Venous Thromboembolism despite Ongoing Prophylaxis after Fast-Track Hip and Knee Arthroplasty: A Prospective Multicenter Study of 34,397 Procedures

Petersen, P. H.; Jørgensen, Christoffer Calov; Kehlet, Henrik

doi:10.1055/s-0039-1696686

Cited by 21 publications

(17 citation statements)

References 23 publications

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“…The lack of a direct and timely relationship between cement implantation and the occurrence of postoperative PE suggests that other factors, such as obesity and delayed mobilization, may also contribute (Table 4). Furthermore, many of the PE events happened despite ongoing thromboprophylaxis, indicating that these events happen in high-risk patients, requiring further investigations as discussed in detail by Petersen et al (2019). We therefore feel that the term "bone cement implantation syndrome" should be used with more caution in this context.…”

Section: Discussionmentioning

confidence: 98%

Postoperative 30-day complications after cemented/hybrid versus cementless total hip arthroplasty in osteoarthritis patients > 70 years

et al. 2020

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Background and purpose — The use of cementless total hip arthroplasty (THA) in elderly patients is debated because of increased risk of early periprosthetic femoral fractures. However, cemented femoral components carry a risk of bone cement implantation syndrome. Hence, we compared in-hospital complications, complications leading to readmission and mortality ≤ 30 days postoperatively between hybrid/cemented (cemented femoral component) vs. cementless THA in osteoarthritis patients > 70 years. Patients and methods — This is a prospective observational cohort study in 9 centers from January 2010 to August 2017. We used 30-day follow-up from the Danish National Patient Registry, patient records, and data from the Danish Hip Arthroplasty Register. Only THAs performed as a result of osteoarthritis were included. Results — 3,368 (42%) of the THAs were cemented/hybrid and 4,728 (58%) cementless. The in-hospital complication risk was 7.7% after cemented/hybrid vs. 5.3% after cementless THA (< 0.001), statistically not significant when adjusting for comorbidities (p = 0.1). There were similar risks of complications causing readmission (5.7% vs. 6.2%) and mortality ≤ 30 days (0.2% vs. 0.3%). 15 cases (0.4%) of pulmonary embolism (PE) were found after cemented/hybrid vs. 4 (0.1%) after cementless THA (p = 0.001); none occurred within 24 hours postoperatively. 2 of the PEs after cementless THA led to mortality. Cemented/hybrid THA remained significantly associated with risk of PE (RR 3.9, p = 0.02), when adjusting for comorbidities. BMI > 35 was associated with highest risk of PE (RR 5.7, p = 0.003). The risk of periprosthetic femoral fracture was 0.2% after cemented/hybrid vs. 1.5% after cementless THA (p < 0.001) and the risk of dislocations was 1.2% after cemented/hybrid THA vs. 1.8% after cementless THA (p = 0.04). Interpretation — The higher risk of PE after cemented/hybrid THA and higher risk of periprosthetic femoral fractures and dislocations after cementless THA highlights that both medically and surgically complications are related to fixation technique and have to be considered.

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Section: Discussionmentioning

confidence: 98%

Postoperative 30-day complications after cemented/hybrid versus cementless total hip arthroplasty in osteoarthritis patients > 70 years

et al. 2020

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“…However, we found no correlation between anticoagulation interruption and DVT, which may be related to the risk of bleeding associated with anticoagulation interruption in this study. For patients hospitalized for total knee and hip replacement within 5 days, Samama et al, Petersen et al, and other large-sample, multi-center studies have confirmed that anticoagulation in these patients is safe only in the hospital [ 14 , 15 ]. However, there are few studies on the timing of anticoagulation after surgery.…”

Section: Discussionmentioning

confidence: 99%

Analysis of perioperative risk factors for deep vein thrombosis in patients with femoral and pelvic fractures

