Is Obesity Associated With Increased Risk of Deep Vein Thrombosis or Pulmonary Embolism After Hip and Knee Arthroplasty? A Large Database Study

Sloan, Matthew; Sheth, Neil P.; Lee, Gwo-Chin

doi:10.1097/corr.0000000000000615

Cited by 111 publications

(91 citation statements)

References 33 publications

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“…We note that although the outright proportion of obese patients is lower, the mean Table 1 SUMMARY OF BASELINE CHARACTERISTICS BMI was about 28kg/m 2 which is consistent with overweight patients. The increase of BMI was associated in several studies with an increased risk of PE, some authors proposing that the vascular inflammatory state being one of the predisposing factors or insulin resistance [8][9].…”

Section: Resultsmentioning

confidence: 99%

Clinical and Laboratory Aspects of the Severity of Pulmonary Embolism in Elderly Patients versus Adult Patients A single centre study

Morgovan¹,

Ivan²,

Buzas³

et al. 2019

Rev.Chim.

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Pulmonary thromboembolism is currently one of the leading causes of disease burden and mortality in Europe, also known as the great masquerader, for its ability to mimic other diseases or to present itself with few symptoms, especially when the pulmonary embolism is very small. With aging population, increased survival of cancer patients and the addition of multiple debilitating diseases such as dementia, heart failure, chronic kidney disease the rate of pulmonary embolism is spiking, with more and more small pulmonary embolism being diagnosed, that may have no immediate impact on mortality, but which may contribute to an increase in morbidity. We have examined retrospectively 108 consecutively cases of pulmonary thromboembolism that have presented in the Emergency Department of Municipal Hospital in Timisoara, Romania over the course of twenty-one months from September 2016 to May 2018 and we evaluated the clinical and laboratory findings in studying the influence of age over the severity of pulmonary embolism.

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Section: Resultsmentioning

confidence: 99%

Clinical and Laboratory Aspects of the Severity of Pulmonary Embolism in Elderly Patients versus Adult Patients A single centre study

Morgovan¹,

Ivan²,

Buzas³

et al. 2019

Rev.Chim.

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“…In a recently published study using Nationwide Inpatient Sample Database, Movahed et al 48 showed that obese patients have significantly higher incidence of PE as compared with non-obese patients. In another recent study in post-orthopaedic surgery patients, Sloan et al 49 showed that both overweight and obese patients had increased risk of PE. However, the risk of extremity venous thromboembolism was not elevated in these patients.…”

Section: Discussionmentioning

confidence: 97%

Pulmonary embolism rule out: positivity and factors affecting the yield of CT angiography

Aggarwal

Eskandari

Priya

et al. 2020

Postgraduate Medical Journal

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ObjectiveCT pulmonary angiography (CTPA) is one of the most commonly ordered CT imaging tests. It is often believed to be overutilised with few recent studies showing a yield of less than 2%. This study aimed to determine the overall positivity rate of CTPA examinations and understand the factors that affect the yield of the CTPA examination.MethodsWe retrospectively analysed 2713 patients who received the CTPA exam between 2016 and 2018. Type of study ordered (CTPA chest or CTPA chest with abdomen and pelvis CT), patient location (emergency department (ED), outpatient, inpatient, intensive care unit (ICU)) and patient characteristics—age, sex and body mass index (BMI) were recorded. A logistic regression analysis was performed to determine what factors affect the positivity rate of CT scans for pulmonary embolism (PE).ResultsWith 296 positive test results, the overall CTPA positivity was 10.9%. Male sex was associated with higher CTPA positivity, gender difference was maximum in 18-year to 35-year age group. Overweight and obese patients had significantly higher positivity as compared with BMI<25 (p<0.05). Higher positivity rate was seen in the BMI 25–40 group (11.9%) as compared with BMI>40 (10.1%) (p<0.05). Significant difference (p<0.001) was also found in CTPA examination yield from ICU (15.3%) versus inpatients (other than ICU) (12.4%) versus ED (9.6%), and outpatients (8.5%). The difference in CTPA yield based on the type of CT order (CTPA chest vs CTPA chest with CT abdomen and pelvis), patient’s age and sex was not significant.ConclusionCTPA yield of 10.9% in this study is comparable to acceptable positivity rate for the USA and is higher than recent studies showing positivity of <2%. Patient characteristics like obesity and ICU or inpatient location are associated with higher rate of CT positivity.

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“…They found the 30-day and 90-day risk of VTED to be lower for revision TKA than for primary TKA after controlling for age, race, gender, and medical comorbidities [ 16 ]. Of note, the data was geographically limited to one state, and smoking status, BMI, and operative time, previously cited risk factors for VTE, were not controlled for [ 26 – 28 ]. The lower VTED risk of revision TKA compared with primary TKA found in our study was not expected.…”

Section: Discussionmentioning

confidence: 99%

Unicompartmental knee arthroplasty and revision total knee arthroplasty have a lower risk of venous thromboembolism disease at 30 days than primary total knee arthroplasty

Schneider

Schmitt

Brown

2020

Knee Surg & Relat Res

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Background While multiple studies have demonstrated a lower venous thromboembolism disease (VTED) risk for unicompartmental knee arthroplasty (UKA) compared to primary total knee arthroplasty (TKA), recent reports have shown that revision TKA also had a lower VTED risk compared to primary TKA, an unexpected finding because of its theoretical increased risk. Given the paucity of up-to-date comparative studies, our goal was to perform a high-powered VTED risk comparison study of UKA and revision TKA to primary TKA using recent data. Methods The National Surgical Quality Improvement Program (NSQIP) database was queried between 2011 and 2018, and we identified 213,234 patients for inclusion: 191,810 primary TKA, 9294 UKA, and 12,130 revision TKA. Demographics, medical comorbidities, and possible VTE risk factors were collected. Thirty-day outcomes, including deep vein thrombosis (DVT), pulmonary embolism (PE), and all-cause VTED were compared between knee arthroplasty types. Results On multivariate analysis, UKA was significantly associated with lower rates of DVT [OR 0.44 (0.31–0.61); P < 0.001], PE [OR 0.42 (0.28–0.65); P < 0.001], and all-cause VTED [OR 0.42 (0.32–0.55); P < 0.001] when compared to primary TKA. Revision TKA was significantly associated with lower rates of PE [OR 0.62 (0.47–0.83); P = 0.002], and all-cause VTED [OR 0.82 (0.70–0.98); P = 0.029] when compared to primary TKA. Conclusions Utilizing recent data from a nationwide patient cohort and controlling for confounding variables, our results showed that both revision TKA and UKA had a lower risk of VTED compared to primary TKA, corroborating the results of recent investigations. Additional prospective investigations are needed to explain this unexpected result.

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Is Obesity Associated With Increased Risk of Deep Vein Thrombosis or Pulmonary Embolism After Hip and Knee Arthroplasty? A Large Database Study

Cited by 111 publications

References 33 publications

Clinical and Laboratory Aspects of the Severity of Pulmonary Embolism in Elderly Patients versus Adult Patients A single centre study

Clinical and Laboratory Aspects of the Severity of Pulmonary Embolism in Elderly Patients versus Adult Patients A single centre study

Pulmonary embolism rule out: positivity and factors affecting the yield of CT angiography

Unicompartmental knee arthroplasty and revision total knee arthroplasty have a lower risk of venous thromboembolism disease at 30 days than primary total knee arthroplasty

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