Risk Factors for Deep Venous Thrombosis Following Orthopaedic Trauma Surgery: An Analysis of 56,000 patients

Abstract

Background:Deep venous thrombosis (DVT) and pulmonary embolism (PE) are recognized as major causes of morbidity and mortality in orthopaedic trauma patients. Despite the high incidence of these complications following orthopaedic trauma, there is a paucity of literature investigating the clinical risk factors for DVT in this specific population. As our healthcare system increasingly emphasizes quality measures, it is critical for orthopaedic surgeons to understand the clinical factors that increase the risk of DVT following orthopaedic trauma.Objectives:Utilizing the ACS-NSQIP database, we sought to determine the incidence and identify independent risk factors for DVT following orthopaedic trauma.Patients and Methods:Using current procedural terminology (CPT) codes for orthopaedic trauma procedures, we identified a prospective cohort of patients from the 2006 to 2013 ACS-NSQIP database. Using Wilcoxon-Mann-Whitney and chi-square tests where appropriate, patient demographics, comorbidities, and operative factors were compared between patients who developed a DVT within 30 days of surgery and those who did not. A multivariate logistic regression analysis was conducted to calculate odds ratios (ORs) and identify independent risk factors for DVT. Significance was set at P < 0.05.Results:56,299 orthopaedic trauma patients were included in the analysis, of which 473 (0.84%) developed a DVT within 30 days. In univariate analysis, twenty-five variables were significantly associated with the development of a DVT, including age (P < 0.0001), BMI (P = 0.037), diabetes (P = 0.01), ASA score (P < 0.0001) and anatomic region injured (P < 0.0001). Multivariate analysis identified several independent risk factors for development of a DVT including use of a ventilator (OR = 43.67, P = 0.039), ascites (OR = 41.61, P = 0.0038), steroid use (OR = 4.00, P < 0.001), and alcohol use (OR = 2.98, P = 0.0370). Compared to patients with upper extremity trauma, those with lower extremity injuries had significantly increased odds of developing a DVT (OR = 7.55, P = 0.006). The trend toward increased odds of DVT among patients with injuries to the hip/pelvis did not reach statistical significance (OR = 4.51, P = 0.22). Smoking was not found to be an independent risk factor for developing a DVT (P = 0.1217).Conclusions:This is the largest study to date using the NSQIP database to identify risk factors for DVT in orthopaedic trauma patients. Although the incidence of DVT was low in our cohort, the presence of certain risk factors significantly increased the odds of developing a DVT following orthopaedic trauma. These findings will enable orthopaedic surgeons to target at-risk patients and implement post-operative care protocols aimed at reducing the morbidity and mortality associated with DVT in orthopaedic trauma patients.

The role of platelet hyperreactivity in venous thromboembolism after total knee arthroplasty in elderly population without pharmacologic prophylaxis: A single‐center study

“…Advanced age >70 years, female sex, obesity, and hypertension have been known as risk factors of VTE after TKA . In this study, platelet aggregation ≥40% was more frequently observed in patients with VTE, while the incidences of these risk factors were not significantly higher.…”

“…Advanced age >70 years, female sex, obesity, and hypertension have been known as risk factors of VTE after TKA. 6,15 Prior clinical studies observed that WBC and platelet counts are correlated with increased platelet aggregation in arterial thrombotic events. 19,20 In the present study, the incidence of previous arterial thrombotic events such as CAD and IS, WBC count, and platelet count showed no significant difference among the aggregation groups, although it was lower in the low aggregation group.…”

“…A few studies have reported that platelet hyperaggregability or hyperreactivity to various agonists is observed in patients with VTE, but the community‐based Framingham Heart Study cohort showed that epinephrine induced platelet aggregability was weakly associated with decreased risk of incidental VTE . Although several studies have analyzed the risk factors for VTE following orthopedic surgery, platelet activity was not assessed for risk stratification of postoperative VTE.…”

A Prospective Study of Clinical Profile, Predisposing Factors and Management of Deep Venous Thrombosis

“…thrombosis In these patients, suggested to be associated with injury of vascular wall, immobility, and activated coagulation pathways. 21 (c) Trauma. higher Incidence of DVT is seen in patients with lower extremity fractures compared to those with trauma at other sites, such as the abdomen, face or thorax.…”

A systematic review—meta-analysis of venous thromboembolic events following primary hip arthroscopy for FAI: clinical and epidemiologic considerations

“…Orthopaedic surgical procedures may carry increased risk for the development of VTE due to temporary endothelial dysfunction at the operation site, venous stasis as a result of patient immobilization during the recovery period and possible hypercoagulability state which is also patient dependent [ 5 ]. According to the American College of Chest Physicians (ACCP), there is no validated tool to assess individual risk factors and their contribution to the development of VTE in patients undergoing orthopaedic procedures [ 6 ].…”