Cheng

2020

J Orthop Surg Res

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Objective Clinical characteristics, anticoagulant protocols, and risk factors of deep vein thrombosis (DVT) in patients with femoral and pelvic fractures were analyzed throughout the perioperative period to provide references for early identification and optimization of risk factors. Methods This was a retrospective study. A total of 569 patients undergoing surgery of femoral and pelvic fractures from May 2018 to December 2019 were included. The clinical data including general conditions, trauma, surgery, anticoagulant protocols, and laboratory indexes were collected. According to the results of deep vein Doppler ultrasonography of the lower extremities, the patients were divided into non-DVT group and DVT group. Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors of preoperative and postoperative DVT. Results The incidence of DVT was 40.25% and preoperative DVT was 26.71%, which was higher than the incidence of postoperative DVT of 17.22%. Most of them were thrombus on the affected side (60.26%) and distal thrombus (81.66%). The average time of DVT formation was 6.55 ± 0.47 days after trauma and 6.67 ± 0.48 days after surgery. Chronic obstructive pulmonary disease (COPD), anemia, hypoproteinemia, non-anticoagulation before surgery, delayed anticoagulation after trauma and admission, high-energy trauma, multiple injuries, drinking history, and advanced age were independent risk factors for perioperative DVT. The increased level of fibrinogen degradation products was an independent risk factor for preoperative DVT. These risk factors were identified to be independently associated with postoperative DVT, including intraoperative blood transfusion, postoperative blood transfusion, pulmonary infection, preoperative non-anticoagulation, postoperative delayed anticoagulation, preoperative waiting time > 7 days, operative time > 2 h, c-reactive protein, fibrinogen level, platelet count 1 day after surgery, c-reactive protein, fibrinogen, and hemoglobin levels 3 days after surgery, comminuted fracture. Conclusions At present, anticoagulation and other DVT prevention and treatment programs have not changed the current situation that the incidence of DVT is still high. Through the analysis of the risk factors of DVT throughout the perioperative period, optimizing the perioperative blood transfusion, preoperative lung disease, hypoproteinemia, anemia, inflammation, etc., and surgery as soon as possible after trauma may further reduce its incidence.

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“…2,4,5 The risk of VTE after orthopedic surgery is 0.4%-1.0% despite the use of thromboprophylaxis, including minor orthopedic procedures. [6][7][8][9][10][11][12][13][14] This study's objective was to investigate the postoperative risk of VTE in all types of lower extremity orthopedic surgery compared with the background population to identify areas needing a more thorough investigation of potential use of thromboprophylaxis. We report 180-day cumulative incidences and hazard ratios (HRs) of VTE after orthopedic surgery in a matched, retrospective cohort study based on Danish national health care register data.…”

Section: Introductionmentioning

confidence: 99%

Venous thromboembolism after lower extremity orthopedic surgery: A population‐based nationwide cohort study

Gade

Kold

Severinsen

et al. 2021

Research and Practice in Thrombosis and Haemostasis

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Background Venous thromboembolism (VTE) causes morbidity and mortality in the general population. Several events occur after lower limb orthopedic surgery, but the contribution from various types of lower limb surgery is not well known. Objective To investigate the postoperative incidence of VTE for all types of lower extremity orthopedic surgery compared with the background population. Methods Individual‐level linkage of Danish nationwide register data for all Danish residents with first‐time orthopedic surgery of the lower limb (1996‐2017) and, for each of these, four controls from the general population matched on age, sex, and history of VTE. Adjusted hazard ratios (HR) compared the postoperative risk of VTE to the matched controls. Results In total 7203 of the 1 012 823 patients with a first orthopedic procedure had a VTE within 180 days after surgery, corresponding to a postoperative cumulative incidence of 0.71% (95% confidence interval [CI], 0.70‐0.73). The cumulative incidence of VTE among controls was 0.11% (95% CI, 0.11‐0.12). The HR of VTE within the first 30 days after surgery below knee level was 20.5 (95% CI, 17.9‐23.5) compared with matched controls. The HRs of VTE after minor distal procedures (eg, meniscectomy and arthroscopies) were 2.9 (95% CI, 1.9‐4.4) to 7.1 (95% CI, 6.4‐8.0). Conclusion All types of lower limb orthopedic surgery including minor distal procedures were associated with higher rates of VTE compared with matched controls, in particular within the first 30 days after surgery.

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Venous Thromboembolism despite Ongoing Prophylaxis after Fast-Track Hip and Knee Arthroplasty: A Prospective Multicenter Study of 34,397 Procedures

Cited by 21 publications

References 23 publications

Postoperative 30-day complications after cemented/hybrid versus cementless total hip arthroplasty in osteoarthritis patients > 70 years

Postoperative 30-day complications after cemented/hybrid versus cementless total hip arthroplasty in osteoarthritis patients > 70 years

Analysis of perioperative risk factors for deep vein thrombosis in patients with femoral and pelvic fractures

Venous thromboembolism after lower extremity orthopedic surgery: A population‐based nationwide cohort study

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