Perioperative air travel increases the risk of venous thromboembolism following lower limb arthroplasty

Abstract

Purpose Venous thromboembolism (VTE) is a significant complication following lower limb arthroplasty (LLA). There is a paucity of evidence with regard to air travel following LLA. Orthopaedic surgeons are often asked by patients regarding air travel following LLA, and there is a need for evidence to guide these patients. Methods This was a retrospective cohort study. We identified two cohorts, one travelling to and from the hospital by air and another, by land. All patients received routine preoperative and post-operative care, and thromboprophylaxis, as per our hospital guidelines. We collected baseline demographics, ASA score and incidence of VTE at 90 days using local patient records and a national joint registry. We also recorded data on flight time and overland distance of travel. Results Two hundred and forty-three patients travelled by air; mean flight time was 74 min. In total, 5498 patients travelled a mean 25.3 miles over land to the hospital. No differences in baseline demographics or ASA score were observed. Four patients developed a VTE in the flight group, with 32 patients suffering a VTE in the control group. There was a significant difference in the VTE rate between the flight and control groups ( p < 0.05); the relative risk of developing a VTE in the flight group was 2.85. Conclusions In our cohort, perioperative short haul air travel is associated with an increased risk of VTE at 90 days following LLA. Orthopaedic surgeons must ensure that their patients are cognizant of the risks associated with perioperative air travel and take measures to minimise these risks.

Risk of Venous Thromboembolism Among Individuals who Frequently Travel by Flight for Work

“…(Kuipers, Venemans-Jellema, et al, 2014) The report clarified that the risk of VTE increases with the duration of the flight journey particularly in the situation of long-haul flights (> 4 hrs) and with even short-duration multiple flights within a short period (Cannegieter et al, 2006). Further existence of certain other known risk factors like obesity, extremes of height, oral contraceptive usage (Mahmood et al, 2022;Ram et al, 2022Ram et al, , 2023 and prothrombotic blood disorders contributes in aggravating the VTE risk significantly among flight passengers. The annual incidence of deep vein thrombosis in the general population is estimated to be about 1 per 1000.…”