Analysis of perioperative risk factors for deep vein thrombosis in patients with femoral and pelvic fractures

Abstract

Objective Clinical characteristics, anticoagulant protocols, and risk factors of deep vein thrombosis (DVT) in patients with femoral and pelvic fractures were analyzed throughout the perioperative period to provide references for early identification and optimization of risk factors. Methods This was a retrospective study. A total of 569 patients undergoing surgery of femoral and pelvic fractures from May 2018 to December 2019 were included. The clinical data including general conditions, trauma, surgery, anticoagulant protocols, and laboratory indexes were collected. According to the results of deep vein Doppler ultrasonography of the lower extremities, the patients were divided into non-DVT group and DVT group. Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors of preoperative and postoperative DVT. Results The incidence of DVT was 40.25% and preoperative DVT was 26.71%, which was higher than the incidence of postoperative DVT of 17.22%. Most of them were thrombus on the affected side (60.26%) and distal thrombus (81.66%). The average time of DVT formation was 6.55 ± 0.47 days after trauma and 6.67 ± 0.48 days after surgery. Chronic obstructive pulmonary disease (COPD), anemia, hypoproteinemia, non-anticoagulation before surgery, delayed anticoagulation after trauma and admission, high-energy trauma, multiple injuries, drinking history, and advanced age were independent risk factors for perioperative DVT. The increased level of fibrinogen degradation products was an independent risk factor for preoperative DVT. These risk factors were identified to be independently associated with postoperative DVT, including intraoperative blood transfusion, postoperative blood transfusion, pulmonary infection, preoperative non-anticoagulation, postoperative delayed anticoagulation, preoperative waiting time > 7 days, operative time > 2 h, c-reactive protein, fibrinogen level, platelet count 1 day after surgery, c-reactive protein, fibrinogen, and hemoglobin levels 3 days after surgery, comminuted fracture. Conclusions At present, anticoagulation and other DVT prevention and treatment programs have not changed the current situation that the incidence of DVT is still high. Through the analysis of the risk factors of DVT throughout the perioperative period, optimizing the perioperative blood transfusion, preoperative lung disease, hypoproteinemia, anemia, inflammation, etc., and surgery as soon as possible after trauma may further reduce its incidence.

The Perioperative Deep Vein Thrombosis in Lower Extremities in Patients With Pelvic Fracture: A Case-Control Study

“…It is 21.09% preoperatively, and increased to 35.16% postoperatively. These percentages were correspondence to the wide range of 3% 6 to 43% 8 in other studies. However, the previously published studies did not report the preoperative and postoperative incidences respectively.…”

“…The incidence of DVT in pelvic fractures is reported to range from 3% 6 to 23%, 7 even 43.28%, 8 in recent studies. However, previous studies only focused on the percentage of DVT, not detailed analysis of DVTs from pelvic fracture.…”

The Best Evidence for the Prevention and Management of Lower Extremity Deep Venous Thrombosis After Gynecological Malignant Tumor Surgery: A Systematic Review and Network Meta-Analysis

“…Evidence 7–10 summarizes the methods of DVT drug prevention for gynecological malignant tumors. Drug prevention should be considered when the risk of thrombosis is greater than the risk of bleeding ( 17 ). About 2–12 h before operation, the highest dose of low molecular weight heparin ( 13 ) was used to prevent postoperative venous thromboembolism in patients with gynecological malignant cancer without relevant treatment contraindications ( 12 ).…”

Incidence and risk factors of preoperative deep venous thrombosis following pelvic and acetabular fractures: a retrospective case–control study

“…It has been widely recognized that orthopaedic patients with elevated BMI have a higher risk of perioperative complications than patients within the normal range [ 23 , 24 ]. However, the impact of elevated BMI on the presence of DVT was not shown in some investigations, partially due to the small sample size as well as to numerous heterogeneities in research objects and study design and screening method [ 7 , 8 , 19 ]. Obesity in the current study was defined as a BMI value over 26.73 kg/m 2 , which was determined according to the ROC analysis.…”