Preoperative deep venous thrombosis (DVT) after femoral neck fracture in the elderly, the incidence, timing, location and related risk factors

Abstract

Objective To investigate the epidemiologic characteristics of deep venous thrombosis (DVT) in elderly patients with femoral neck fracture. Methods Retrospective analysis was performed on elderly patients with femoral neck fractures admitted to two institutions from January 2016 to October 2019. Duplex ultrasonography (DUS) was used to detect DVT. Patients’ hospitalization medical records were retrieved to collect the data, which were related to demographics, comorbidities, injury and laboratory results on admission. Patients with preoperative DVT were defined as the case group and those without DVT as control group, and compared using the univariate analyses. Multivariate logistic regression analysis was used to identify the independent factors associated with DVT. Results Totally, 980 patients met the predefined criteria and were included. Sixty-seven patients were diagnosed to have preoperative DVT, with incidence of 6.8% for overall, 1.7% for proximal and 5.1% for distal DVT. The mean time from injury to diagnosis of DVT was 6.0 ± 4.7 days (median, 5.0). Most (76.1%) patients with DVT had thrombi solely in the injured extremity, in contrast with 14.9% (10/67) in the uninjured and 9.0% (6/67) in both injured and uninjured extremity. Multivariate analysis showed chronic renal insufficiency (OR, 3.37; 95%CI, 1.57 to 7.28), current smoking status (OR, 2.42; 95%CI, 1.23 to 5.63), time from injury to DUS (OR, 1.26; 95%CI, 1.07 to 1.61) and PLT > 220*109/L (OR, 1.94; 95%CI, 1.31 to 3.77) were independent factors for DVT. Conclusion Preoperative DVT is not very prevalent following elderly femoral neck fractures, but with a certain proportion in the uninjured extremity, necessitating the more attention. These identified risk factors aid in patient counseling, individualized risk assessment and risk stratification, and should be kept in mind.

Prevalence and risk factors of preoperative deep venous thrombosis in closed patella fracture: a prospective cohort study

“…Wang et al [ 14 ] reported that 83.6% of the DVTs were located in the injured extremity, 5.4% in the bilateral extremity, and 11.0% solely in the uninjured extremity in patients with isolated lower limb fracture. Niu et al [ 21 ] found that 76.1% of the DVTs solely involved the injured leg, 9.0% involved bilateral legs, and 14.9% solely involved the uninjured legs in the geriatric patients with a femoral neck fracture. However, some studies got slightly different results.…”

“…We also found that the majority of the DVTs in closed patella fracture were distal DVT. In contrast with this, the rate of proximal DVT in the hip was much higher [ 8 , 11 , 21 , 23 ]. This demonstrated that the location of DVT may be associated with the fracture anatomical sites, the more proximal to the hip of the fracture site, the higher risk of the proximal DVT.…”

Effect of ERAS Combined with Comfortable Nursing on Quality of Life and Complications in Femoral Neck Fractures of the Aged People

“…However, due to the physiological particularity of the elderly, the functional recovery of the bones of patients after fracture is often poor [ 5 ]. Statistics show that the elderly are prone to infection, deep vein thrombosis (DVT), pulmonary embolism, joint stiffness, and other complications after fracture [ 6 , 7 ]. Thus, to find an effective rehabilitation and nursing program is a vital task to improve hip joint dysfunction and reduce complications in elderly patients.…”

Prevalence of preoperative Deep Venous Thrombosis (DVT) following elderly intertrochanteric fractures and development of a risk prediction model

“…Among the 6 independent factors identified, most were repeatedly investigated in literature, such as delay to admission or DVT screening [ 10 , 17 – 19 ], higher BMI or obesity [ 18 , 19 ], peripheral vascular disease [ 19 ], reduced albumin [ 18 ] and elevated D-Dimer level [ 1 , 10 , 17 – 19 ]. The relatively prolonged time from injury to DVT examination (mean, 4.1 days) must be explain.…”

“…myocardial infarction or ischemic stroke or bleeding events [ 16 ], seriously complicating the surgical care. Despite the such clinical importance, existing studies on this topic are inadequate, reporting greatly variable prevalence rates of DVT and identified controversial risk factors without or limited adjustment for confounders [ 1 , 10 , 17 – 20 ], which are not necessarily applicable to populations in different settings.…”