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Xiang G, Dong X, Lin S, Cai L, Zhou F, Luo P, Zhu J. A nomogram for prediction of deep venous thrombosis risk in elderly femoral intertrochanteric fracture patients: A dual-center retrospective study. Front Surg 2023; 9:1028859. [PMID: 36684366 PMCID: PMC9852608 DOI: 10.3389/fsurg.2022.1028859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/25/2022] [Indexed: 01/07/2023] Open
Abstract
Objective Deep venous thrombosis (DVT) of the lower extremity is a common perioperative complication of femoral intertrochanteric fracture. This study aimed to identify the risk factors of lower extremity deep vein thrombosis (DVT) in elderly femoral intertrochanteric fracture patients and establish a nomogram model. Methods From August 2014 to June 2021, a total of 1,652 femoral intertrochanteric fracture patients over the age of 65 were enrolled in our study. We distinguished independent risk factors by univariate and multivariate Cox analyses. A nomogram model was then built, and the discriminative and calibration of the model was evaluated through receiver operating characteristics (ROC) and calibration plots. Results A total of 378 patients developed DVT (292 in the training group, 86 in the validation group) while the remaining patients did not. According to the univariate and multivariate Cox analyses results, age (OR = 1.07, 95% CI: 1.04-1.10), fibrinogen (OR = 2.09, 95% CI: 1.68-2.60), D-dimer (OR = 1.33, 95% CI: 1.27-1.40), time from injury to admission (OR = 1.78, 95% CI: 1.55-2.05), functional status (OR = 4.21, 95% CI: 2.86-6.20), and diabetes (OR = 1.65, 95% CI: 1.10-2.48) were identified as independent risk factors of DVT. The ROC values for DVT of the training and validation group were 0.862 and 0.912, and the P-value of the Hosmer-Lemeshow calibration test was 0.767. Conclusion This nomogram model can be used to predict the probability of preoperative DVT in elderly patients with femoral intertrochanteric fracture and guide physician in perioperative thrombosis management.
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Affiliation(s)
- Guangheng Xiang
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoyu Dong
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou, China
| | - Shenglei Lin
- Department of Orthopaedic, Wenzhou Central Hospital, Wenzhou, China
| | - Leyi Cai
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Feiya Zhou
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peng Luo
- Department of Orthopaedic, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Juanjuan Zhu
- Department of Geriatrics and Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China,Correspondence: Juanjuan Zhu
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The Association between the Hematocrit at Admission and Preoperative Deep Venous Thrombosis in Hip Fractures in Older People: A Retrospective Analysis. J Clin Med 2023; 12:jcm12010353. [PMID: 36615152 PMCID: PMC9821762 DOI: 10.3390/jcm12010353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Hematocrit, a commonly used hematological indicator, is a simple and easily applicable test. As a marker of anisocytosis and anemia, it indicates the percentage of blood cells per unit volume of whole blood. This study aimed to evaluate the association between the level of the hematocrit at admission and preoperative deep vein thrombosis (DVT) in hip fractures of older people. We collected the demographic and clinical characteristics of patients with geriatric hip fractures between 1 January 2015, and 30 September 2019, at the largest trauma center in northwestern China. Doppler ultrasonography was used to diagnose DVT. The correlation between hematocrit levels at admission and preoperative DVT was assessed using linear and nonlinear multivariate logistic regression, according to the adjusted model. All analyzes were performed using EmpowerStats and R software. In total, 1840 patients were included in this study, of which 587 patients (32%) had preoperative DVT. The mean hematocrit level was 34.44 ± 5.64 vol%. Linear multivariate logistic regression models showed that admission hematocrit levels were associated with preoperative DVT (OR = 0.97, 95% CI: 0.95−0.99; p = 0.0019) after adjustment for confounding factors. However, the linear association was unstable, and nonlinearity was identified. An admission hematocrit level of 33.5 vol% was an inflection point for the prediction. Admission hematocrit levels <33.5 vol% were not associated with preoperative DVT (OR = 1.00, 95% CI: 0.97−1.04, p = 0.8230), whereas admission hematocrit levels >33.5 vol% were associated with preoperative DVT (OR = 0.94, 95% CI: 25 0.91−0.97, p = 0.0006). Hematocrit levels at admission were nonlinearly associated with preoperative DVT, and hematocrit at admission was a risk factor for preoperative DVT. However, the severity of a low hematocrit was not associated with preoperative DVT when the hematocrit was <33.5 vol%.
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Xiong X, Li T, Yu S, Cheng B. Association Between Red Blood Cell Indices and Preoperative Deep Vein Thrombosis in Patients Undergoing Total Joint Arthroplasty: A Retrospective Study. Clin Appl Thromb Hemost 2022; 28:10760296221149029. [PMID: 36572965 PMCID: PMC9806375 DOI: 10.1177/10760296221149029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To investigate the association of red blood cell (RBC), hemoglobin (Hb), red cell distribution width-coefficient of variation (RDW-CV), and red cell distribution width-standard deviation (RDW-SD) with preoperative deep vein thrombosis (DVT) in patients undergoing total joint arthroplasty (TJA). METHODS A total of 2059 TJA patients were enrolled. We used the ratios of RBC, Hb, RDW-CV, and RDW-SD to DVT before TJA to create the receiver operator characteristic (ROC) curve, thereby calculating the cut-off values and the area under the curve (AUC). The patients were categorized into groups based on cut-off value, and risk factors for DVT before TJA were subsequently analyzed. We included the variates that were statistically significant in the univariate analysis in the multivariate binary logistic regression analysis. RESULTS Preoperative DVT occurred in 107 cases (5.20%). Based on the ROC curve, we found that the AUC for RBC, Hb, RDW-CV, and RDW-SD were 0.658, 0.646, 0.568, and 0.586, respectively. Multivariate binary regression analysis revealed that the risk of preoperative DVT in TJA patients with RBC≤3.92*109 /L, Hb≤118g/L, RDW-CV≥13.2%, and RDW-SD≥44.6fL increased 3.02 (P < 0.001, 95% confidence interval (CI) [2.0-4.54]), 2.15 (P < 0.001, 95% CI [1.42-3.24]), 1.54 (P = 0.038, 95% CI [1.03-2.3]), and 1.98 times (P = 0.001, 95% CI [1.32-2.98]), respectively. The risk of preoperative DVT in patients with corticosteroid use increased approximately 2.6 times (P = 0.002, 95% CI [1.22-5.81]). CONCLUSION We found that decreased RBC and Hb, increased RDW-CV and RDW-SD, and corticosteroid use were independent risk factors for preoperative DVT in patients undergoing TJA.
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Affiliation(s)
- Xiaojuan Xiong
- Department of Anesthesiology, Army Medical Center of PLA, Daping Hospital, Army Medical University, Chongqing, China
| | - Ting Li
- Department of Anesthesiology, Army Medical Center of PLA, Daping Hospital, Army Medical University, Chongqing, China
| | - Shuang Yu
- Department of Anesthesiology, Army Medical Center of PLA, Daping Hospital, Army Medical University, Chongqing, China
| | - Bo Cheng
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,Bo Cheng, Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University Yuzhong District, 1 Youyi Road, Chongqing 400000, China.
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Scala A, Borrelli A, Improta G. Predictive analysis of lower limb fractures in the orthopedic complex operative unit using artificial intelligence: the case study of AOU Ruggi. Sci Rep 2022; 12:22153. [PMID: 36550192 PMCID: PMC9780352 DOI: 10.1038/s41598-022-26667-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
The length of stay (LOS) in hospital is one of the main parameters for evaluating the management of a health facility, of its departments in relation to the different specializations. Healthcare costs are in fact closely linked to this parameter as well as the profit margin. In the orthopedic field, the provision of this parameter is increasingly complex and of fundamental importance in order to be able to evaluate the planning of resources, the waiting times for any scheduled interventions and the management of the department and related surgical interventions. The purpose of this work is to predict and evaluate the LOS value using machine learning methods and applying multiple linear regression, starting from clinical data of patients hospitalized with lower limb fractures. The data were collected at the "San Giovanni di Dio e Ruggi d'Aragona" hospital in Salerno (Italy).
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Affiliation(s)
- Arianna Scala
- grid.4691.a0000 0001 0790 385XDepartment of Public Health, University of Naples “Federico II”, Naples, Italy
| | - Anna Borrelli
- San Giovanni di Dio e Ruggi d’Aragona” University Hospital, Salerno, Italy
| | - Giovanni Improta
- grid.4691.a0000 0001 0790 385XDepartment of Public Health, University of Naples “Federico II”, Naples, Italy ,Interdepartmental Center for Research in Healthcare Management and Innovation in Healthcare (CIRMIS), Naples, Italy
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Xiong X, Xu S, Li T, Cheng B. Correlation of the severity of anemia in patients undergoing total joint arthroplasty with preoperative deep vein thrombosis: a retrospective cohort study. J Orthop Surg Res 2022; 17:554. [PMID: 36539891 PMCID: PMC9769050 DOI: 10.1186/s13018-022-03457-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To explore the correlation of the severity of preoperative anemia with deep vein thrombosis (DVT) in patients undergoing total joint arthroplasty (TJA). METHODS A total of 2461 TJA patients were classified into anemia and non-anemia groups or DVT and non-DVT groups. A logistic regression model was established using propensity score matching (PSM) analysis with preoperative anemia of TJA patients as a dependent variable and DVT-related variables as covariates. The caliper value was set as 0.01, and the anemia and non-anemia groups were matched based on the ratio of 1:1 (835 pairs). Finally, data of all patients were analyzed by binary logistic regression. RESULTS Preoperative anemia was observed in 872 cases (35.43%) and DVT in 170 cases (6.91%). Binary logistic regression after PSM revealed that the DVT risk of patients with preoperative, moderate and severe anemia increased by 1.82 [P = 0.00, 95% confidence interval (95% CI) (1.32-2.48)], 2.77 [P = 0.00, 95% CI (1.72-4.45)], and 8.26 [P = 0.00, 95% CI (3.22-21.16)] times, respectively. The risks of blood transfusion in the perioperative period in patients with anemia, mild anemia, moderate anemia, and severe anemia increased by 3.52 times [P = 0.00, 95% CI (2.78-4.47)], 2.13 [P = 0.00, 95% CI (1.63-2.79)], 7.22 [P = 0.00, 95% CI (5.30-9.83)], and 61.37 [P = 0.00, 95% CI (14.21-265.04)] times, respectively. CONCLUSION Preoperative anemia is an independent risk factor for preoperative DVT and blood transfusion in the perioperative period for TJA patients. The more severe the preoperative anemia, the greater the risk of preoperative DVT and perioperative blood transfusion in TJA patients. Therefore, patients with preoperative anemia, especially with moderate and severe anemia, should be screened for DVT formation before undergoing TJA. Trial registration ChiCRT2100054844.
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Affiliation(s)
- Xiaojuan Xiong
- grid.410570.70000 0004 1760 6682Department of Anesthesiology, Army Medical Center of PLA, Daping Hospital, Army Medical University, 10 ChangjiangZhilu, Yuzhong District, Chongqing, 400042 China
| | - Shenglian Xu
- grid.410570.70000 0004 1760 6682Department of Anesthesiology, Army Medical Center of PLA, Daping Hospital, Army Medical University, 10 ChangjiangZhilu, Yuzhong District, Chongqing, 400042 China
| | - Ting Li
- grid.410570.70000 0004 1760 6682Department of Anesthesiology, Army Medical Center of PLA, Daping Hospital, Army Medical University, 10 ChangjiangZhilu, Yuzhong District, Chongqing, 400042 China
| | - Bo Cheng
- grid.452206.70000 0004 1758 417XDepartment of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400000 China
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Xiong X, Li T, Cheng B. Association between glycosylated hemoglobin, diabetes mellitus, and preoperative deep vein thrombosis in patients undergoing total joint arthroplasty: a retrospective study. J Orthop Surg Res 2022; 17:430. [PMID: 36175967 PMCID: PMC9524082 DOI: 10.1186/s13018-022-03328-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background To investigate the association between the level of glycosylated hemoglobin (HbA1c) and preoperative deep vein thrombosis (DVT) and that between diabetes mellitus (DM) and preoperative DVT in patient undergoing total joint arthroplasty (TJA). Methods A total of 1386 patients were enrolled. We created the receiver operating characteristic (ROC) curve of HbA1c, and based on the cutoff value, patients were divided into two groups. Risk factors were subsequently examined. Chi-square test or Fisher’s exact test was adopted for enumeration data. The results were expressed in percentages (%), and DVT-related variates were analyzed. We included the variates that were statistically significant in the univariate analysis in the multivariate binary logistic regression analysis and calculated the adjusted odds ratio (OR) and 95% confidence interval (95% CI). Results Preoperative DVT was 100 cases (7.22%) and DM in 301 cases (21.7%). We determined the cutoff value of HbA1c of 6.15% using the ROC curve as the area under the curve (AUC) was 0.548. Univariate logistic regression revealed that the risk of preoperative DVT in TJA patients with HbA1c ≥ 6.15%, HbA1c between 7 and 7.9%, HbA1c ≥ 8%, DM, female, and major surgery in the last 12 months increased by 1.84 (P = 0.005; 95% CI [1.20–2.80]), 2.22 (P = 0.028, 95% CI [1.09–4.52]), 2.47 (P = 0.013, 95% CI [1.21–5.04]), 2.03 (P = 0.004, 95% CI [1.25–3.30]); 1.85 (P = 0.010, 95% CI [1.16–2.95]); and 2.86 times (P = 0.006, 95% CI [1.35–6.05]), respectively. And multivariate logistic regression revealed that the risk of preoperative DVT in TJA patients with HbA1c ≥ 6.15%, HbA1c between 7 and 7.9%, HbA1c ≥ 8%, DM patients, female patients, and major surgery in the last 12 months increased by 1.77 (P = 0.009, 95% CI [1.16–2.72]); 2.10 (P = 0.043, 95% CI [1.02–4.30]); 2.50 (P = 0.013, 95% CI [1.22–5.14]); 2.01 (P = 0.005, 95% CI [1.23–3.28]); 1.80 (P = 0.014, 95% CI [1.13–2.89]); and 3.04 times (P = 0.004, 95% CI [1.42–6.49]), respectively. Conclusion We conclude that HbA1c ≥ 6.15%, DM, female and major surgery in the last 12 months are the independent risk factors for preoperative DVT in patients undergoing TJA. And patients with a higher HbA1c level are at an increased risk of preoperative DVT. Trial registration: ChiCRT2100054844.
