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Incidence and risk factors for symptomatic venous thromboembolism following anterior cruciate ligament reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To determine the incidence of symptomatic venous thromboembolism (VTE) following anterior cruciate ligament (ACL) reconstruction using a large national database and to identify corresponding independent risk factors.

Methods

The Humana administrative claims database was reviewed for patients undergoing ACL reconstruction from 2007 to 2017. Patient demographics, medical comorbidities, as well as concurrent procedures were recorded. Postoperative incidence of VTE was measured by identifying symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) at 30 days, 90 days, and 1 year postoperatively. Univariate analysis and binary logistic regression were performed to determine independent risk factors for VTE following surgery.

Results

A total of 11,977 patients were included in the study. The incidence of VTE was 1.01% (n = 120) and 1.22% (n = 146) at 30 and 90 days, respectively. Analysis of VTE events within the first postoperative year revealed that 69.6% and 84.3% of VTEs occurred within 30 and 90 days of surgery, respectively. Logistic regression identified age ≥ 45 (odds ratio [OR] = 1.88; 95% confidence interval [CI] 1.32–2.68; p < 0.001), inpatient surgery (OR = 2.07; 95% CI 1.01–4.24; p = 0.045), COPD (OR = 1.51; 95% CI 1.02–2.24; p = 0.041), and tobacco use (OR = 1.75; 95% CI 1.17–2.62; p = 0.007), as well as concurrent PCL reconstruction (OR = 3.85; 95% CI 1.71–8.67; p = 0.001), meniscal transplant (OR = 17.68; 95% CI 3.63–85.97; p < 0.001) or osteochondral allograft (OR = 15.73; 95% CI 1.79–138.43; p = 0.013) as independent risk factors for VTE after ACL reconstruction.

Conclusions

The incidence of symptomatic postoperative VTE is low following ACL reconstruction, with the majority of cases occurring within 90 days of surgery. Risk factors include age ≥ 45, inpatient surgery, COPD, tobacco use and concurrent PCL reconstruction, meniscal transplant or osteochondral allograft.

Level of evidence

III.

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Funding

There was no funding obtained for this study.

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Authors and Affiliations

  1. Rush University Medical Center, 1611 W Harrison St, Chicago, IL, 60612, USA

    Enrico M. Forlenza, Kevin C. Parvaresh, Matthew R. Cohn, Ophelie Lavoie-Gagne, Yining Lu, William Cregar & Brian Forsythe

  2. Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Zain M. Khazi

Authors
  1. Enrico M. Forlenza
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  2. Kevin C. Parvaresh
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  4. Ophelie Lavoie-Gagne
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  7. William Cregar
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Contributions

Author participation using the ICMJE criteria for authorship: EMF, KCP, MRC, OLG, ZMK, YL, WC: Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; Drafting the work or revising it critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. BF: Drafting the work or revising it critically for important intellectual content; Final approval of the version to be published; Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Brian Forsythe.

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This study was granted exemption from the Institutional Review Board as PearlDiver uses deidentified patient information.

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Appendix 1: International classification of disease (ICD) codes

Appendix 1: International classification of disease (ICD) codes

 

ICD-9

ICD-10

Deep vein thrombosis

45340, 45341, 45342, 45382, 45383, 45384

I8240, I82401, I82402, I82403, I82409, I82410, I82411, I82412, I82413, I82419, I82420, I82421, I82422, I82423, I82429, I82430 to I82499, I824Y1, I824Y2, I824Y3, I824Y9, I824Z1, I824Z2, I824Z3, I824Z9, I82621 to I82629

Pulmonary embolism

41510, 41511, 41519

I2600, I2602, I2609, I2699

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Forlenza, E.M., Parvaresh, K.C., Cohn, M.R. et al. Incidence and risk factors for symptomatic venous thromboembolism following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 30, 1552–1559 (2022). https://doi.org/10.1007/s00167-021-06583-y

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