Graduated compression stockings in the prevention of postoperative pulmonary embolism. A propensity-matched retrospective case-control study of 24 273 patients
| Autor: | Elisa M Müller, Alexander Buia, Knut Kröger, T. C. Schmandra, Ernst Hanisch, Eva Herrmann, Kenan Suna |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
business.industry Incidence (epidemiology) Pulmonary embolism Case-control study General Medicine Perioperative medicine.disease 03 medical and health sciences Venous thrombosis 0302 clinical medicine Deep vein thrombosis 030220 oncology & carcinogenesis Relative risk Internal medicine Propensity score matching Clinical endpoint Medicine 030211 gastroenterology & hepatology Surgery Compression stocking business Original Research Venous thromboembolism |
| Zdroj: | Annals of Medicine and Surgery |
| ISSN: | 2049-0801 |
| Popis: | Introduction Recommendations for venous thromboembolism and deep venous thrombosis (DVT) prophylaxis using graduated compression stockings (GCS) is historically based and has been critically examined in current publications. Existing guidelines are inconclusive as to recommend the general use of GCS. Patients/Methods: 24 273 in-patients (general surgery and orthopedic patients) undergoing surgery between 2006 and 2016 were included in a retrospectively analysis from a single center. From January 2006 to January 2011 perioperative GCS was employed additionally to drug prophylaxis and from February 2011 to March 2016 patients received drug prophylaxis alone. According to german guidelines all patients received venous thromboembolism prophylaxis with weight-adapted LMWH. Risk stratification (low risk, moderate risk, high risk) was based on the guideline of the American College of Chest Physicians. Data analysis was performed before and after propensity matching (PM). The defined primary endpoint was the incidence of symptomatic or fatal pulmonary embolism (PE). A secondary endpoint was the incidence of deep venous thromboembolism (DVT). Results After risk stratification (low risk n = 16 483; moderate risk n = 4464; high risk n = 3326) a total of 24 273 patient were analyzed. Before to PM the relative risk for the occurrence of a PE or DVT was not increased by abstaining from GCS. After PM two groups of 11 312 patients each, one with and one without GCS application, were formed. When comparing the two groups, the relative risk (RR) for the occurrence of a pulmonary embolism was: Low Risk 0.99 [CI95% 0.998–1.000]; Moderate Risk 0.999 [CI95% 0.95–1.003]; High Risk 0.996 [CI95% 0.992–1.000] (p > 0.05). The incidence of PE in the total group LMWH alone was 0.1% (n = 16). In the total group using LMWH + GCS, the incidence was 0.3% (n = 29). RR after PM was 0.999 [CI95% 0.998–1.00]. Conclusion In comparison to prior studies with only small numbers of patients our trial shows in a large group of patients with moderate and high risk developing VTE we can support the view that abstaining from GCS-use does not increase the incidence of symptomatic or fatal PE and symptomatic DVT. Highlights • The abstain of GCS did not result in higher incidence of pulmonary embolism. • Concerning PE abstain of GCS shows no increase of relative risk in the group not using GCS vs. the group using GCS additionally to LMWH-prophylaxis. • This effect is shown in the overall and the high risk population validating the results of prospectively randomized trials in a real world scenario. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|