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Affiliation(s)
- Xiaojuan Xiong
- Department of Anesthesiology, Army Medical Center of PLA, Daping Hospital, Army Medical University, 10 Changjiang Zhilu, Yuzhong District, Chongqing, 400042, China
| | - Ting Li
- Department of Anesthesiology, Army Medical Center of PLA, Daping Hospital, Army Medical University, 10 Changjiang Zhilu, Yuzhong District, Chongqing, 400042, China
| | - Bo Cheng
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400000, China.
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Cheng X, Fan L, Hao J, He H, Yan J, Zhu Y. Red Cell Distribution Width-to-High-Density Lipoprotein Cholesterol Ratio (RHR): A Promising Novel Predictor for Preoperative Deep Vein Thrombosis in Geriatric Patients with Hip Fracture. Clin Interv Aging 2022; 17:1319-1329. [PMID: 36072306 PMCID: PMC9443816 DOI: 10.2147/cia.s375762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background Deep vein thrombosis (DVT) is a devastating complication in geriatric patients before hip fracture surgery, and the predictive value of red cell distribution width (RDW) and high-density lipoprotein cholesterol (HDL-C) for DVTs after hip fracture remains to be established. This study aimed to assess the predictive value of RDW, HDL-C, and RDW-to-HDL-C ratio (RHR) in preoperative DVTs screening. Methods We retrospectively analyzed the data of geriatric patients (≥65 years old) admitted for hip fracture surgery between 2015 and 2020. The receiver operating characteristic (ROC) curve and related parameters were used to evaluate the predictive value of the biomarkers. Patients were divided into two groups according to the cutoff value of RHR, and propensity score matching (PSM) and subgroup analyses were performed to assess the true correlations between RHR and DVT. Results Among 2566 eligible patients included, we identified RDW with the area under ROC curve (AUC) of 0.532, cut-off value of 15.89, specificity of 88.2%, sensitivity of 18.2%, HDL-C with AUC of 0.574, cut-off value of 1.20, specificity of 55.6%, sensitivity of 59.3%, and RHR with AUC of 0.578, cut-off value of 13.45, specificity of 71.3%, sensitivity of 43.4%. RHR (>13.45) was independently associated with 1.54-fold risk (95% CI: 1.11–2.14, P=0.011) of DVTs among the post-PSM cohort. And compared with the counterparts, the relative risk of RHR associated with DVT was higher in the subgroups of aged 65–79 years (1.61 vs 1.45), non-hypoproteinemia (2.70 vs 1.29), non-diabetic (1.58 vs 1.41), non-hypertension (2.40 vs 1.06), ASA score I-II (2.38 vs 1.04), and femoral neck fracture (1.70 vs 1.50). Conclusion RDW, HDL-C and RHR were valuable biomarkers in predicting preoperative DVTs in geriatric patients with hip fracture, and RHR would be more efficient in the subgroups of younger age, better medical condition or femoral neck fracture.
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Affiliation(s)
- Xinqun Cheng
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People’s Republic of China
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, People’s Republic of China
| | - Lingjia Fan
- Department of Orthopadic Surgery, Shandong First Medical University, Jinan, 250000, People’s Republic of China
| | - Jiabei Hao
- Basic Medical College, Hebei Medical University, Shijiazhuang, 050017, People’s Republic of China
| | - Honghou He
- Basic Medical College, Hebei Medical University, Shijiazhuang, 050017, People’s Republic of China
| | - Jincheng Yan
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People’s Republic of China
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, People’s Republic of China
- Correspondence: Jincheng Yan; Yanbin Zhu, Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People’s Republic of China, Email ;
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, People’s Republic of China
- Hebei Orthopedic Research Institute, Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, People’s Republic of China
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Sun W, Ai D, Yao Y, Ren K, Lu J, Sun H, Wu X, Jiang Q. The application of Caprini Risk Assessment Model in evaluation of deep vein thrombosis for patients with end-stage osteoarthritis before arthroplasty. BMC Musculoskelet Disord 2022; 23:767. [PMID: 35953802 PMCID: PMC9373495 DOI: 10.1186/s12891-022-05712-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background Deep vein thrombosis (DVT) was a fatal complication of knee arthroplasty. We had neglected the risk factors of preoperative DVT although patients undergoing knee arthroplasty were at high risk for VTE. This study was to determine the risk factors for preoperative DVT and application of Caprini Risk Assessment Model (RAM) in patients with end-stage knee osteoarthritis (OA). Methods We retrospectively analyzed 1808 cases with end-stage knee OA undergoing primary knee arthroplasty from May 2015 to December 2020. Based on the results of ultrasonography in lower extremities, all patients were divided into non-DVT group and DVT group. Distribution of risk factors and risk levels were compared using χ2 test between two groups. Binary logistic regression analysis was used to determine the risk factors and relationship of risk levels and preoperative DVT. Results The incidence of preoperative DVT was 5.53% (n = 100). Distribution of the study population by risk level was low, 4.09%; moderate, 23.95%; high, 66.98%; and highest 4.98%. Female (P = 0.002), age (P = 0.012), swollen legs (P = 0.035) and history of blood clots (P < 0.001) was correlated with preoperative DVT. Difference among four risk levels was significant (P = 0.007). Patients with highest risk level had statistically significant association with preoperative DVT (P = 0.005, OR = 2.93, 95%CI [1.375–6.246]). Conclusion The incidence of preoperative DVT was 5.53% in end-stage knee OA patients. The gender (female) and age were independent risk factors for preoperative DVT. The risk group classification by Caprini RAM was significantly associated with preoperative DVT. The usage of Caprini RAM before knee arthroplasty may be beneficial for prophylaxis of DVT.
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Affiliation(s)
- Wei Sun
- Nanjing Medical University, Nanjing, China.,Department of Orthopedics, the Affiliated Jiangyin Hospital of Southeast University Medical College, Wuxi, China
| | - Dongmei Ai
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yao Yao
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.,Laboratory for Bone and Joint Disease, Model Animal Research Center (MARC), Nanjing University, Nanjing, China
| | - Kewei Ren
- Department of Orthopedics, the Affiliated Jiangyin Hospital of Southeast University Medical College, Wuxi, China
| | - Jun Lu
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.,Laboratory for Bone and Joint Disease, Model Animal Research Center (MARC), Nanjing University, Nanjing, China
| | - Huiqing Sun
- Department of Orthopedics, the Affiliated Jiangyin Hospital of Southeast University Medical College, Wuxi, China
| | - Xiaotao Wu
- Nanjing Medical University, Nanjing, China. .,The Spine Center, Department of Orthopedics, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing, China.
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China. .,Laboratory for Bone and Joint Disease, Model Animal Research Center (MARC), Nanjing University, Nanjing, China.
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Incidence and risk factors of preoperative deep vein thrombosis in patients with intertrochanteric fractures: a retrospective study. J Orthop Surg Res 2022; 17:375. [PMID: 35922845 PMCID: PMC9351110 DOI: 10.1186/s13018-022-03268-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 07/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The risk of perioperative complications remains high in patients with intertrochanteric fractures. Immobilization after injury may predispose these patients to deep vein thrombosis (DVT) while waiting for surgery. The aims of this study were to determine the incidence of preoperative DVT in patients with intertrochanteric fractures and identify independent risk factors. METHODS This retrospective study included patients with intertrochanteric fractures waiting for surgical interventions at our institution from June 2018 to December 2020. All patients received pharmacologic thromboprophylaxis after admission and ultrasound screening for DVT in both lower limbs before surgery. Demographic, clinical and laboratory data of these patients were collected to perform univariate analysis first. Subsequently, factors with a significant difference in univariate analysis were introduced into the multivariate logistic regression analysis to determine the independent risk factors for preoperative DVT. RESULTS A total of 266 patients were enrolled in this study. Seventy-one patients (26.7%) developed DVTs before surgery. The majority of DVTs were distal types (91.5%). There were 40 patients with DVTs only in the affected limb, 7 patients with DVTs only in the unaffected limb, and 24 patients with DVTs in both lower limbs. Advanced age, female, prolonged period from injury to admission, combined cranial trauma, shorter thrombin time, increased level of D-dimer and lower level of albumin proved to be the independent risk factors for preoperative DVT. CONCLUSIONS We observed a high incidence of preoperative DVT in patients with intertrochanteric fractures. Identification of patients at high risk may improve the prevention and treatment of preoperative DVT in this population.
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Wang T, Guo J, Long Y, Yin Y, Hou Z. Risk factors for preoperative deep venous thrombosis in hip fracture patients: a meta-analysis. J Orthop Traumatol 2022; 23:19. [PMID: 35391566 PMCID: PMC8991371 DOI: 10.1186/s10195-022-00639-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/20/2022] [Indexed: 02/02/2023] Open
Abstract
Study design A meta-analysis. Background Hip fracture (HF), as common geriatric fracture, is related to increased disability and mortality. Preoperative deep vein thrombosis (DVT) is one of the most common complications in patients with hip fractures, affecting 8–34.9% of hip fracture patients. The study aimed to assess the risk factors of preoperative DVT after hip fractures by meta-analysis. Methods An extensive search of the literature was performed in the English databases of PubMed, Embase, and the Cochrane Library; and the Chinese databases of CNKI and WAN FANG. We collected possible predictors of preoperative DVT from included studies, and data analysis was conducted with RevMan 5.3 and STATA 12.0. Results A total of 26 English articles were included, and the rate of DVT was 16.6% (1627 of 9823 patients) in our study. Our findings showed that advanced age [p = 0.0003, OR = 0.13 95% CI (0.06, 0.21)], female patients [p = 0.0009, OR = 0.82 95% CI (0.72, 0.92)], high-energy injury [p = 0.009, OR = 0.58 95% CI (0.38, 0.87)], prolonged time from injury to admission [p < 0.00001, OR = 0.54 95% CI (0.44, 0.65)], prolonged time from injury to surgery [p < 0.00001, OR = 2.06, 95% CI (1.40, 2.72)], hemoglobin [p < 0.00001, OR = − 0.32 95% CI (− 0.43, − 0.21)], coronary heart disease [p = 0.006, OR = 1.25 95% CI (1.07, 1.47)], dementia [p = 0.02, OR = 1.72 95% CI (1.1, 2.67)], liver and kidney diseases [p = 0.02, OR = 1.91 95% CI (1.12, 3.25)], pulmonary disease [p = 0.02, OR = 1.55 95% CI (1.07, 2.23)], smoking [p = 0.007, OR = 1.45 95% CI (1.11, 1.89)], fibrinogen [p = 0.0005, OR = 0.20 95% CI (0.09, 0.32)], anti-platelet drug [p = 0.01, OR = 0.51 95% CI (0.30, 0.85)], C-reactive protein [p = 0.02, OR = 5.95 95% CI (1.04, 10.85)], < 35 g/l albumin [p = 0.006, OR = 1.42 95% CI (1.1, 1.82)], and thrombosis history [p < 0.00001, OR = 5.28 95% CI (2.85, 9.78)] were risk factors for preoperative DVT. Conclusions Many factors, including advanced age, female patients, high-energy injury, prolonged time from injury to admission, prolonged time from injury to surgery, patients with a history of coronary heart disease, dementia, liver and kidney diseases, pulmonary disease, smoking, and thrombosis, fibrinogen, C-reactive protein, and < 35 g/l albumin, were found to be associated with preoperative DVT. Our findings suggested that the patient with above characteristics might have preoperative DVT. Level of evidence: Level III.
Supplementary Information The online version contains supplementary material available at 10.1186/s10195-022-00639-6.
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Affiliation(s)
- Tao Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Junfei Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Yubin Long
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Yingchao Yin
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China. .,Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopaedic Equipment (Third Hospital of Hebei Medical University), Shijiazhuang, China.
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11
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Yang W, Wei Q, Wang H, Ding K, Li M, Li C, Liang C, Zhu Y, Chen W. Preoperative incidence and risk factors of deep venous thrombosis in patients with isolated femoral shaft fracture. BMC Surg 2022; 22:83. [PMID: 35246102 PMCID: PMC8896081 DOI: 10.1186/s12893-022-01534-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/24/2022] [Indexed: 11/12/2022] Open
Abstract
Background Preoperative deep vein thrombosis (DVT) of the lower extremities delays surgery in patients with femoral shaft fractures and impairs functional recovery. However, studies on preoperative DVT in patients with femoral shaft fractures are still rare. This study was aimed to retrospectively analyze the preoperative incidence, location and risk factors associated with DVT in patients with femoral shaft fractures. Methods Data of patients with femoral shaft fractures and treated with surgery at the Third Hospital of Hebei Medical University were retrospectively collected from January 2013 to December 2019. The information collected included demographic data, comorbidities, injury-related data and laboratory tests. Patients were divided into DVT and non-DVT groups. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors. Results A total of 432 patients were included in this study, of whom 114 (26.4%) patients were diagnosed with preoperative DVT (all asymptomatic) and injured extremities of 78.1% (89/114) were investigated. Multivariate analysis showed that older age (increase in each 10 years), delay time from injury to operation (in each day), FIB > 4 g/L were independent risk factors for preoperative DVT. Conclusion Patients with femoral shaft fractures (especially the elderly and patients with the above-mentioned conditions) are at the risk of DVT right from admission to surgery hence should be intensively monitored and provided with prompt treatment to prevent DVT.
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Affiliation(s)
- Weijie Yang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University; Orthopaedic Institution of Hebei Province; Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Qun Wei
- Department of Hospital Infection Control, Department of Public Health, Hebei General Hospital, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Haicheng Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University; Orthopaedic Institution of Hebei Province; Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Kai Ding
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University; Orthopaedic Institution of Hebei Province; Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Ming Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University; Orthopaedic Institution of Hebei Province; Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Chao Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University; Orthopaedic Institution of Hebei Province; Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Chunhui Liang
- Department of Pharmacy, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, People's Republic of China.
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University; Orthopaedic Institution of Hebei Province; Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University; Orthopaedic Institution of Hebei Province; Key Laboratory of Biomechanics of Hebei Province, No. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.
