Symptomatic venous thromboembolism and mortality in orthopaedic surgery – an observational study of 45 968 consecutive procedures

Abstract

BackgroundLittle information exists on the presentation of symptomatic venous thromboembolism (VTE) in orthopaedic surgery when a defined protocol for thromboprophylaxis is used. The objective with this study was to establish the VTE rate and mortality rate in orthopaedic surgery.MethodsWe performed a prospective, single centre observational cohort study of 45 968 consecutive procedures in 36 388 patients over a 10 year period. Follow-up was successful in 99.3%. The primary study outcome was the incidence of symptomatic deep vein thrombosis (DVT), symptomatic pulmonary embolism (PE) and mortality at 6 weeks, specified for different surgical procedures. The secondary outcome was to describe the DVT distribution in proximal and distal veins and the proportion of VTEs diagnosed after hospital discharge. For validation purposes, a retrospective review of VTEs diagnosed 7–12 weeks postoperatively was also performed.ResultsIn total, 514 VTEs were diagnosed (1.1%; 95% CI: 1.10-1.14), the majority (84%) after hospital discharge (432 out of 514).With thromboprophylaxis, high incidence of VTE was found after internal fixation (IF) of pelvic fracture (12%; 95% CI: 5–26), knee replacement surgery (3.7%; 95% CI: 2.8-5.0), after internal fixation (IF) of proximal tibia fracture (3.8%; 95% CI: 2.3-6.3) and after IF of ankle fracture (3.6%; 95% CI: 2.9-4.4). Without thromboprophylaxis, high incidence of VTE was found after Achilles tendon repair (7.2%; 95% CI: 5.5-9.4). In total 1094 patients deceased (2.4%; 95% confidence interval (CI): 2.33- 2.44) within 6 weeks of surgery. Highest mortality was seen after lower limb amputation (16.3%, CI: 13.8-19.1) and after hip hemiarthroplasty due to hip fracture (9.6%, CI; 7.6-12.1).ConclusionThe overall incidence of VTE is low after orthopaedic surgery but our study highlights surgical procedures after which the risk for VTE remains high and improved thromboprophylaxis is needed.

Deep vein thrombosis in arthroscopic surgery and chemoprophylaxis recommendation in an Asian population

“…This is comparable to larger-scale studies that reported clinically symptomatic DVT incidences of 2.1%, 2.8% and 3.7% for patients who underwent arthroplasty. (9,12,13) However, the patients in those studies had both mechanical and chemical thromboprophylaxis, while the patients in the present study only had mechanical prophylaxis.…”

Thromboprophylaxis Following Hip And Knee Arthroplasty

“…62, 184 The majority of VTE occurred following discharge, which has also been previously reported in the literature. 51,62,143,184,185 As all readmissions to hospital for VTE treatment were under medical units, local VTE incidence following arthroplasty may be underestimated by surgical teams.…”

“…85,88 Interestingly, the type of anaesthesia may also infuence VTE risk: regional anaesthesia has been reported to carry a lower VTE risk than general anaesthesia; consequently it is often recommended in guidelines and commonly used in practice. 17,51,89,90 A recent study reported that East Asian patients experience very little to no symptomatic VTE following hip and knee arthroplasty, suggesting the value of using routine thromboprophylaxis is debatable in East Asia. 81 Notably, studies in South East Asia have actually reported higher symptomatic VTE rates to other studies (5.1%).…”

“…For example, the risk of dying is significantly higher following hip arthroplasty compared to knee arthroplasty (3.0% vs. 0.1%). 47,51 Moreover,…”

“…In particular, extending thromboprophylaxis beyond the first fourteen days after surgery can reduce relative VTE risk by approximately 50% to 70%, compared to employing thromboprophylaxis for fourteen days or less. 51,68,[75][76][77][78]93 …”