.82％[深静脉血栓（DVT）; 0.43％肺部栓塞（PE）]。通过程序，盆腔开放和内部固定（orif）和股骨IMN的最高率为1.70％（0.98％DVT; 0.78％PE）和1.33％（0.75％DVT; 0.58％PE），而胫骨IMN具有最低的VTE的发生率0.34％（0.17％DVT; 0.17％PE）。在髋部骨折中，股骨颈orif的VTE率为0.98％（0.59％DVT; 0.39％PE），而跨转化液钙率较低的0.59％（0.20％DVT; 0.39％PE）。结论：尽管遵守现代VTEP协议，但不可申请的VTE发生在0.82％的盆腔和下肢整形外科创伤患者中。根据骨盆orif中观察到的最高速率的损伤/固定方法，发病率在0.34％和1.70％之间的范围为0.34％和1.70％。在质量绩效的薪酬时代，卫生系统和审计机构重要的是调和可预防和不可辩护的VTE之间的差异。

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