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12
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Ma J, Qin J, Shang M, Zhou Y, Zhang Y, Zhu Y. Incidence and risk factors of preoperative deep venous thrombosis in closed tibial shaft fracture: a prospective cohort study. Arch Orthop Trauma Surg 2022; 142:247-253. [PMID: 33219844 DOI: 10.1007/s00402-020-03685-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/04/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate the preoperative morbidity of deep venous thrombosis (DVT) and predictive risk factors associated with DVT after closed tibial shaft fracture. METHODS Ultrasonography and blood analyses were performed preoperatively in patients who sustained tibial shaft fracture between October 2014 and December 2018. Univariate analyses were used in the data of demographics, comorbidities, mechanism of injury, concomitant fractures and laboratory biomarkers. Multivariate logistic regression analyses were conducted to determine the independent risk factors associated with DVT. RESULTS In total, 918 patients with an operatively treated tibial shaft fracture were included, among whom 122 patients had preoperative DVTs, indicating a crude morbidity of 13.3%. Ninety-two of 758 (12.1%) patients with isolated tibial shaft fracture developed DVT, while 30 of 160 (18.8%) patients with concurrent fracture presented with DVT. The average interval between fracture and initial diagnosis of DVT was 3.1 days (median, 2 days), ranging from 0 to 33 days. Among DVT-positive patients, 16 (13.1%) patients presented with proximal DVT and 106 (86.9%) patients had distal DVT. Multivariate logistic regression analysis showed four independent risk factors were significantly correlated to the development of DVT, including increased age (OR = 1.17, p = 0.003), diabetes (OR = 1.99, p = 0.009), serum hydroxybutyrate dehydrogenase > 182 U/L (OR = 1.83, p = 0.008), and delay to DUS (in each day) (OR = 1.13, p < 0.001). CONCLUSION In the present cohort study, the incidence of DVT was 12.1% in patients with isolated tibial shaft fracture. We suggest individualized risk stratification and early anticoagulation for patients with high risk factors including pre-existing diabetes, HBDH > 182 U/L, delay to DUS and older age. LEVEL OF EVIDENCE Level III, a prospective cohort study.
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Affiliation(s)
- Jiangtao Ma
- Hebei Orthopedic Clinical Research Center, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
- Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Jin Qin
- Hebei Orthopedic Clinical Research Center, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
- Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Meishuang Shang
- Hebei Orthopedic Clinical Research Center, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
- Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yali Zhou
- Hebei Orthopedic Clinical Research Center, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China
- Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
- Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
- Chinese Academy of Engineering, Beijing, 100088, People's Republic of China.
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People's Republic of China.
- Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
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13
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Cong Y, Huang H, Zhang BF, Deng H, Lei J, Ke C, Han S, Zhang K, Wang P. The Correlation Between Preoperative Lower Extremity Deep Vein Thrombosis (DVT) and the Time from Injury to Surgery (TFITS). Clin Appl Thromb Hemost 2022; 28:10760296221108961. [PMID: 35850538 PMCID: PMC9309766 DOI: 10.1177/10760296221108961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate the correlation between preoperative DVT and the time from
injury to surgery (TFITS), and provide a clinical reference for the
prevention of preoperative DVT. Patients and methods We collected the clinical data of patients with lower extremities fractures
between September 1, 2014, and May 31, 2019. Doppler ultrasonography was
used to diagnose DVT. Patients were divided into the 0-2d group, 3-4d group,
5-7d group, and >7d group according to TFITS. The correlation between
TFITS and preoperative DVT was assessed using logistic regression according
to the adjusted model. Result A total of 2831 patients were included in the study. The mean(+/-SD) TFITS
was 6.11 ± 3.76 (0 to 21 d). A total of 821 (29.0%) cases had preoperative
DVT, with the incidence of DVT being 8.0% in the 0-2d group, 23.8% in the
3-4d group, 32.0% in the 5-7d group, and 36.2% in the >7d group, with
statistically significant differences(P<0.05) among all the groups. The
incidence of preoperative DVT increased with prolonged preoperative time. In
the fully adjusted model, TFITS was positively correlated with the incidence
of preoperative DVT (OR: 1.093; 95% CI: 1.068-1.118; P = 0.000), and the
strength of the association increased with increasing time. Conclusion TFITS was an independent risk factor on the incidence of preoperative DVT.
After excluding the effect of other factors, each 1d increases in TFITS was
correlated with a 9.3% increase in the risk of preoperative DVT. The TFITS
should be decreased to reduce the risk of preoperative DVT.
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Affiliation(s)
- Yuxuan Cong
- Department of Orthopedic Trauma, Honghui Hospital, 12480Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, Shaanxi Province, 710054, People's Republic of China
| | - Hai Huang
- Department of Orthopedic Trauma, Honghui Hospital, 12480Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, Shaanxi Province, 710054, People's Republic of China
| | - Bin-Fei Zhang
- Department of Orthopedic Trauma, Honghui Hospital, 12480Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, Shaanxi Province, 710054, People's Republic of China
| | - Hongli Deng
- Department of Orthopedic Trauma, Honghui Hospital, 12480Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, Shaanxi Province, 710054, People's Republic of China
| | - Jinlai Lei
- Department of Orthopedic Trauma, Honghui Hospital, 12480Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, Shaanxi Province, 710054, People's Republic of China
| | - Chao Ke
- Department of Orthopedic Trauma, Honghui Hospital, 12480Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, Shaanxi Province, 710054, People's Republic of China
| | - Shuang Han
- Department of Orthopedic Trauma, Honghui Hospital, 12480Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, Shaanxi Province, 710054, People's Republic of China
| | - Kun Zhang
- Department of Orthopedic Trauma, Honghui Hospital, 12480Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, Shaanxi Province, 710054, People's Republic of China
| | - Pengfei Wang
- Department of Orthopedic Trauma, Honghui Hospital, 12480Xi'an Jiaotong University, No. 555 Youyi East Road, Xi'an, Shaanxi Province, 710054, People's Republic of China
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Role of a new age-adjusted D-dimer cutoff value for preoperative deep venous thrombosis exclusion in elderly patients with hip fractures. J Orthop Surg Res 2021; 16:649. [PMID: 34717681 PMCID: PMC8557539 DOI: 10.1186/s13018-021-02801-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/18/2021] [Indexed: 11/20/2022] Open
Abstract
Objective This study aimed to describe the characteristics of plasma D-dimer level with increasing age and establish a new age-adjusted D-dimer cutoff value for excluding preoperative lower limb deep vein thrombosis (DVT) in elderly patients with hip fractures. Methods This was a retrospective study of elderly patients who presented with acute hip fracture in our institution between June 2016 and June 2019. All patients underwent D-dimer test and duplex ultrasound. Patients were divided into six 5-year-apart age groups. The optimal cutoff value for each group was calculated by using receiver operating characteristic (ROC) curves, whereby the new age-adjusted D-dimer cutoff value was determined. The sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were calculated and compared when different D-dimer cutoff values were applied, i.e., conventional 0.5 mg/L, previously well-established age-adjusted cutoff value (age × 0.01 mg/L) and the new age-adjusted D-dimer cutoff value herein. Results There were 2759 patients included, 887 males and 1872 females, with an average age of 78 years. In total, 280 patients were diagnosed with preoperative DVT. The optimal cutoff values for the six age groups were 0.715 mg/L, 1.17 mg/L, 1.62 mg/L, 1.665 mg/L, 1.69 mg/L and 1.985 mg/L, respectively, and the calculated age-adjusted coefficient was 0.02 mg/L. With this new coefficient applied, the specificity was 61%, clearly higher than those for conventional threshold (0.5 mg/L, 37%) or previously established age-adjusted D-dimer threshold (age × 0.01 mg/L, 22%). In contrast, the sensitivity was lower than that (59% vs 85% or 77%) when D-dimer threshold of 0.5 mg/L or age-adjusted cutoff value (age × 0.01 mg/L) was used. The other indexes as PPV (15%, 11% and 12%) and NPV (93%, 93% and 94%) were comparable when three different D-dimer thresholds were applied. Conclusions We developed a new age-adjusted D-dimer cutoff value (age × 0.02 mg/L) for a specified high-risk population of patients aged 65 years or older with hip fractures, and demonstrated the improved utility of the D-dimer test for exclusion of DVT. This formula can be considered for use in elderly hip fracture patients who meet the applicable standards as preoperative DVT screening, after its validity is confirmed by more well-evidenced studies.
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Wang J, Breda K, Moon CN, Little MTM, Lin CA. COVID-19 Shelter-In-Place Orders Associated With Delayed Presentation and Deep Venous Thrombosis in Geriatric Hip Fractures. Orthopedics 2021; 44:223-228. [PMID: 34292806 DOI: 10.3928/01477447-20210621-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Geriatric hip fractures benefit from timely surgery. At the onset of the corona-virus disease 2019 (COVID-19) pandemic, shelter-in-place (SIP) orders were mandated in high-risk cities. The authors hypothesized that geriatric patients with hip fractures were more likely to present to the hospital greater than 24 hours after injury during SIP orders. They retrospectively reviewed patients 65 years or older who presented with hip fractures between March 20, 2020, and May 24, 2020 (SIP group), and between March 20, 2019, and May 24, 2019 (historical group). Primary outcomes were incidence of presentation greater than 24 hours after injury and mean number of days between injury and presentation. Secondary outcomes were incidence of preoperative deep venous thrombosis (DVT) and 30- and 90-day mortality rates. Thirty-three patients comprised the SIP group, and 50 patients comprised the historical group. There were no significant differences in their demographics or medical comorbidities. The SIP group was more likely to present greater than 24 hours after injury (P=.05) and presented a greater number of days after injury (P=.02). There was a significant difference in the incidence of preoperative DVT (P=.03). There were no significant differences in 30- and 90-day mortality rates. Geriatric patients who sustained hip fractures during SIP restrictions for COVID-19 were more likely to present greater than 24 hours after injury, have a greater number of days between injury and presentation, and be diagnosed with a preoperative DVT. [Orthopedics. 2021;44(4):223-228.].
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Caesar U, Karlsson L, Hamrin Senorski E, Karlsson J, Hansson-Olofsson E. Delayed and cancelled orthopaedic surgery; are there solutions to reduce the complex set of problems? A systematic literature review. Int J Clin Pract 2021; 75:e14092. [PMID: 33590942 DOI: 10.1111/ijcp.14092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 02/12/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Unexpected cancellations of, and delays to, orthopaedic surgery have adverse effects, with a negative impact on hospital performance and undesirable patient outcomes. As cancellations and delays are common, finding measures to prevent them is a matter of urgency. METHODS The present systematic review conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and the Cochrane Handbook. Peer-reviewed studies reporting on cancellations or delays in patients requiring emergency orthopaedic or planned orthopaedic surgery that compared care action/intervention with no action or traditional care were included. The Grading of Recommendations Assessment, Development and Evaluation used to assess the quality of evidence of the results from the included studies. The objective of the present study was systematically to search and review the literature for qualitative evidence of factors that might reduce cancellations of and delays to orthopaedic surgical procedures. RESULTS The electronic search yielded 1209 studies and eight articles were included in the performed quality assessment. The heterogeneity of the studies and the lack of calculations and statistics in the studies resulted in no meta-analysis. The result of the quality assessment indicated that the evidence ranked from low to very low across the different outcomes. The main limiting factor, which was the reason for a decrease in quality in some outcomes, was the study designs, which were non-randomised control or retrospective approach. The interventions in the included studies could help to support a reduction in the risk of cancelled and delayed orthopaedic procedures. CONCLUSION This systematic literature review has revealed important evidence to help reduce the risk of cancelled and delayed orthopaedic procedures associated with a variety of care action exposures. They include a fast-track pathway, pre-operative guidelines and telephone contact with patients prior to surgery, as well as careful consideration of additional pre-operative tests.
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Affiliation(s)
- Ulla Caesar
- Department of Orthopaedics, Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
- Faculty of Caring Sciences Work Life & Social Welfare, Boras University, Boras, Sweden
| | - Louise Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabeth Hansson-Olofsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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17
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van Rijckevorsel VAJIM, Roukema GR, Klem TMAL, Kuijper TM, de Jong L. Antithrombotics in Patients With a Femoral Neck Fracture: Evaluating Daily Practice in an Observational Cohort Study. Geriatr Orthop Surg Rehabil 2021; 12:21514593211037755. [PMID: 34395048 PMCID: PMC8361536 DOI: 10.1177/21514593211037755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Geriatric hip fracture patients are characterized by frailty due to multiple comorbidities, such as cardiovascular disease, in which the use of antithrombotics is frequent. The aim of this study is to assess the effect of antithrombotics on perioperative care and patient outcomes after hip hemiarthroplasty following current guidelines. Materials and Methods This observational cohort study included all consecutively admitted patients with a femoral neck fracture requiring hip hemiarthroplasty between January 1st 2010, and May 16th 2016, in two level II trauma teaching hospitals. Patients with multiple trauma injuries were excluded. Results In total, n = 907 patients (68% female (n = 615), median age 84 years) were included of which n = 142 used a vitamin K antagonist (VKA) and n = 213 used antiplatelet (AP) therapy. Both were associated with more packed cell supplementation (.4 ± 1.1 units and .3 ± .8 units vs .2 ± .6 units, P < .001 and P = .03, respectively). VKA was associated with more hematomas compared no antithrombotics (23% vs 11%, P = .001). VKA had a longer time to surgery compared to no antithrombotics and AP (24 hours vs 19 and 20 hours, P < .001 and P < .001, respectively) and longer admission duration (9 days vs 7 days P < .001. There were no differences in 30 day mortality nor in 1-year mortality rates. Discussion All modifiable causes for deep SSI, such as hematomas, should be prevented in acute hip fracture surgery. Since antithrombotics are associated with hematomas, an optimal handling in perioperative setting is necessary. Conclusion VKA was associated with longer time to surgery, more hematomas, and longer admission duration. VKA and AP were associated with more packed cell supplementation.
