Venous thromboembolism risk factors and usefulness of a risk scoring system in lower limb orthopedic surgery

Abstract

We previously developed a computerized clinical decision support system based on national consensus guidelines and previous studies. This system was used to assess the risk of venous thromboembolism. In this study, we examined the risk factors for venous thromboembolism in patients who underwent lower limb orthopedic surgery using our risk scoring system, to investigate the association between the total risk score and the occurrence of venous thromboembolism. We retrospectively evaluated the records of 649 patients who underwent lower limb orthopedic surgery at a tertiary care center in Japan between January 2015 and August 2018. Venous thromboembolism was confirmed using ultrasonography or computed tomography angiography. The computerized clinical decision support system was used throughout the hospitalization period. Independent risk factors for postoperative venous thromboembolism were identified using logistic regression analysis. Age (≥68 years) was significantly associated with an increased risk of venous thromboembolism (adjusted odds ratio: 1.06, 95% confidence interval: 1.03–1.09; P < 0.001). Furthermore, the Cochran–Armitage trend test revealed a significant positive correlation between the total risk score and the occurrence of venous thromboembolism ( P < 0.001). Our risk scoring system may be used preoperatively to determine the need for venous thromboembolism prophylaxis. This study suggests that age (≥68 years) may be a risk factor for venous thromboembolism after lower limb orthopedic surgery. Additional studies are needed to validate these results.

Efficacy of the bleeding risk scoring system for optimal prophylactic anticoagulation therapy of venous thromboembolism in trauma patients: a single-center, retrospective, observational cohort study

“…In our hospital, we used a computerized clinical decision support system (CCDSS) to assess the risk factors for VTE, including background factors, surgical type, and patient history [ 8 ]. CCDSS provides appropriate prophylaxis for VTE according to the VTE risk level.…”

Anticoagulant therapy in orthopedic surgery – a review on anticoagulant agents, risk factors, monitoring, and current challenges

“…Though CCDSS provides appropriate recommendations for VTE prophylaxis, few patients who underwent lower limb orthopedic surgery still developed VTE. 45 Evaluation of bleeding risk is as important as evaluating other risk factors but no RAMs have been validated until now for evaluating the bleeding risk in orthopedic patients. 2 The ACCP 2012 guidelines suggest assessing previous major bleeding, severe renal failure, concomitant use of antiplatelet agents, and surgical factors, such as history of difficult-to-control surgical bleeding for evaluating bleeding risk during the current operative procedure, extensive surgical dissection, and revision surgery.…”

“…A recent Japanese study concluded age >68 years (adjusted odds ratio: 1.06, 95% confidence interval [CI]: 1.03-1.09; p < 0.001) as a high-risk factor for VTE in orthopedic patients undergoing lower limb surgery. 45 Multiple Environmental and Genetic Assessment of Risk Factors for Venous Thrombosis (MEGA) study prominently highlighted previous history of VTE in orthopedic patients as a major risk factor of VTE and emphasized importance of collecting VTE history as part of the preadmission inquiry. Recurrent VTE after major orthopedic surgery was also identified as a highest-risk factor (hazard ratio [HR], 4.0; 95% CI: 1.3-12.4 for recurrence at 1 month), with a cumulative incidence of recurrent VTE of 2% at 1 month, 3% at 3 months, 5% at 6 months, and 10.5% at 1 year 46 A major drawback in assessing the VTE based on individual risk factors is the lack of uniformity.…”

Haemostatic, Inflammatory, and Haematological Biomarkers Among Orthopaedic Patients With Prolonged Immobilization and the Risk of Hypercoagulable States

“…Deep vein thrombosis (DVT) and pulmonary embolism (PE) are collectively known as venous thromboembolism (VTE). VTE affects millions of people globally and is one of the primary causes of morbidity and mortality among inpatients [1]. A study reported an incidence rate of VTE ranging from 5% to 63% in trauma patients not receiving prophylaxis [2].…”