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

Abstract

Background This study aimed to investigate the prevalence of preoperative deep venous thrombosis (DVT) following intertrochanteric fractures in the elderly and identify the associated factors, based on which a risk prediction model was developed. Method This was a retrospective single-center study of elderly patients presenting with intertrochanteric fractures between our institution between January 2017 and December 2020. Patients' duplex ultrasound (DUS) or venography results were retrieved to evaluate whether they had a preoperative deep venous thrombosis (DVT) of bilateral extremities, whereby patients were dichotomized. Various variables of interest on demographics, comorbidities, injury and biomarkers were extracted and their relationship between DVT were investigated. Statistically significant variables tested in multivariate logistics regression analyses were used to develop a risk prediction model. Results There were 855 patients eligible to be included in this study, and 105 were found to have preoperative DVT, with a prevalence rate of 12.3%. Ten factors were tested as significantly different and 2 marginally significant between DVT and non-DVT groups in the univariate analyses, but only 6 demonstrated the independent effect on DVT occurrence, including history of a VTE event (OR, 4.43; 95%CI, 2.04 to 9.62), time from injury to DVT screening (OR, 1.19; 95%CI, 1.13 to 1.25), BMI (OR, 1.11; 95%CI, 1.04–1.18), peripheral vascular disease (OR, 2.66; 95%CI, 1.10 to 6.40), reduced albumin (2.35; 95%CI, 1.48 to 3.71) and D-Dimer > 1.0 mg/L(OR, 1.90; 95%CI, 1.13 to 3.20). The DVT risk model showed an AUC of 0.780 (95%CI, 0.731 to 0.829), with a sensitivity of 0.667 and a specificity of 0.777. Conclusion Despite without a so high prevalence rate of DVT in a general population with intertrochanteric fracture, particular attention should be paid to those involved in the associated risk factors above. The risk prediction model exhibited the improved specificity, but its validity required further studies to verify.

Prediction model of deep vein thrombosis risk after lower extremity orthopedic surgery

“…For example, PDW was an independent predictor for postoperative DVT events of people experienced cervical carcinoma [ 57 ], and for preoperative DVT of ones followed foot who experienced fractures [ 58 ]. As the same combination of D-Dimer with PDW, or TT in our study, it was considered to have a significant ability to distinguish between DVT and non-DVT in other results [ 59 , 60 ].…”

The association between admission serum albumin and preoperative deep venous thrombosis in geriatrics hip fracture: a retrospective study of 1819 patients with age ≥ 65 years

“…A retrospective study by Song et al reported that a lower albumin level was the independent risk factor for preoperative DVT in 266 patients [ 25 ]. Wang et al reported that reduced albumin was associated with preoperative DVT in a risk prediction model [ 26 ]. In a meta-analysis, Wang et al found that albumin < 35 g/L was a risk factor for preoperative DVT [ 21 ].…”

Development and validation of a nomogram for predicting the risk of immediate postoperative deep vein thrombosis after open wedge high tibial osteotomy

“…In addition, the nomogram showed good predictive performance after internal and external validation. Elevated D-dimer levels and hypoproteinemia are recognized risk factors for DVT in orthopedic patients, and their relevance has been widely discussed in the literature [3,9,21,40]. Albumin has heparin-like efects and its low levels induce hyperibrinogenemia and platelet aggregation, a process that can be reversed by albumin infusion [35].…”