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Affiliation(s)
| | - Gert R Roukema
- Surgery Department, Maasstad Hospital, Rotterdam, the Netherlands
| | - Taco M A L Klem
- Surgery Department, Franciscus Hospital, Rotterdam, the Netherlands
| | | | - Louis de Jong
- Surgery Department, Franciscus Hospital, Rotterdam, the Netherlands
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18
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Outcome of unstable pertrochanteric fractures in high-risk geriatric treated with external fixators. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:867-874. [PMID: 34155571 DOI: 10.1007/s00590-021-03066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/17/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To review the outcome of high-risk geriatrics with unstable pertrochanteric fractures treated with external fixator. METHODS Eighteen consecutive patients with pertrochanteric fractures were operated with external fixator by using closed reduction technique. AO type, accompanying diseases, operating time, transfused blood units, duration of hospitalization, complications, healing time and mortality were recorded. Patients were followed clinically and radiologically for two years at least. The Harris Hip Score was used to document hip function at each regular follow-up. RESULTS Fifteen patients with average age of 71.5 years were available for final evaluation. The mean operating time was 41.1 min and union was achieved in all cases with an average time of 16 weeks. The mean Harris Hip Score at one, three, six, twelve and twenty-four months post-operatively was 42.07 ± 8.55; 55.07 ± 11.62; 70.07 ± 10.32; 86.27 ± 9.06 and 89.27 ± 8.81 respectively. Complications included all the patients undergoing loss of some motion in the knee and four of them had to experience revision surgery because of knee stiffness, ten cases of pin-tract infections, seven cases of deep venous thrombosis, two cases of migration of the screws and two cases limb shortening. CONCLUSIONS The use of external fixator in high-risk geriatric provided a satisfactory long-term efficacy, but the short-term functional results were quite unsatisfactory owing to high complication rate. Therefore, the advantages and disadvantages should be fully weighed when using external fixators, which was especially suitable for those patients who could not tolerate prolonged operative time and open surgery. LEVEL OF EVIDENCE IV Therapeutic study, level 4.
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Zhou FL, Wang LH, Dai CQ, Shentu GJ, Xu GH. Risk Factors and Outcomes for Preoperative Asymptomatic Pulmonary Embolism in Patients Aged 60 Years and Over with Hip Fracture. Orthop Surg 2021; 13:958-965. [PMID: 33818010 PMCID: PMC8126953 DOI: 10.1111/os.12983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the risk factors for, and outcomes of, preoperative asymptomatic pulmonary embolism (PE) in patients ≥60 years old following delayed operation for hip fracture. Methods From March 2017 to December 2018, 90 patients aged ≥60 years with hip fracture who suffered a delay in surgery were recruited to this prospective study following admission to our hospital. Computed tomography pulmonary angiography (CTPA) was used to detect preoperative asymptomatic PE and calculated its incidence. Time from injury to admission, baseline characteristics, medical comorbidities, and blood biomarker levels were evaluated as potential risk factors. Logistic regression analysis was used to identify risk factors. Mortality and major bleeding events were recorded and compared between individuals with PE and without. Data were analyzed by t‐test, Mann–Whitney U test, χ2 test, Fisher's exact test, and logistic regression analysis. Results The incidence of preoperative asymptomatic PE was 18.9% (17/90 patients). In the univariate analysis, the risk factors for preoperative asymptomatic PE were male sex, hypertension, cerebrovascular accident, smoking, plasma D‐dimer level, potassium level, urea level, creatinine level, and cysteine level. Multivariate logistic regression analysis showed that the risk of preoperative asymptomatic PE was higher in patients with hypertension (odds ratio [OR] = 10.048; 95% confidence interval [CI], 1.118–90.333), cerebrovascular accident (OR = 20.135; 95% CI, 1.875–216.164), smoking (OR = 48.741; 95% CI, 4.155–571.788), high plasma D‐dimer levels (OR = 1.200; 95% CI, 1.062–157.300), and high plasma potassium levels (OR = 12.928; 95% CI, 1.062–157.300). All patients were followed up for 21.0 months (range, 2 to 36 months). Mortality within the first year postoperatively was higher in patients with PE (29.41% vs 9.59%, P = 0.046). Conclusions In view of the high incidence of preoperative asymptomatic PE and the inferior prognosis in individuals with PE, routine CTPA examination for preoperative asymptomatic PE could be useful for patients aged ≥60 years with hip fracture for whom surgery is delayed.
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Affiliation(s)
- Fang-Lun Zhou
- Department of Arthrology, Dongyang People's Hospital, Wenzhou Medical University Affiliated Dongyang Hospital, Dongyang, China
| | - Li-Hong Wang
- Department of Arthrology, Dongyang People's Hospital, Wenzhou Medical University Affiliated Dongyang Hospital, Dongyang, China
| | - Cheng-Qian Dai
- Department of Arthrology, Dongyang People's Hospital, Wenzhou Medical University Affiliated Dongyang Hospital, Dongyang, China
| | - Guo-Jian Shentu
- Department of Arthrology, Dongyang People's Hospital, Wenzhou Medical University Affiliated Dongyang Hospital, Dongyang, China
| | - Guo-Hong Xu
- Department of Arthrology, Dongyang People's Hospital, Wenzhou Medical University Affiliated Dongyang Hospital, Dongyang, China
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Fan J, Zhou F, Xu X, Zhang Z, Tian Y, Ji H, Guo Y, Lv Y, Yang Z, Hou G. Clinical predictors for deep vein thrombosis on admission in patients with intertrochanteric fractures: a retrospective study. BMC Musculoskelet Disord 2021; 22:328. [PMID: 33810786 PMCID: PMC8019175 DOI: 10.1186/s12891-021-04196-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/24/2021] [Indexed: 01/22/2023] Open
Abstract
Background Limited studies were available to investigate the prevalence of deep vein thrombosis (DVT) on admission in elderly patients with intertrochanteric fractures. The aim of present study was to evaluate risk factors and the prevalence of pre-admission DVT in elderly patients with intertrochanteric fractures. Methods This retrospective study included 788 elderly patients with intertrochanteric fracture who were eligible for this study from January 1, 2010, to December 31, 2019. Color doppler ultrasonography was performed for DVT detection at admission. All patients’ clinical data were collected. Univariate analysis and stepwise backward multivariate logistic regression were used to identify the risk factors contributing to the occurrence of DVT. Results The overall prevalence of pre-admission DVT in patients with intertrochanteric fractures was 20.81% (164 of 788 patients). The mean time from injury to admission was 2.1 days in the total population, 2.96 and 1.87 days in patients with and without DVT. Univariate analysis showed that significantly elevated risk of DVT were found in patients with longer time from injury to admission, high energy injury, lower Hb value, higher BMI, diabetes, chronic obstructive pulmonary disease (COPD), atrial fibrillation, dementia, varicose veins, higher age-adjusted CCI, higher ASA class and A3 type intertrochanteric fractures (P < 0.05). The adjusted multivariate logistic regression analysis demonstrated that longer time from injury to admission, high energy trauma, COPD, lower Hb, diabetes and A3 type intertrochanteric fractures were independent risk factors of pre-admission DVT. Conclusions A high prevalence of pre-admission DVT was found in elderly Chinese patients with intertrochanteric fractures. Therefore, surgeons should be aware of the high prevalence of DVT for elderly patients with intertrochanteric fractures in order to prevent intraoperative and postoperative PE and other lethal complications.
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Affiliation(s)
- Jixing Fan
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Fang Zhou
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China.
| | - Xiangyu Xu
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Zhishan Zhang
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Yun Tian
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Hongquan Ji
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Yan Guo
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Yang Lv
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Zhongwei Yang
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Guojin Hou
- Department of Orthopedics, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
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Abstract
Hip fracture is a leading cause of profound morbidity in individuals aged 65 years and older, ranking in the top 10 causes of loss of disability-adjusted life-years for older adults. Worldwide, the number of people with hip fracture is expected to rise significantly due to the aging population and other factors. Physical therapist management is recommended within medical, surgical, and multidisciplinary clinical practice guideline (CPGs) and is considered to be the standard of care in rehabilitation for people with hip fracture. The goal of this CPG was to review the evidence relevant to physical therapist management and to provide evidence-based recommendations for physical therapy diagnosis, prognosis, intervention, and assessment of outcome in adults with hip fracture. J Orthop Sports Phys Ther 2021;51(2):CPG1-CPG81. doi:10.2519/jospt.2021.0301.
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Incidence and risk factors for deep venous thrombosis of lower extremity after surgical treatment of isolated patella fractures. J Orthop Surg Res 2021; 16:90. [PMID: 33509241 PMCID: PMC7844981 DOI: 10.1186/s13018-021-02240-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/17/2021] [Indexed: 01/27/2023] Open
Abstract
Background Limited information exists on the incidence of postoperative deep venous thromboembolism (DVT) in patients with isolated patella fractures. The objective of this study was to investigate the postoperative incidence and locations of deep venous thrombosis (DVT) of the lower extremity in patients who underwent isolated patella fractures and identify the associated risk factors. Methods Medical data of 716 hospitalized patients was collected. The patients had acute isolated patella fractures and were admitted at the 3rd Hospital of Hebei Medical University between January 1, 2016, and February 31, 2019. All patients met the inclusion criteria. Medical data was collected using the inpatient record system, which included the patient demographics, patient’s bad hobbies, comorbidities, past medical history, fracture and surgery-related factors, hematological biomarkers, total hospital stay, and preoperative stay. Doppler examination was conducted for the diagnosis of DVT. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors. Results Among the 716 patients, DVT was confirmed in 29 cases, indicating an incidence of 4.1%. DVT involved bilateral limbs (injured and uninjured) in one patient (3.4%). DVT involved superficial femoral common vein in 1 case (3.4%), popliteal vein in 6 cases (20.7%), posterior tibial vein in 11 cases (37.9%), and peroneal vein in 11 cases (37.9%). The median of the interval between surgery and diagnosis of DVT was 4.0 days (range, 1.0-8.0 days). Six variables were identified to be independent risk factors for DVT which included age category (> 65 years old), OR, 4.44 (1.34-14.71); arrhythmia, OR, 4.41 (1.20-16.15); intra-operative blood loss, OR, 1.01 (1.00-1.02); preoperative stay (delay of each day), OR, 1.43 (1.15-1.78); surgical duration, OR, 1.04 (1.03-1.06); LDL-C (> 3.37 mmol/L), OR, 2.98 (1.14-7.76). Conclusion Incidence of postoperative DVT in patients with isolated patella fractures is substantial. More attentions should be paid on postoperative DVT prophylaxis in patients with isolated patella fractures. Identification of associated risk factors can help clinicians recognize the risk population, assess the risk of DVT, and develop personalized prophylaxis strategies.
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Ma J, Du P, Qin J, Zhou Y, Liang N, Hu J, Zhang Y, Zhu Y. Incidence and risk factors predicting deep venous thrombosis of lower extremity following spinal fractures. Sci Rep 2021; 11:2441. [PMID: 33510388 PMCID: PMC7843965 DOI: 10.1038/s41598-021-82147-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/15/2021] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to investigate the presence of preoperative DVT following spinal fracture and the association between the presence of DVT and risk factors. Ultrasonography and blood analyses were performed preoperatively in patients diagnosed with spinal fracture between October 2014 and December 2018. Univariate analyses were performed on the data of demographics, comorbidities, location of injury, spinal cord injury (SCI) grading and laboratory biomarkers. The receiver operating characteristic (ROC) curve analysis was employed to obtain the optimal D-dimer cut-off value for diagnosis. In total, 2432 patients with spinal fractures were included, among whom 108 (4.4%) patients had preoperative DVTs. The average interval between fracture and initial diagnosis of DVT was 4.7 days (median, 2 days), ranging from 0 to 20 days; 78 (72.2%) were diagnosed within 7 days after injury and 67 (62.0%) within 3 days; 19 (17.5%) patients had proximal vein involved and 89 (82.4%) presented in distal veins. Multivariate logistic regression suggested six risk factors independently correlated to DVT, including delay to DUS (in each day) (odds ratio [OR] = 1.11), ASA class III-IV (OR = 2.36), ASIA grade (A/B) (OR = 2.36), ALB < 3.5 g/dL (OR = 2.08), HDL-C < 1.1 mmol/L (OR = 1.68) and D-Dimer > 1.08 µg/ml (OR = 2.49).
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Affiliation(s)
- Jiangtao Ma
- Hebei Orthopedic Clinical Research Center, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Pei Du
- Department of Infection Control and Prevention, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Jin Qin
- Hebei Orthopedic Clinical Research Center, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yali Zhou
- Hebei Orthopedic Clinical Research Center, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Ningxi Liang
- Hebei Orthopedic Clinical Research Center, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Jinglve Hu
- Hebei Orthopedic Clinical Research Center, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Chinese Academy of Engineering, Beijing, 100088, People's Republic of China.
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Orthopaedic Institution of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, People's Republic of China.
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Post-operative deep vein thrombosis in patients over sixty years of age diagnosed with closed distal femur fractures undergoing open reduction internal fixation. INTERNATIONAL ORTHOPAEDICS 2021; 45:1615-1623. [PMID: 33420554 DOI: 10.1007/s00264-020-04933-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE New-onset deep vein thrombosis (DVT) reportedly affects prognosis and surgical outcomes of elderly patients. However, its effect on distal femur fractures (DFFs) remains unclear. We aimed to address the epidemiological characteristics and the associated predictors for post-operative DVT in patients with closed DFFs over age 60 years old. PATIENTS AND METHODS We designed a prospective cohort trial at our hospital between October 2018 and June 2020 and recruited consecutive 140 patients over age 60 years diagnosed with closed DFFs. We examined location and prognosis of postoperative DVT and then conducted a three month follow-up. We used Duplex ultrasonography (DUS) to diagnose DVT in all patients and then classified the subjects into DVT and non-DVT groups. We further classified DVTs into proximal, distal, and mixed thromboses and then performed Whitney U test or t test, receiver operating characteristic (ROC) curve analysis, Chi-square test, and multiple logistic regression analysis to confirm the adjusted factors of post-operative DVT. RESULTS We found a 35% (n = 49) overall incidence of post-operative DVTs, which occurred 5.7 days following open reduction internal fixation (ORIF). Among patients with post-operative DVTs, 53.1% (n = 26) and 10.2% (n = 5) were distal and proximal thromboses, respectively. Additionally, peroneal veins were the most common DVT sites (71.4%, n = 35). Multivariate analysis revealed that venous thrombosis at admission (odds ratio [OR], 4.619; 95% confidence interval [CI]: 2.072-10.299; P = 0.000), operation duration over 195 minutes (OR, 3.289; 95% CI, 1.155-9.370; P = 0.026), intra-operative blood loss over 325 mL (OR, 2.538; 95% CI, 1.047-6.155; P = 0.039) were the three independent risk factors of post-operative DVT. Unified antithrombotic agents after diagnosis showed that 16.3% (n = 8) of DVTs were completely recanalized, 12.6 days after first diagnosis. CONCLUSION Our findings indicate a strong association between venous thrombosis at admission, the longer operation duration, and considerable intra-operative blood loss with high risk of post-operative DVTs in patients over age 60 years with closed DFFs. Preventive approaches for postoperative DVTs should seek to shorten operation duration and reduce intra-operative blood loss.
