Incidence and risk factors for venous thromboembolism following surgical treatment of fractures below the hip: a meta‐analysis

Abstract

Venous thromboembolism (VTE) is a common complication after surgical treatment of fractures, which is associated with significant morbidity and mortality. Identifying the risk factors for VTE is important for preventive strategies to reduce the incidence of VTE. Therefore, we conducted a meta-analysis to evaluate the incidence of VTE and the risk factors influencing the development of VTE in patients who underwent surgery for fractures below the hip. PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, China) and CNKI (National Knowledge Infrastructure, China) databases were systematically searched to identify cohort or case-control studies that investigated the incidence and risk factors for VTE following surgical treatment of fractures below the hip. VTE risk ratios (RRs) were pooled by use of a fixed-effect model or a random-effect model, depending on the heterogeneity among the included studies. Heterogeneity between the studies was assessed by I statistics. Twenty-three studies with a total of 191 294 patients who met the inclusion criteria were included in this meta-analysis. Our results demonstrated that age (≥60 years) (RR = 1·85, 95% confidence interval (CI): 1·34, 2·55; P = 0·000), previous VTE(RR = 5·25, 95% CI: 2·77, 9·96; P = 0·000), heart failure (RR = 1·74, 95% CI: 1·34, 2·27; P = 0·000), current smoking status (RR = 1·23, 95% CI: 1·07, 1·41; P = 0·004), hypertension (RR = 1·62, 95% CI: 1·27, 2·06; P = 0·000), hyperlipidaemia (RR = 2·16, 95% CI: 1·79, 2·62; P = 0·000), diabetes mellitus (RR = 1·46, 95% CI: 1·27, 1·68; P = 0·000), obesity (RR = 1·58, 95% CI: 1·35,·1·85; P = 0·000), multiple fractures (RR = 2·14, 95% CI: 1·00, 4·60; P = 0·050), varicose veins (RR = 3·07, 95% CI: 1·12, 8·47; P = 0·030), prolonged operation time (weighted mean differences (WMD) = 1·22, 95% CI: 0·63, 1·81; P = 0·000) and prolonged bed rest time (WMD = 3·12, 95% CI: 2·96, 3·29; P = 0·000) were associated with an increased risk of developing VTE. The other variables, including age (<60 years), previous smoking, immobility, pregnancy, cancer, open fractures and combination with trauma were not identified as significant risk factors for VTE. Almost all the risk factors mentioned above are in line with the known risk factors for VTE following surgery for fractures below the hip. Thus, surgeons should pay close attention to patients with these medical conditions in order to reduce the incidence of VTE following surgical treatment of fractures below the hip.

Does diabetes type increase the odds of venous thromboembolism following traumatic injury?

“…However, an association between diabetes and VTE was found in a meta-analysis that examined the incidence and risk factors for VTE among patients who had surgical treatment of fractures below the hip (RR=1.46, 95% CI 1.27 to 1.68; p=0.000). 11 And, Paffrath et al 22 found an independent association of concomitant diseases, which included diabetes, renal failure, malignancies, and coagulation disorders, with the development of VTE (OR=1.98, 95% CI 1.39 to 2.83, p<0.005).…”

“… 20 Within the trauma literature, studies examining VTE risk after trauma appear to account for age, sex, injury characteristics, and treatment, 1 3 6 8 but less often consider concomitant pre-existing conditions, 7 22 or specifically diabetes. 10 11 …”

“… 1 2 Increased age, obesity, smoking, pregnancy, history of VTE, blood transfusion, surgery, hospitalization over 48 hours, mechanical ventilation, and the following injury-specific characteristics are recognized VTE risk factors for trauma patients: pelvic/lower extremity trauma, head trauma, venous injury, femur or tibia fracture, and spinal cord injury. 1 3–9 Diabetes mellitus (diabetes), an increasingly common comorbidity, has rarely been studied as a potential independent risk factor for VTE development in trauma populations and these studies did not differentiate the diabetes type, 10 11 despite the condition's physiological disposition to thrombophilia. 12 13 …”

High risk of venous thromboembolism after orthopedic surgery in patients with thrombophilia

“…In addition to pharmacological thromboprophylaxis, improvements of surgical techniques, reduced operation time, immediate postoperative mobilization, and shorter hospital stay have contributed to a strongly reduced incidence of postoperative VTE in these patients. In recent studies, the estimated postoperative incidence of VTE for a wide range of orthopedic interventions is approximately 1% to 2% 4‐9 . This amounts to high numbers considering the high frequency of these procedures, and it is currently unclear how this incidence could be lowered.…”

Assessing the Rate of Antipsychotic Use in Ambulatory Care Patients With a Venous Thromboembolism

“…10-12 Most publications assessing HLD find that lipid-lowering therapy decreases the risk of VTE, but there is variability relating HLD directly to VTE risk. 13-15…”