Incidence of venous thromboembolism and bleeding events in patients with lower extremity orthopedic surgery: a retrospective analysis of a Japanese healthcare database

Abstract

BackgroundOrthopedic surgeries of lower extremities such as total knee arthroplasty (TKA), total hip arthroplasty (THA), and hip fracture surgery (HFS) are widely considered to carry a high risk of developing deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE). Growing attention to epidemiological studies using a healthcare database led us to quantify the risks using a Japanese database to reveal recent medical care for such events.MethodsThe study comprised 36,947 patients who had undergone orthopedic surgeries of the lower extremities and whose medical information from April 2008 to September 2013 was available. The source population of the database was derived from 100 acute-care hospitals with Diagnosis Procedure Combination. The events were defined by diagnosis, medication, imaging, and laboratory tests.ResultsA breakdown of patients who underwent orthopedic surgeries by type of surgery showed 13.6% for TKA, 10.4% for THA, 56.8% for HFS, 1.5% for rupture of Achilles tendon, and 18.0% for simple fracture of lower extremities. The incidence for DVT, PTE, and bleeding events by type of surgery was 1.3, 0.2, and 1.0% for TKA; 0.9, 0.2, and 1.1% for THA; and 0.4, 0.1, and 1.8% for HFS, respectively. The population for risk factor analysis consisted of patients with similar background factors who underwent TKA, THA, or HFS. The statistically significant risk factors for PTE analyzed by the backward elimination procedure in a multivariate model were female sex, history of venous thromboembolism (VTE), thrombophilia, and varicose veins of lower extremity.ConclusionsThe incidence of DVT, PTE, and bleeding events and the risk factors for DVT and PTE in patients by type of orthopedic surgeries of lower extremities found in our study are considered to be rational as they reflect evidence from real-world cases.Trial registrationUniversity Hospital Medical Information Network Clinical Trials Registry UMIN000012667 Electronic supplementary materialThe online version of this article (doi:10.1186/s13018-017-0549-4) contains supplementary material, which is available to authorized users.

Impact of prestorage leucoreduction of autologous whole blood on length of hospital stay with a subgroup analysis in bilateral hip arthroplasty

“…Incidence (0Á5%) of perioperative deep vein thrombosis in this study was within those of recent reports (0Á06% or 1Á1%) among hip/limb surgery or total hip arthroplasty overall in Japan [21,22]. Along with our ageing…”

“…Incidence (0·5%) of perioperative deep vein thrombosis in this study was within those of recent reports (0·06% or 1·1%) among hip/limb surgery or total hip arthroplasty overall in Japan . Along with our ageing population and progressively westernized diet, combined with improved sensitivity of various diagnosis techniques, the number of pulmonary embolism and deep vein thrombosis diagnoses is increasing in Japan.…”

“…Third, the study ran over ten years, during which preventive measures for thrombosis and infection had improved. The incidence rate 0·5% was comparable to that Japan overall (1·1%) after lower limb surgery . However, we cannot totally deny a possibility of subclinical or small thrombosis formed pre‐ or postevaluation of D‐dimmer assay at day 3 and sonography at day 7.…”

Comparative effectiveness and safety of warfarin and dabigatran in patients with non-valvular atrial fibrillation in Japan: A claims database analysis

“…The definition of stroke, systemic embolism, and intracranial bleeding used in the present study (Supplementary Table 1) has been validated in previous research using the MDV claims database [13]. The definition of a bleeding event has also been validated previously [14]. Major bleeding was defined as any transfusion and/or any hospitalization with associated bleeding, which was recorded as the medical condition requiring the most healthcare resource during the hospitalization in DPC in-patient claims.…”

Thromboembolic risk after lumbar spine surgery: a cohort study on 325 000 French patients

“…The presence of cancer is known to increase VTE risk by up to 12-fold [30,31]. A previous history of VTE was an independent risk factor after elective lowerlimb surgery in a study by Fuji et al, or after elective cranial surgery in a study by Smith et al [32,33]. Cardiac failure, respiratory disorders and renal diseases have been associated with an increased VTE risk after hip or knee arthroplasty [5,28].…”