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Cao J, Li S, Ma Y, Li Z, Liu G, Liu Y, Jiao J, Zhu C, Song B, Jin J, Liu Y, Wen X, Cheng S, Wan X, Wu X. Risk factors associated with deep venous thrombosis in patients with different bed-rest durations: A multi-institutional case-control study. Int J Nurs Stud 2020; 114:103825. [PMID: 33352438 DOI: 10.1016/j.ijnurstu.2020.103825] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/16/2020] [Accepted: 10/29/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Deep vein thrombosis represents a threat to public health and a heavy economic burden to society, and often occurs as a complication or cause of death in bedridden patients. How to prevent deep vein thrombosis is a general concern in clinical practice. However, it remains uncertain whether the risk factors for deep vein thrombosis would be affected by different bed-rest durations. Solving this issue will be invaluable for the provision of more rational medical care to prevent deep vein thrombosis. OBJECTIVE To explore whether risk factors for deep vein thrombosis are affected by bed-rest durations and to identify different risk factors in groups with different bed-rest durations. DESIGN A retrospective multicenter case-control study. SETTINGS AND PARTICIPANTS This multicenter study was conducted in wards with high rates of bed rest in 25 general hospitals in China. Participants were bedridden patients from these wards. METHODS Bedridden patients were identified from the research database of bedridden patients' major immobility complications. These data were collected from prospective descriptive studies by a standardized web-based online case report form. Cases were defined as bedridden patients who suffered deep vein thrombosis during hospitalization (n=186). Each case was matched with three controls, bedridden patients who did not suffer deep vein thrombosis in the same center with the same bed-rest duration (n=558). Descriptive statistics, univariate analysis, and multivariate conditional logistic regression models were employed. RESULTS Among 23,985 patients, the overall incidence of deep vein thrombosis during hospitalization was 1.0%. Multivariate analysis showed that for patients with bed-rest duration of 4 weeks or less, older age (odds ratio [OR] =1.027, 95% confidence interval [CI] 1.013-1.041) and being in a surgical department (OR=2.527, 95% CI 1.541-4.144) were significantly associated with increased risk of deep vein thrombosis. Female sex (OR=4.270, 95% CI 1.227-14.862), smoking (OR=10.860, 95% CI 2.130-55.370), and special treatment (OR=3.455, 95% CI 1.006-11.869) were independent factors predicting deep vein thrombosis for patients with bed-rest durations from 5 to 8 weeks. For those with bed-rest durations from 9 to 13 weeks, Charlson Comorbidity Index (OR=1.612, 95% CI 1.090-2.385) was the only independent risk factor for deep vein thrombosis. CONCLUSIONS Risk factors for deep vein thrombosis varied among patients with different bed-rest durations. This finding is helpful for nurses to increase their awareness of prevention of deep vein thrombosis in patients with different bed-rest durations, and lays a more solid foundation for clinical decision making.
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Affiliation(s)
- Jing Cao
- Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, China.
| | - Shuya Li
- Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, China.
| | - Yufen Ma
- Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Zhen Li
- Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Ge Liu
- Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Ying Liu
- Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Jing Jiao
- Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Chen Zhu
- Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, China
| | - Baoyun Song
- Department of Nursing, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yilan Liu
- Department of Nursing, Wuhan Union Hospital, Wuhan, Hubei, China
| | - Xianxiu Wen
- Department of Nursing, Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Shouzhen Cheng
- Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Beijing, China
| | - Xinjuan Wu
- Chinese Academy of Medical Sciences, Peking Union Medical College, Peking Union Medical College Hospital, 1 Shuaifuyuan, Dongcheng District, Beijing, China.
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Yoon JY, Kim S, Chang JS, Yoon PW, Kim JW. Venous thromboembolism after delayed surgery for a hip fracture: A retrospective cohort study. Geriatr Gerontol Int 2020; 20:1151-1156. [PMID: 33058481 DOI: 10.1111/ggi.14055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/15/2020] [Accepted: 09/24/2020] [Indexed: 01/14/2023]
Abstract
AIM The purpose of this study was to investigate the demographic characteristics and prevalence of postoperative venous thromboembolism (VTE) in delayed hip fracture patients referred to our hospital (a tertiary referral center), and further verify the effect of intensive prophylaxis protocol in preventing the occurrence of VTE. METHODS We retrospectively evaluated 264 hip fracture patients whose surgery was delayed by >24 h. The patients were divided into two groups, according to the VTE prophylaxis protocol (conventional vs intensive). We evaluated the time from injury to surgery, and analyzed the prevalence of postoperative symptomatic VTE between the groups. The patient outcome measures, including in-hospital mortality and 30-day-mortality after hip surgery, were also evaluated. RESULTS The mean time from injury to operation was 127.4 h (95% confidence interval 92.2-162.7 h). The incidence of postoperative symptomatic VTE was 5.9% in the conventional prophylaxis group and 0.8% in the intensive prophylaxis group. The intensive prophylaxis group had a significantly lower incidence of postoperative VTE (P = 0.036). Eight patients with deep vein thrombosis on preoperative screening who underwent inferior vena cava filter insertion did not develop postoperative symptomatic VTE. Logistic regression analysis results also showed that the protocol statistically reduced the development of VTE (odds ratio 0.14, 95% CI 0.02-1.21, P = 0.042). CONCLUSIONS Delayed hip fracture surgery resulted in a higher incidence of VTE in patients who received conventional prophylaxis; however, our intensive prophylaxis protocol successfully prevented postoperative symptomatic VTE, including pulmonary embolism. Geriatr Gerontol Int 2020; 20: 1151-1156.
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Affiliation(s)
- Jae Youn Yoon
- Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Shinseok Kim
- Department of Orthopaedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jae Suk Chang
- Department of Orthopaedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Pil Whan Yoon
- Department of Orthopaedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopaedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Xu Y, You D, Krzyzaniak H, Ponich B, Ronksley P, Skeith L, Salo P, Korley R, Schneider P, Carrier M. Effect of oral anticoagulants on hemostatic and thromboembolic complications in hip fracture: A systematic review and meta-analysis. J Thromb Haemost 2020; 18:2566-2581. [PMID: 32574420 DOI: 10.1111/jth.14977] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hip fracture patients on oral anticoagulants (OACs) experience increased time-to-surgery and higher mortality compared to non-anticoagulated patients. However, it is unclear whether pre-injury OAC status and its associated operative delay are associated with worsening of peri-operative hemostasis or an increased risk of postoperative thromboembolism. METHODS We performed a systematic review to identify studies that directly compared hemostatic and thromboembolic outcomes among hip fracture patients on an OAC prior to admission with those not on anticoagulants. Random effects meta-analyses were used to pool all outcomes of interest (estimated blood loss, transfusion requirements, and postoperative thromboembolism). RESULTS Twenty-one studies involving 21 417 patients were included. Estimated blood loss was higher among patients presenting with OACs compared to those not anticoagulated (mean difference 31.0 mL, 95% confidence interval [CI] 6.2-55.7). Anticoagulated patients also had a 1.3-fold higher risk of receiving red blood cell transfusions (odds ratio [OR] 1.34, 95% CI 1.20-1.51); however, rates of postoperative thromboembolism were similar regardless of anticoagulation status (OR 0.96, 95% CI 0.40-2.79 for venous thromboembolism; OR 0.58, 95% CI 0.25-1.36 for arterial thromboembolism). No subgroup effect was found based on anticoagulant type or degree of surgical delay. CONCLUSION Hip fracture patients on OACs experience increased surgical blood loss and higher risk of red blood cell transfusions. However, the degree of surgical delay did not mitigate this risk, and there was no difference in postoperative thromboembolism. The impact of appropriate, timely OAC reversal on blood conservation and expedited surgery in anticoagulated hip fracture patients warrants urgent evaluation.
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Affiliation(s)
- Yan Xu
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Daniel You
- Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Halli Krzyzaniak
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brett Ponich
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Leslie Skeith
- Department of Medicine, Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, AB, Canada
| | - Paul Salo
- Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Robert Korley
- Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Prism Schneider
- Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Fu YH, Liu P, Xu X, Wang PF, Shang K, Ke C, Fei C, Yang K, Zhang BF, Zhuang Y, Zhang K. Deep vein thrombosis in the lower extremities after femoral neck fracture: A retrospective observational study. J Orthop Surg (Hong Kong) 2020; 28:2309499019901172. [PMID: 31994963 DOI: 10.1177/2309499019901172] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The actual incidence of deep vein thrombosis (DVT) in femoral neck fractures is underestimated. This study aimed to investigate the incidence of DVT in the lower extremities after femoral neck fracture before and after operation. METHODS The clinical data of patients with femoral neck fractures treated at Xi'an Honghui Hospital between July 1, 2016, and December 31, 2018, were collected. The patients were examined with ultrasonography before and after operation and divided into thrombosis and non-thrombosis groups according to their ultrasonographic results. The incidence of DVT was reported as a percentage. RESULTS The incidence rates of preoperative and postoperative DVT were 32% and 56%, respectively. DVT on the uninjured side constituted 45% of all preoperative DVT and 43% of all postoperative DVT. Peripheral DVT constituted 90% and 84% of all preoperative and postoperative DVT, respectively. Diabetes was an independent risk factor of preoperative DVT. Blood loss was an independent risk factor of postoperative DVT, and open reduction and internal fixation surgical procedure was independent protective factor of postoperative DVT as compared with hemiarthroplasty and total hip replacement. CONCLUSIONS The incidence rates of preoperative and postoperative DVT in the patients with femoral neck fracture were high, and orthopedists should pay more attention to DVT as a complication.
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Affiliation(s)
- Ya-Hui Fu
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Ping Liu
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Xin Xu
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Peng-Fei Wang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Kun Shang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Chao Ke
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Chen Fei
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Kun Yang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Bin-Fei Zhang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Yan Zhuang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Kun Zhang
- Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, People's Republic of China
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Deep Vein Thrombosis in Patients with Intertrochanteric Fracture: A Retrospective Study. Indian J Orthop 2020; 54:101-108. [PMID: 32952916 PMCID: PMC7474015 DOI: 10.1007/s43465-020-00166-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/01/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to investigate the incidences of pre- and post-operative lower extremity deep venous thrombosis (DVT) in hospitalized patients with intertrochanteric fractures and to analyze the relevant risk factors. METHODS A retrospective study was conducted between July 2014 and October 2016 in 218 intertrochanteric fracture patients who presented at Xi'an Honghui Hospital and underwent Doppler ultrasonography for DVT diagnosis. We divided DVT into distal, proximal, and mixed thrombosis. Patients were divided into either the thrombosis or no thrombosis group according to preoperative and postoperative ultrasonography results. All patients were evaluated for the risk factors associated with thrombosis. RESULTS A total of 37.61% of preoperative patients had DVT, and the postoperative incidence increased to 58.72%. The days between fracture and hospitalization and the days between fracture and surgery were independent risk factors for preoperative DVT. The days between fracture and hospitalization and d-dimer levels at postoperative 1 day were independent risk factors of postoperative DVT. In total 23.4% of the patients progressed from having no thrombosis preoperatively to having distal, proximal, or mixed DVT postoperatively (22.02%, 0.46%, and 0.92%, respectively). Distal DVT constituted 86.59% and 90.63% of all preoperative and postoperative DVTs, respectively. CONCLUSION Intertrochanteric fracture is a common type of hip fracture in the elderly, and the incidence of DVT after intertrochanteric fracture may be underestimated. Early intervention (early admission and early surgery) might reduce the incidence of DVT.
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Feng L, Xu L, Yuan W, Xu Z, Feng Z, Zhang H. Preoperative anemia and total hospitalization time are the independent factors of preoperative deep venous thromboembolism in Chinese elderly undergoing hip surgery. BMC Anesthesiol 2020; 20:72. [PMID: 32241254 PMCID: PMC7114807 DOI: 10.1186/s12871-020-00983-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 03/10/2020] [Indexed: 12/25/2022] Open
Abstract
Background This study was designed to explore the prevalence and risk factors of preoperative deep venous thromboembolism (DVT) in Chinese elderly with hip fracture. Methods From January 1, 2012, to December 31, 2018, 273 elderly patients over 70 years old with elective hip surgery were collected from the electronic medical records. Collected data included demographic characteristics, comorbidities, ASA classification, types of previous operations, types of anesthesia, operation time, fracture to operation time, preoperative hemoglobin level, anemia, blood-gas analysis, cardiac function, whether transfusion, preoperative hospitalization, postoperative hospitalization, electrocardiograph, lower limb venous ultrasonography and total hospitalization time. Results In these 273 patients, 15(5.6%) had ultrasonography evidence of DVT in affected limbs before surgery. Three of all patients received an temporary inferior vena cave filter placement preoperatively. Fracture to surgery time, preoperative hemoglobin level, anemia, preoperative hospitalization, pulmonary disease and total hospitalization time were statistically different between DVT group and non-DVT group (P < 0.05 for all). Moreover, preoperative anemia (OR: 0.144, 95%CI: 0.026–0.799, P = 0.027) and total hospitalization time (OR: 1.135; 95%CI: 1.023–1.259, P = 0.017) were the two independent risk factors for preoperative DVT. Conclusion Preoperative anemia and total hospitalization time were independent risk factors for venous DVT in Chinese elderly with hip fracture.
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Affiliation(s)
- Long Feng
- Medicine School of Chinese PLA, No.28, Fuxing Road, Beijing, 100853, China.,Department of Anesthesia, Hainan Hospital of Chinese PLA General Hospital, No.80, Jianglin Road, Sanya, 572000, China
| | - Longhe Xu
- Department of Anesthesia Operation Center, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing, 100853, China
| | - Weixiu Yuan
- Department of Anesthesia, Hainan Hospital of Chinese PLA General Hospital, No.80, Jianglin Road, Sanya, 572000, China
| | - Zhipeng Xu
- Department of Anesthesia Operation Center, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing, 100853, China
| | - Zeguo Feng
- Department of Anesthesia Operation Center, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing, 100853, China.
| | - Hong Zhang
- Medicine School of Chinese PLA, No.28, Fuxing Road, Beijing, 100853, China. .,Department of Anesthesia Operation Center, Chinese PLA General Hospital, No.28, Fuxing Road, Beijing, 100853, China.
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Kim HC, Park JH, Song JM, Hwang JJ, Hong SB, Oh YM, Lee SD, Lee JS. Safety of early orthopedic surgery in patients with intermediate/low- or low-risk pulmonary embolism. J Thorac Dis 2020; 12:232-239. [PMID: 32274089 PMCID: PMC7138980 DOI: 10.21037/jtd.2020.01.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Preoperative pulmonary embolism (PE) is one of the comorbidities in patients with hip fracture. However, previous studies have not identified the optimal timing of surgery in these patients, who might require early surgery. This study aimed to investigate the safety and clinical feasibility of early surgery in patients with hip fracture and acute PE. Methods The medical records of 156 patients with hip fracture, who were suspected to have PE and underwent pulmonary computed tomography angiography at Asan Medical Center from January 2008 to December 2017, were retrospectively reviewed. After excluding patients who were diagnosed with PE during the postoperative period, the baseline characteristics and clinical course were compared between patients preoperatively diagnosed with PE (PE group) and patients without PE during the hospital stay (non-PE group). Adverse outcomes were evaluated during 3 months postoperatively. Results The baseline characteristics were not different between the PE group (n=90) and the non-PE group (n=50). All patients in the PE group were classified as having an intermediate/low or low risk according to the European Society of Cardiology guidelines and underwent surgery within 30 days after the PE diagnosis (median duration: 2 days). None of the patients in both groups developed symptomatic venous thromboembolism (VTE) during the follow-up. Moreover, there were no statistically significant differences in major bleeding, clinically relevant nonmajor (CRNM) bleeding, transfusion amount, bleeding site, and length of hospital stay between the PE and non-PE groups. Conclusions Our results suggest that early surgery might be a reasonable treatment option in patients with hip fracture and acute PE.
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Affiliation(s)
- Ho Cheol Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin-Han Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jong-Min Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.,Center for Pulmonary Hypertension and Venous Thrombosis, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae-Joon Hwang
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.,Center for Pulmonary Hypertension and Venous Thrombosis, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang-Do Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.,Center for Pulmonary Hypertension and Venous Thrombosis, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Thromboprophylaxis an update of current practice: Can we reach a consensus? OTA Int 2019; 2:e027. [PMID: 33937659 PMCID: PMC7997114 DOI: 10.1097/oi9.0000000000000027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 12/17/2018] [Indexed: 12/21/2022]
Abstract
Diagnosis, prophylaxis, and management of venous thromboembolism (VTE) in patients with fractures remain a highly controversial topic with little consensus in clinical practice or the literature. The following manuscript represents a summary of evidence presented at the 2017 OTA Annual Meeting Symposium; "Thromboprophylaxis an Update of Current Practice: Can We Reach A Consensus?" The need for prophylaxis in pelvic and acetabular fracture patients; the existing body of evidence related to VTE, pulmonary embolism (PE), and prophylaxis for patients with fractures about the knee; current evidence in Edinburgh Scotland, regarding VTE prophylaxis in patients with isolated ankle fractures and the risk of VTE in patients with a hip fracture are topics that are addressed. The reader will benefit from the wisdom of this compilation of global contributions on thromboprophylaxis.
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Impression of Delayed Pelvic and Acetabular Fracture Fixation on the Prevalence of Preoperative Venous Thromboembolic Events. Trauma Mon 2019. [DOI: 10.5812/traumamon.84945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
Venous thromboembolism (VTE) including pulmonary embolism (PE) and deep vein thrombosis (DVT) is one of the leading causes of preventable cardiovascular disease in the United States (US) and is the number one preventable cause of death following a surgical procedure. Post-operative VTE is associated with multiple short and long-term complications. We will focus on reviewing the many faces of VTE in detail as they represent common challenging scenarios in clinical practice.
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Xing F, Li L, Long Y, Xiang Z. Admission prevalence of deep vein thrombosis in elderly Chinese patients with hip fracture and a new predictor based on risk factors for thrombosis screening. BMC Musculoskelet Disord 2018; 19:444. [PMID: 30572863 PMCID: PMC6302421 DOI: 10.1186/s12891-018-2371-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 12/04/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Elderly hip fracture (HF) patients are at very high risk of developing deep vein thrombosis (DVT), which increases their perioperative mortality. However, data focusing on the admission prevalence of DVT in elderly Chinese patients with hip fracture are limited. Venography and ultrasonography are not suitable for most elderly HF patients; there is also controversy about the prognostic value of D-dimer in elderly patients. Thus, our primary goal was to clarify the prevalence of and risk factors for DVT in elderly Chinese HF patients at admission. Our secondary goal was to evaluate the diagnostic value of a new predictor of DVT based on the risk factors for elderly HF patients. METHODS This retrospective study was conducted in the West China Hospital, Sichuan University. Between January 2015 and January 2017, 248 elderly Chinese HF patients (> 60 years) were enrolled in this study. The subjects were diagnosed with DVT using ultrasonography or venography. All the patients' clinical data were obtained, including demographic variables, medical history, comorbidities, and laboratory results. A stepwise multiple logistic regression analysis was used to identify the risk factors contributing to the occurrence of DVT. The value of the new DVT predictor was calculated using a formula based on the coefficient regression and independent variables. A receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic value of different factors. RESULTS Of the study patients, 74 (29.8%) were diagnosed with DVT, including sixty-five (87.8%) with distal peripheral, five (6.8%) with proximal central and four (5.4%) with mixed DVT. A multivariate logistic regression analysis showed that five risk factors increased the occurrence of DVT at admission, including gender, age, time from injury to admission, fibrinogen, and D-dimer. The new DVT predictor was calculated using the following formula: 1.131× (female = 1, male = 0) + 0.071 × age (years) + 0.571 × time from injury to admission (days) + 1.028 × fibrinogen(g/L) + 0.123 × D-dimer(g/L). The diagnostic value of the new predictor was highest among those risk predictors whose AUC (area under the ROC curves) value was 0.852. CONCLUSIONS The results of this study revealed a high prevalence of DVT in elderly Chinese HF patients at admission. Moreover, the new predictor, based on risk factors, was a good method to improve the diagnosis of DVT.
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Affiliation(s)
- Fei Xing
- Department of Orthopaedics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Lang Li
- Department of Orthopaedics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ye Long
- Department of Orthopaedics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zhou Xiang
- Department of Orthopaedics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, 610041, Sichuan, People's Republic of China.
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High prevalence of deep vein thrombosis in elderly hip fracture patients with delayed hospital admission. Eur J Trauma Emerg Surg 2018; 46:913-917. [PMID: 30523360 DOI: 10.1007/s00068-018-1059-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Deep vein thrombosis (DVT) is a common complication in hip fracture patients, associated with significant morbidity and mortality. Research has focused on postoperative DVT, with scant reports on preoperative prevalence. The aim of this study was to describe the prevalence of preoperative DVT in patients accessing medical care ≥ 48 h after a hip fracture. METHODS We included elderly patients admitted ≥ 48 h after sustaining a hip fracture, between September 2015 and October 2017. Patients with a previous episode of DVT, undergoing anticoagulation therapy, with pathologic fractures or undergoing cancer treatment were excluded. Of 273 patients, 59 were admitted at least 48 h after the fracture. DVT screening by Doppler ultrasound of both lower extremities was carried upon hospital admission. We recorded age, sex, Charlson comorbidity index and ASA score, fracture type, time since injury, time from admission to surgery and total length of hospital stay. RESULTS We studied 41 patients, 79 (± 10.34) years old. The delay from injury to admission was 120 h (48-696 h). Seven patients (17.1%) had a DVT upon admission. There were no significant differences between patients with and without DVT, regarding time from admission to surgery or the total length of the hospital stay. CONCLUSIONS The prevalence of DVT in patients admitted ≥ 48 h after a hip fracture was 17.1%. The diagnosis and management of DVT did not increase time to surgery or hospital stay. Our results suggest routine screening for DVT in patients consulting emergency services ≥ 48 h after injury.
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Xia ZN, Xiao K, Zhu W, Feng B, Zhang BZ, Lin J, Qian WW, Jin J, Gao N, Qiu GX, Weng XS. Risk assessment and management of preoperative venous thromboembolism following femoral neck fracture. J Orthop Surg Res 2018; 13:291. [PMID: 30458869 PMCID: PMC6245713 DOI: 10.1186/s13018-018-0998-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/06/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Limited studies are available to investigate the prevalence of preoperative venous thromboembolism (VTE) in elderly patients with femoral neck fractures. Our primary aim was to determine the incidences of VTE and its risk or protective factors in such patient population. The secondary objective was to evaluate the need of therapeutic anticoagulation for isolated calf muscular venous thrombosis (ICMVT) prior to femoral neck fracture surgery. METHODS This is a retrospective case-control study, including 301 femoral neck fracture patients who were admitted to our institution between January 2014 and March 2017. Bilateral Doppler ultrasonography was performed in each of the patients as a preoperative VTE screening. The event rate of VTE was calculated, and significant risk or protective factors were determined by using a multivariate logistic regression model. Patients with ICMVT were divided into anticoagulation and no anticoagulation groups to assess the efficacy and safety of preoperative therapeutic anticoagulation. Intraoperative blood loss, drainage volume, blood transfusion, perioperative hemoglobin change, and rate of thrombosis extension were compared between the two groups. RESULTS The overall preoperative incidence of VTE in patients with femoral neck fracture was 18.9% (57/301), in which deep vein thrombosis (DVT) was 18.9% and pulmonary embolism (PE) was 1%. Among the DVT cases, 77.2% (44/57) were ICMVTs. Multiple fractures (odds ratio [OR] = 9.418; 95% confidence interval [CI] = 2.537 to 34.96), coexisting movement disorder (OR = 3.862; 95% CI = 1.658 to 8.993), bed rest for more than 7 days (OR = 2.082; 95% CI = 1.011 to 4.284) as well as elevated levels of D-dimer (OR = 1.019; 95% CI = 1.002 to 1.037) and fibrinogen (OR = 1.345; 95% CI = 1.008 to 1.796) led to an increase in the risk of VTE, while the recent use of antiplatelet drug (OR = 0.424; 95% CI = 0.181 to 0.995) and prophylactic anticoagulation (OR = 0.503; 95% CI = 0.263 to 0.959) decreased the risk of VTE. For the 39 patients with ICMVT undergoing femoral neck fracture surgery, there were no significant differences in the rate of thrombosis extension between anticoagulation and no anticoagulation groups, but significantly decreased postoperative hemoglobin was observed in the anticoagulation group. CONCLUSION Our findings showed a high prevalence of preoperative VTE in elderly patients with femoral neck fracture, with risk factors identified. We found that the most detected VTE were ICMVTs. Our study suggested that a direct surgery without preoperative use of therapeutic anticoagulation for ICMVT would not reduce the risk of thrombus extension, and the therapeutic use of anticoagulation may worsen postoperative anemia.
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Affiliation(s)
- Ze-Nan Xia
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Ke Xiao
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Wei Zhu
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Bin Feng
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Bao-Zhong Zhang
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jin Lin
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Wen-Wei Qian
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jin Jin
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Na Gao
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Gui-Xing Qiu
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Xi-Sheng Weng
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China.
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Green CM, Shah N. A Protocol for the Management of the Inpatient Fracture Neck of Femur is Required. Open Orthop J 2018; 12:358-363. [PMID: 30288190 PMCID: PMC6142671 DOI: 10.2174/1874325001812010358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/30/2018] [Accepted: 08/07/2018] [Indexed: 11/24/2022] Open
Abstract
Falls within a hospital environment are a major cause of morbidity and may even lead to mortality. Pathways for patients suffering a Fractured Neck of Femur (FNOF) in the community are well established following the development of the Blue Book, BOAST guidelines and National Hip Fracture Database (NHFD). However, there is no such agreed pathway for patients suffering FNOF within a hospital environment. Such patients have been demonstrated to have a higher risk of delays in medical optimisation, delays in operative management, and mortality. There is, therefore, a need to create a nationally agreed guideline for the care of the “inpatient FNOF” as this is an important subgroup of patients. This article highlights this issue as well as advising medical staff on how to identify a potential FNOF within a hospital environment in order to ensure prompt management of a vulnerable group of patients.
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Affiliation(s)
- Carl Malcolm Green
- Cavendish Hip Fellow, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Herries Road, Sheffield, S5 7AU, England
| | - Nikhil Shah
- Consultant Orthopaedic Surgeon, Wrightington Hospital, Hall Lane, Wigan, WN6 9EP, England
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Perioperative incidence and locations of deep vein thrombosis following specific isolated lower extremity fractures. Injury 2018; 49:1353-1357. [PMID: 29804881 DOI: 10.1016/j.injury.2018.05.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/14/2018] [Accepted: 05/22/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine perioperative incidence and locations of deep vein thrombosis (DVT) in injured and uninjured lower extremities following isolated lower extremity fractures (ILEFs). METHODS Retrospective analysis of a prospectively collected data of a consecutive patient series with ILEFs who underwent surgical treatment between September 2014 and September 2017 was performed. Patients' bilateral lower extremities were screened for DVT with duplex ultrasonography (DUS) before and after surgery. DVT occurrence was analyzed by location of DVT and fracture site. All patients received pharmacologic thromboprophylaxis while hospitalized. Data on demographics, time to surgery, time of DUS examinations, length of hospital stay and symptomatic pulmonary embolism (PE) was collected. RESULTS 1825 patients were included in the study. The incidence of symptomatic PE was 1.6%. All patients were screened with DUS of the bilateral lower extremities in a mean of 3.5 days (range: 0-18 days) after injury, and a mean of 3.6 days (range: 1-11 days) after surgery. Preoperative DUS detected DVT in 547 patients (30.0%), including 3.7% of patients with proximal DVT. 792 patients (43.4%) were found to have a DVT postoperatively, but only 6.2% of patients with proximal DVT. Proximal DVT was detected postoperatively of the represented fractures: 6.5% of the hip, 14.5% of the femoral shaft, 4.5% of the tibial plateau, 4.6% of the tibial shaft, 1.7% of the patellar, and 2.0% of the peri-ankle. Interestingly, the rate of DVT in an uninjured lower limb was significantly higher postoperatively compared to preoperatively (16.4% vs. 4.9%), however, only 0.2% of patients had proximal DVT. CONCLUSIONS While the perioperative incidence of overall DVT is high following ILEFs, the majority were distal DVT, and the rate of symptomatic PE was low. Femoral shaft fractures were associated with the highest incidence for proximal DVT. The incidence was lower in more distal fractures. The majority of patients diagnosed with DVT postoperatively had already shown symptoms of DVT prior to surgery. DVT can occur in both the injured and uninjured leg, with an obviously higher incidence in the injured leg. The incidence of proximal DVT in an uninjured leg is rare.
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Park JS, Jang JH, Park KY, Moon NH. High energy injury is a risk factor for preoperative venous thromboembolism in the patients with hip fractures: A prospective observational study. Injury 2018; 49:1155-1161. [PMID: 29709377 DOI: 10.1016/j.injury.2018.04.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/07/2018] [Accepted: 04/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to identify the incidence of preoperative venous thromboembolism (VTE), and determine if high energy hip fracture affects preoperative VTE occurrence. METHODS Three-hundred nine patients (244 low and 61 high energy injuries) treated between March 2015 and March 2017 were included in this study. Indirect multidetector computed tomographic venography for the detection of preoperative VTE was performed at admission. The incidence of preoperative VTE was compared between high and low energy injury hip fractures. Logistic regression analysis was used to identify independent risk factors for preoperative VTE. RESULTS The overall incidence of preoperative VTE was 18.4% (56 of 305 patients). Preoperative VTE was identified in 17 (27.9%) and 39 (16.0%) patients in the high and low energy injury groups, respectively (p = 0.034). Multivariate logistic regression analysis showed that high energy injury, history of VTE, and myeloproliferative disease were significant predictive factors of preoperative VTE (OR = 2.451; 95% CI = 1.227-4.896, OR = 11.174; 95% CI = 3.500-35.673, OR = 6.936; 95% CI = 1.641-29.321, respectively) CONCLUSION: Because high energy hip fracture is significantly associated with preoperative VTE occurrence, preoperative evaluation and proper thromboprophylaxis should be performed for patients with a high-energy hip fracture.
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Affiliation(s)
- Jin Sup Park
- Division of Cardiology, Pusan National University Hospital, Busan, Republic of Korea
| | - Jae Hoon Jang
- Trauma Center, Pusan National University Hospital, Busan, Republic of Korea
| | - Ki Young Park
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Nam Hoon Moon
- Department of Orthopaedic Surgery, Bio-medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
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Zhang BF, Wei X, Huang H, Wang PF, Liu P, Qu SW, Li JH, Wang H, Cong YX, Zhuang Y, Zhang K. Deep vein thrombosis in bilateral lower extremities after hip fracture: a retrospective study of 463 patients. Clin Interv Aging 2018; 13:681-689. [PMID: 29713152 PMCID: PMC5912380 DOI: 10.2147/cia.s161191] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective To investigate the incidences of deep vein thrombosis (DVT) before and after operation in inpatients with hip fractures in both lower extremities. Patients and methods We collected the clinical data of 463 patients with lower extremities fractures who presented at Xi'an Honghui Hospital between July 1, 2014, and October 31, 2016 and met all the inclusion criteria. Doppler ultrasonography was used to diagnose DVT. The patients were examined preoperatively and postoperatively and divided into the thrombosis and non-thrombosis group according to the ultrasonographic findings. We divided the DVT cases into central, peripheral, and mixed thromboses. Results The incidence of preoperative DVT was 34.98%, and the prevalence of DVT on the uninjured side was 13.60%. This composition ratio increased to 57.23% postoperatively, and the prevalence of DVT on the uninjured side was 25.05%. Age (odds ratio [OR], 1.03; 95% CI: 1.01-1.04; P=0.002), venous thrombosis at admission (OR, 4.05; 95% CI, 2.30-7.13; P=0.000), and the days between the fracture and the operation (OR, 1.10; 95% CI, 1.02-1.20; P=0.020) were the independent risk factors of preoperative DVT. Coronary heart disease (OR, 1.85; 95% CI: 1.18-2.89; P=0.007), venous thrombosis at admission (OR, 22.35; 95% CI: 6.78-73.60; P=0.000), days between fracture and operation (OR, 1.06; 95% CI: 1.01-1.11; P=0.021), and blood loss (OR, 1.002; 95% CI: 1.000-1.003; P=0.014) were independent risk factors of postoperative DVT. Conclusion The actual incidence of DVT after hip fracture may be underestimated. The incidences of preoperative and postoperative DVTs and the incidence of DVT on the uninjured limb were high.
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Affiliation(s)
- Bin-Fei Zhang
- Department of Orthopedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Beilin District, Xi'an, Shaanxi, China
| | - Xing Wei
- Department of Orthopedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Beilin District, Xi'an, Shaanxi, China
| | - Hai Huang
- Department of Orthopedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Beilin District, Xi'an, Shaanxi, China
| | - Peng-Fei Wang
- Department of Orthopedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Beilin District, Xi'an, Shaanxi, China
| | - Ping Liu
- Department of Orthopedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Beilin District, Xi'an, Shaanxi, China
| | - Shuang-Wei Qu
- Department of Orthopedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Beilin District, Xi'an, Shaanxi, China
| | - Jia-Hao Li
- Department of Orthopedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Beilin District, Xi'an, Shaanxi, China
| | - Hu Wang
- Department of Orthopedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Beilin District, Xi'an, Shaanxi, China
| | - Yu-Xuan Cong
- Department of Orthopedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Beilin District, Xi'an, Shaanxi, China
| | - Yan Zhuang
- Department of Orthopedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Beilin District, Xi'an, Shaanxi, China
| | - Kun Zhang
- Department of Orthopedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Beilin District, Xi'an, Shaanxi, China
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Shin WC, Lee SM, Suh KT. Recent Updates of the Diagnosis and Prevention of Venous Thromboembolism in Patients with a Hip Fracture. Hip Pelvis 2017; 29:159-167. [PMID: 28955681 PMCID: PMC5612975 DOI: 10.5371/hp.2017.29.3.159] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 06/14/2017] [Accepted: 06/15/2017] [Indexed: 01/09/2023] Open
Abstract
Venous thromboembolism (VTE) is a potentially fatal complication that is relatively common after hip surgery. Since patients with a hip fracture have a higher risk of preoperative VTE due to an inability to ambulate after injury and aggravation of underlying age-related conditions, it may be difficult to effectively prevent VTE using only conventional approaches. Very few studies have been published reporting on the prevalence and prevention of VTE in patients with a hip fracture compared to those with hip arthroplasty. For this reason, we aimed to share recent updates on the diagnosis and prevention of VTE in patients with a hip fracture. Preoperative screening tests to diagnose VTE need to be performed more actively following hip fracture and indirect multidetector computed tomography venography is considered the most effective test for this purpose. As the risk of VTE appears to increase with time following a hip fracture, preventive measures should be taken as soon as possible in patients with a hip fracture. A wide variety of mechanical and pharmacological options are available for prophylaxis. When considering patient compliance and preventive impact, intermittent pneumatic compression devices and foot pumps are recommended as mechanical modalities. Of the available preventive medications for patients with a hip fracture, low molecular weight heparin seems to be the most appropriate option because of its short half-life and fast onset of action. Surgery should be performed as soon as possible in patients with hip fractures, and we recommend mechanical and pharmacological methods as active interventions immediately after injury to prevent VTE.
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Affiliation(s)
- Won Chul Shin
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Min Lee
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Kuen Tak Suh
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Li Q, Dai B, Xu J, Yao Y, Song K, Zhang H, Chen D, Jiang Q. Can patients with femoral neck fracture benefit from preoperative thromboprophylaxis?: A prospective randomized controlled trial. Medicine (Baltimore) 2017; 96:e7604. [PMID: 28723807 PMCID: PMC5521947 DOI: 10.1097/md.0000000000007604] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The effectiveness of preoperative thromboprophylaxis remains obscure in patients with femoral neck fracture. The purpose of the current study was to investigate whether these patients benefit from preoperative thromboprophylaxis. METHODS In this prospective, randomized controlled trial, a total of 80 patients with femoral neck fracture were randomly assigned to receive either rivaroxaban or conservative treatment before surgery. For all patients, color Doppler ultrasound of both lower extremities was performed immediately after admission. The primary efficacy outcome was venous thromboembolism (VTE) defined as deep vein thrombosis (DVT) or pulmonary embolism (PE). The primary safety outcome was major bleeding. RESULT Compared with conservative treatment, rivaroxaban could significantly reduce the incidence of DVT from 19.5% (8/41) to 2.6% (1/39) (P = .016). Preoperatively, there were a total of 9 occurrences of DVT including 8 DVT in the conservative treatment group and 1 in the oral rivaroxaban group. All cases of DVT were asymptomatic, with 8 of them diagnosed as isolated muscular calf vein thromboses. There were no differences between the 2 groups in terms of the overall incidence of major bleeding. CONCLUSION Thromboprophylaxis with rivaroxaban prior to surgery can effectively reduce the risk of preoperative DVT for patients with femoral neck fracture without increasing the risk of bleeding.
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Affiliation(s)
- Qiangqiang Li
- Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University
| | - Bingyang Dai
- Laboratory for Bone and Joint Diseases, Model Animal Research Center, Nanjing University
- Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital Affiliated with the Medical School of Nanjing University, Nanjing, Jiangsu
| | - Jiacheng Xu
- Department of Orthopedics, The first Affiliated Hospital of Nantong University, Nantong
| | - Yao Yao
- Laboratory for Bone and Joint Diseases, Model Animal Research Center, Nanjing University
- Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital Affiliated with the Medical School of Nanjing University, Nanjing, Jiangsu
| | - Kai Song
- Laboratory for Bone and Joint Diseases, Model Animal Research Center, Nanjing University
- Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital Affiliated with the Medical School of Nanjing University, Nanjing, Jiangsu
| | | | - Dongyang Chen
- Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University
- Laboratory for Bone and Joint Diseases, Model Animal Research Center, Nanjing University
- Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital Affiliated with the Medical School of Nanjing University, Nanjing, Jiangsu
| | - Qing Jiang
- Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University
- Laboratory for Bone and Joint Diseases, Model Animal Research Center, Nanjing University
- Department of Sports Medicine and Adult Reconstructive Surgery, Nanjing Drum Tower Hospital Affiliated with the Medical School of Nanjing University, Nanjing, Jiangsu
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Luksameearunothai K, Sa-ngasoongsong P, Kulachote N, Thamyongkit S, Fuangfa P, Chanplakorn P, Woratanarat P, Suphachatwong C. Usefulness of clinical predictors for preoperative screening of deep vein thrombosis in hip fractures. BMC Musculoskelet Disord 2017; 18:208. [PMID: 28532441 PMCID: PMC5440897 DOI: 10.1186/s12891-017-1582-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent studies showed that preoperative deep vein thrombosis (DVT) was common after hip fracture (HF), and preoperative DVT screening has been recommended for preventing the fatal DVT-related complications, especially in elderly HF patients with high surgical risk. However, to our knowledge, no previous studies have demonstrated the correlation between the clinical risk predictors and preoperative DVT. Therefore, this study aimed to correlate those clinical predictors related to DVT risk assessment with the incidence of preoperative DVT. METHODS A prospective study was conducted, between July 2015 and June 2016, in 92 HF patients. All patients were evaluated for the DVT-related risk, as patients' characteristics, clinical signs, D-dimer, DVT risk assessment score (Wells score and Caprini score), and then underwent doppler ultrasonography preoperatively. The incidence of preoperative DVT was correlated with each clinical risk predictor, and then significant factors were calculated for diagnostic accuracy. RESULTS The average patients' age was 78 ± 10 years. Sixty-eight patients (74%) were female. The incidence of preoperative DVT was 16.3% (n = 15). The median time from injury to doppler ultrasonography was 2 days (range 0-150 days). DVT group showed a significantly higher in Wells score and Caprini score compared to the non-DVT group (p < 0.05 all). Sensitivity and specificity of Wells score ≥ 2 and Caprini score ≥12 were 47 and 81, and 93 and 35%, respectively. CONCLUSION DVT risk assessment may be helpful for stratifying the risk of preoperative DVT in elderly HFs. Those with Caprini score ≥ 12 should be screened with doppler ultrasonography preoperatively. Those with Wells score 0-1 had low risk for preoperative DVT, so the surgery could perform without delay.
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Affiliation(s)
- Kitchai Luksameearunothai
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, 10400 Thailand
- Department of Orthopaedics, Faculty of Medicine Vajira Hospital, Navamindrahiraj University, Bangkok, Thailand
| | - Paphon Sa-ngasoongsong
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, 10400 Thailand
| | - Noratep Kulachote
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, 10400 Thailand
| | - Sorawut Thamyongkit
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, 10400 Thailand
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Praman Fuangfa
- Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pongsthorn Chanplakorn
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, 10400 Thailand
| | - Patarawan Woratanarat
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, 10400 Thailand
| | - Chanyut Suphachatwong
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Ratchathewi, Bangkok, 10400 Thailand
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Shin WC, Woo SH, Lee SJ, Lee JS, Kim C, Suh KT. Preoperative Prevalence of and Risk Factors for Venous Thromboembolism in Patients with a Hip Fracture: An Indirect Multidetector CT Venography Study. J Bone Joint Surg Am 2016; 98:2089-2095. [PMID: 28002372 DOI: 10.2106/jbjs.15.01329] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This retrospective cohort study investigated the prevalence of and risk factors for preoperative venous thromboembolism (VTE) in patients with a hip fracture and a delay of >24 hours from injury to surgery. METHODS This observational study included 208 patients with a hip fracture surgically treated at 1 university hospital between December 2010 and August 2014. Patients underwent indirect multidetector computed tomographic (MDCT) venography for preoperative VTE detection after admission. Overall VTE risk and median time from injury to CT scan were calculated. Age, sex, fracture type, time from injury to CT scan, body mass index, preinjury mobility score, previous anticoagulation treatment, previous hospitalization for VTE, varicose veins, and medical comorbidities were considered potential risk factors. RESULTS The prevalence of preoperative VTE was 11.1% (23 of 208 patients), including 12 patients with deep vein thrombosis alone, 7 patients with pulmonary embolism alone, and 4 patients with both. The mean time from injury to CT scan was 4.9 days. The delay from the time of injury to CT scan averaged 7.6 days for patients who developed preoperative VTE, compared with 4.2 days for patients who had not developed VTE. In the adjusted models, female sex, subtrochanteric fracture, pulmonary disease, cancer, previous hospitalization for VTE, and varicose veins were risk factors for VTE. The final multivariate logistic regression analysis demonstrated that female sex (odds ratio [OR] = 5.86; 95% confidence interval [CI] = 1.21 to 28.21), subtrochanteric fracture (OR = 22.17; 95% CI = 4.02 to 122.06), pulmonary disease (OR = 21.10; 95% CI = 5.35 to 83.21), and previous hospitalization for VTE (OR = 16.36; 95% CI = 3.41 to 78.43) increased the risk of VTE. CONCLUSIONS Our findings show a high prevalence of preoperative VTE in patients with a hip fracture. Therefore, preoperative investigation for VTE should be routinely considered for patients in whom surgery is delayed for >24 hours. At this time, indirect MDCT venography seems to be effective and useful. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Won Chul Shin
- 1Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea 2Department of Orthopedic Surgery, Medical Research Institute, Pusan National University School of Medicine, Yangsan, Republic of Korea 3Department of Statistics, Pusan National University, Busan, Republic of Korea
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The preoperative incidence of deep vein thrombosis (DVT) and its correlation with postoperative DVT in patients undergoing elective surgery for femoral neck fractures. Arch Orthop Trauma Surg 2016; 136:1459-64. [PMID: 27535672 DOI: 10.1007/s00402-016-2535-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Data on the incidence of preoperative deep vein thrombosis (DVT) in patients, who are waiting for elective hip replacement for femoral neck fractures, are limited. Our primary goal was to determine the prevalence and risk factors of preoperative DVT in acute hip fracture patients awaiting hemi- or total hip arthroplasty using venography. The secondary objective was to find a possible relationship between preoperative and postoperative DVT. METHODS We enrolled 119 consecutive patients with subcapital femoral neck fracture, who were awaiting hip replacement at our institution. All of them received venography before and after surgery. We used univariate analysis and multivariate logistic regression analysis to identify the risk factors for preoperative DVT. RESULTS Of the patients, 35 patients (29.4 %) developed DVT in affected limbs before surgery. Both long duration of immobilization and increased level of D-dimer were associated with preoperative DVT independently. Intriguingly, 66.7 % of patients who were diagnosed with DVT after surgery had thrombus in the same location, as they did before surgery. CONCLUSIONS We identified the high incidence and risk factors of preoperative DVT in patients awaiting elective surgery for femoral neck fractures. The majority of patients diagnosed with DVT postoperatively had already had thrombus before surgery.
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Kim KK, Won Y, Won YY. The Efficacy of Low Molecular Weight Heparin for the Prevention of Venous Thromboembolism after Hip Fracture Surgery in Korean Patients. Yonsei Med J 2016; 57:1209-13. [PMID: 27401653 PMCID: PMC4960388 DOI: 10.3349/ymj.2016.57.5.1209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/04/2016] [Accepted: 02/17/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the efficacy of low-molecular-weight heparin (LMWH) for the prevention of venous thromboembolism in Korean patients who underwent hip fracture surgery (HFS). MATERIALS AND METHODS Prospectively, a total 181 cases were classified into the LMWH user group (116 cases) and LMWH non-user group (65 cases). Each group was sub-classified according to fracture types as follows: 81 cases of intertrochanteric fracture (group A: 49, group B: 32) and 100 cases of neck fracture (group C: 67, group D: 33). We compared the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) according to LMWH use. RESULTS Of the 181 cases, four DVTs were found in the LMWH user groups (1 in group A, and 3 in group C). One case of PE was found in LMWH non-user group D. The incidences of DVT and PE showed no statistically significant differences between the LMWH user and non-user groups (p=0.298 and 0.359, respectively). In subgroup analysis, no statistically significant differences were found between groups A and B and between groups C and D. CONCLUSION The administration of LMWH was not effective in the prevention of venous thromboembolism and PE in the Korean patients who underwent HFS.
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Affiliation(s)
- Kwang Kyoun Kim
- Department of Orthopedic Surgery, Stanford University College of Medicine (Visiting professor), Stanford, CA, USA
- Department of Orthopaedic Surgery, Konyang University School of Medicine, Deajeon, Korea
| | - Yougun Won
- Department of Orthopaedic Surgery, Konyang University School of Medicine, Deajeon, Korea
- Department of Orthopaedics, Graduate School of Medicine, Yonsei University, Seoul, Korea.
| | - Ye Yeon Won
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Korea
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Niu E, Yang A, Harris AHS, Bishop J. Which Fixation Device is Preferred for Surgical Treatment of Intertrochanteric Hip Fractures in the United States? A Survey of Orthopaedic Surgeons. Clin Orthop Relat Res 2015; 473:3647-55. [PMID: 26208608 PMCID: PMC4586189 DOI: 10.1007/s11999-015-4469-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 07/15/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND The best treatment for intertrochanteric hip fractures is controversial. The use of cephalomedullary nails has increased, whereas use of sliding hip screws has decreased despite the lack of evidence that cephalomedullary nails are more effective. As current orthopaedic trainees receive less exposure to sliding hip screws, this may continue to perpetuate the preferential use of cephalomedullary nails, with important implications for resident education, evidence-based best practices, and healthcare cost. QUESTIONS/PURPOSES We asked: (1) What are the current practice patterns in surgical treatment of intertrochanteric fractures among orthopaedic surgeons? (2) Do surgical practice patterns differ based on surgeon characteristics, practice setting, and other factors? (3) What is the rationale behind these surgical practice patterns? (4) What postoperative approaches do surgeons use for intertrochanteric fractures? METHODS A web-based survey containing 20 questions was distributed to active members of the American Academy of Orthopaedic Surgeons. Three thousand seven-hundred eighty-six of 10,321 invited surgeons participated in the survey (37%), with a 97% completion rate (3687 of 3784 responded to all questions in the survey). The survey elicited information regarding surgeon demographics, preferred management strategies, and decision-making rationale for intertrochanteric fractures. RESULTS Surgeons use cephalomedullary nails most frequently for treatment of intertrochanteric hip fractures. Sixty-eight percent primarily use cephalomedullary nails, whereas only 19% primarily use sliding hip screws, and the remaining 13% use cephalomedullary nails and sliding hip screws with equal frequency. The cephalomedullary nail was the dominant approach regardless of experience level or practice setting. Surgeons who practiced in a nonacademic setting (71% versus 58%; p < 0.001), did not supervise residents (71% versus 61%; p < 0.001), or treated more than five intertrochanteric fractures a month (78% versus 67%; p < 0.001) were more likely to use primarily cephalomedullary nails. Of the surgeons who used only cephalomedullary nails, ease of surgical technique (58%) was cited as the primary reason, whereas surgeons who used only sliding hip screws cite familiarity (44%) and improved outcomes (37%) as their primary reasons. Of those who use only short cephalomedullary nails, ease of technique (59%) was most frequently cited. Postoperatively, 67% allow the patient to bear weight as tolerated. Nearly all respondents (99.5%) use postoperative chemical thromboprophylaxis. CONCLUSIONS Despite that either sliding hip screw or cephalomedullary nail fixation are associated with equivalent outcomes for most intertrochanteric femur fractures, the cephalomedullary nail has emerged as the preferred construct, with the majority of surgeons believing that a cephalomedullary nail is easier to use, associated with improved outcomes, or is biomechanically superior to a sliding hip screw. The difference between what is evidence-based and what is done in clinical practice may be attributed to several factors, including financial considerations, educational experience, or inability of our current outcomes measures to reflect the experiences of surgeons. The educators, researchers, and policymakers among us must work harder to better define the roles of sliding hip screws and cephalomedullary nails and ensure that the increasing population with hip fractures receives high-quality and economically responsible care. LEVEL OF EVIDENCE Level V, therapeutic study.
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Affiliation(s)
- Emily Niu
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, M/C 6342, Redwood City, CA, 94063, USA.
| | - Arthur Yang
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, M/C 6342, Redwood City, CA, 94063, USA
| | - Alex H S Harris
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, M/C 6342, Redwood City, CA, 94063, USA
| | - Julius Bishop
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, M/C 6342, Redwood City, CA, 94063, USA
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Nyholm AM, Gromov K, Palm H, Brix M, Kallemose T, Troelsen A. Time to Surgery Is Associated with Thirty-Day and Ninety-Day Mortality After Proximal Femoral Fracture: A Retrospective Observational Study on Prospectively Collected Data from the Danish Fracture Database Collaborators. J Bone Joint Surg Am 2015; 97:1333-9. [PMID: 26290084 DOI: 10.2106/jbjs.o.00029] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We hypothesized that undergoing surgery as soon as possible reduces early mortality in patients with a proximal femoral fracture. Our aim was to evaluate the association between surgical delay and early mortality in these patients. METHODS We performed a retrospective analysis of prospectively collected data from the Danish Fracture Database and the Civil Registration System on patients who were fifty years of age or older and had undergone surgery for a proximal femoral fracture. Femoral head fracture (classified as OTA/AO 31C per the OTA/AO classification system), high-energy trauma, pathological fractures, multiple fractures, and surgeries performed with implants not commonly used were excluded. End points were adjusted odds ratios for thirty-day and ninety-day mortality. RESULTS For the 3517 surgeries included in this study, the median patient age was 82.0 years (range, fifty-one to 107 years), 2458 patients (70%) were female, and 1720 surgeries (49%) were performed because of a trochanteric fracture. Within twelve hours, 722 of the surgeries (21%) had been performed; within twenty-four hours, 2482 surgeries (71%); within thirty-six hours, 3024 surgeries (86%); within forty-eight hours, 3242 surgeries (92%); and within seventy-two hours, 3353 surgeries (95%). Unsupervised surgeons with an education level below that of an attending surgeon performed the surgery in 1807 (51%) of all cases. The thirty-day mortality was 380 (10.8%) and the ninety-day mortality was 612 (17.4%). The risk of thirty-day mortality increased with a surgical delay of more than twelve hours (odds ratio, 1.45; p = 0.02), more than twenty-four hours (odds ratio, 1.34; p = 0.02), and more than forty-eight hours (odds ratio, 1.56; p = 0.02); the risk of ninety-day mortality increased with a surgical delay of more than twenty-four hours (odds ratio, 1.23; p = 0.04). An education level of the surgeon below that of an attending surgeon increased the risk of thirty-day mortality (odds ratio, 1.28; p = 0.035) and ninety-day mortality (odds ratio, 1.26; p = 0.016). Increasing American Society of Anesthesiologists score and male sex significantly increased both thirty-day and ninety-day mortality. CONCLUSIONS In this study, a surgical delay of more than twelve hours significantly increased the adjusted risk of thirty-day mortality and a surgical delay of more than twenty-four hours significantly increased the adjusted risk of ninety-day mortality. The adjusted risk of both thirty-day and ninety-day mortality increased significantly when the education level of the surgeon was below that of an attending surgeon. The study findings challenge orthopaedic departments to facilitate fast surgical treatment supported by attending orthopaedic surgeons.
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Affiliation(s)
- Anne Marie Nyholm
- Department of Orthopaedic Surgery (A.M.N., K.G., H.P., and A.T.) and Clinical Research Centre (T.K.), Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, DK-2650 Hvidovre, Denmark. E-mail address for A.M. Nyholm:
| | - Kirill Gromov
- Department of Orthopaedic Surgery (A.M.N., K.G., H.P., and A.T.) and Clinical Research Centre (T.K.), Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, DK-2650 Hvidovre, Denmark. E-mail address for A.M. Nyholm:
| | - Henrik Palm
- Department of Orthopaedic Surgery (A.M.N., K.G., H.P., and A.T.) and Clinical Research Centre (T.K.), Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, DK-2650 Hvidovre, Denmark. E-mail address for A.M. Nyholm:
| | - Michael Brix
- Department of Orthopaedic Surgery, Odense University Hospital, Sønder Boulevard 29, DK-5000 Odense C, Denmark
| | - Thomas Kallemose
- Department of Orthopaedic Surgery (A.M.N., K.G., H.P., and A.T.) and Clinical Research Centre (T.K.), Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, DK-2650 Hvidovre, Denmark. E-mail address for A.M. Nyholm:
| | - Anders Troelsen
- Department of Orthopaedic Surgery (A.M.N., K.G., H.P., and A.T.) and Clinical Research Centre (T.K.), Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, DK-2650 Hvidovre, Denmark. E-mail address for A.M. Nyholm:
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Cho YH, Byun YS, Jeong DG, Han IH, Park YB. Preoperative Incidence of Deep Vein Thrombosis after Hip Fractures in Korean. Clin Orthop Surg 2015; 7:298-302. [PMID: 26330950 PMCID: PMC4553276 DOI: 10.4055/cios.2015.7.3.298] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 06/03/2015] [Indexed: 11/16/2022] Open
Abstract
Background The purpose of the current study was to investigate the incidence of preoperative deep vein thrombosis (DVT) after hip fractures in Korea. Methods In this prospective study, we enrolled 152 Korean geriatric patients who had suffered hip fractures due to a simple fall and were hospitalized between January 2013 and December 2013. There were 52 male and 100 female patients, and their mean age was 78.2 years. There were 96 trochanteric fractures and 56 femoral neck fractures. All patients were examined for DVT: 26 by ultrasonography and 126 by computed tomography venography. The patients having DVT underwent inferior vena cava filter insertion before the surgical intervention. Results Preoperatively, none of the patients had any signs or symptoms of DVT; however, 4 patients were identified as having asymptomatic DVT. The overall incidence of DVT was 2.6% (4/152). The mean time to arrival at emergency room after injury was 32.6 hours. Mean time elapsed to undergo surgery after hospitalization was 24.9 hours. The average time to hospitalization after injury was 237 hours for patients with DVT versus 27.5 hours for patients without DVT. DVT developed within 72 hours in two of the 137 patients (1.4%) and after 72 hours in two of the remaining 15 patients (13.3%) hospitalized. Conclusions While the preoperative incidence of DVT after hip fractures was relatively low (2.6%) in the Korean geriatric population, we confirmed that getting no treatment within 72 hours after injury increased the incidence of DVT. Thus, we conclude from this study that a workup for DVT should be considered in cases where admission or surgery has been delayed for more than 72 hours after injury.
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Affiliation(s)
- Young-Ho Cho
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Young-Soo Byun
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Dae-Geun Jeong
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - In-Ho Han
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Young-Bo Park
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
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