Skip to main content

Advertisement

SpringerLink
Log in

High prevalence of deep vein thrombosis in elderly hip fracture patients with delayed hospital admission

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cauley JA, Chalhoub D, Kassem AM, Fuleihan GE-H. Geographic and ethnic disparities in osteoporotic fractures. Nat Rev Endocrinol. 2014;10:338–51.

    Article  Google Scholar 

  2. Zahn HR, Skinner JA, Porteous MJ. The preoperative prevalence of deep vein thrombosis in patients with femoral neck fractures and delayed operation. Injury. 1999;30:605–7.

    Article  CAS  Google Scholar 

  3. Smith EB, Parvizi J, Purtill JJ. Delayed surgery for patients with femur and hip fractures—risk of deep venous thrombosis. J Trauma. 2011;70:E113–6.

    Article  Google Scholar 

  4. Wolberg AS, Rosendaal FR, Weitz JI, Jaffer IH, Agnelli G, Baglin T, et al. Venous thrombosis. Nat Rev Dis Prim Nat Publ Group. 2015;1:15006.

    Article  Google Scholar 

  5. Hefley FG, Nelson CL, Puskarich-May CL. Effect of delayed admission to the hospital on the preoperative prevalence of deep-vein thrombosis associated with fractures about the hip. J Bone Jt Surg Am. 1996;78:581–3.

    Article  Google Scholar 

  6. Cho Y-H, Byun Y-S, Jeong D-G, Han I-H, Park Y-B. Preoperative incidence of deep vein thrombosis after hip fractures in Korean. Clin Orthop Surg Korean Orthop Assoc. 2015;7:298–302.

    Article  Google Scholar 

  7. Mears SC, Kates SL. A guide to improving the care of patients with fragility fractures, 2nd ed. Geriatr Orthop Surg Rehabil, vol 6. Los Angeles: SAGE PublicationsSage; 2015. pp. 58–120.

    Google Scholar 

  8. Zamora T, Klaber I, Urrutia J. Hip fracture in the elderly. Clin Med Insights Geriatr. 2017;10:1–10.

    Google Scholar 

  9. Bengoa F, Carrasco M, Amenábar PP, Schweitzer D, Botello E, Klaber I. Optimización perioperatoria del paciente anciano con fractura osteoporótica de cadera. Rev Med Chil. 2017;145:1437–46.

    Article  Google Scholar 

  10. Grigoryan KV, Javedan H, Rudolph JL. Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma. 2014;28:e49–55.

    Article  Google Scholar 

  11. Mears SC, Kates SL. A guide to improving the care of patients with fragility fractures, 2nd ed. Geriatr Orthop Surg Rehabil. 2015;6:58–120.

    Article  Google Scholar 

  12. Kates SL, Blake D, Bingham KW, Kates OS, Mendelson DA, Friedman SM. Comparison of an organized geriatric fracture program to united states government data. Geriatr Orthop Surg Rehabil. 2010;1:15–21.

    Article  Google Scholar 

  13. Friedman SM, Mendelson DA, Bingham KW, Kates SL. Impact of a comanaged geriatric fracture center on short-term hip fracture outcomes. Arch Intern Med. 2009;169:1712–7.

    Article  Google Scholar 

  14. Friedman SM, Mendelson DA, Kates SL, McCann RM. Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population. J Am Geriatr Soc. 2008;56:1349–56.

    Article  Google Scholar 

  15. Kates SL, Mendelson DA, Friedman SM. Co-managed care for fragility hip fractures (Rochester model). Osteoporos Int J Establ result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2010;21:621–5.

    Article  Google Scholar 

  16. Geerts WH, Code KI, Jay RM, Chen E, Szalai JP. A prospective study of venous thromboembolism after major trauma. N Engl J Med Mass Med Soc. 1994;331:1601–6.

    Article  CAS  Google Scholar 

  17. McNamara I, Sharma A, Prevost T, Parker M. Symptomatic venous thromboembolism following a hip fracture. Acta Orthop. 2009;80:687–92.

    Article  Google Scholar 

  18. Rosencher N, Vielpeau C, Emmerich J, Fagnani F, Samama CM, ESCORTE group. Venous thromboembolism and mortality after hip fracture surgery: the ESCORTE study. J Thromb Haemost. 2005;3:2006–14.

    Article  CAS  Google Scholar 

  19. O’Brien J, Duncan H, Kirsh G, Allen V, King P, Hargraves R, Mendes L, Perera T, Catto P, Schofield S, Ploschke H. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: pulmonary embolism prevention (PEP) trial. Lancet. 2000;355:1295–302.

    Article  Google Scholar 

  20. Todd CJ, Freeman CJ, Camilleri-Ferrante C, Palmer CR, Hyder A, Laxton CE, et al. Differences in mortality after fracture of hip: the east Anglian audit. BMJ. 1995;310:904–8.

    Article  CAS  Google Scholar 

  21. Eriksson BI, Lassen MR, PENTasaccharide in HIp-FRActure Surgery Plus Investigators. Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery: a multicenter, randomized, placebo-controlled, double-blind study. Arch Intern Med. 2003;163:1337.

    Article  CAS  Google Scholar 

  22. Meignan M, Rosso J, Gauthier H, Brunengo F, Claudel S, Sagnard L, et al. Systematic lung scans reveal a high frequency of silent pulmonary embolism in patients with proximal deep venous thrombosis. Arch Intern Med. 2000;160:159–64.

    Article  CAS  Google Scholar 

  23. Douketis JD, Kearon C, Bates S, Duku EK, Ginsberg JS. Risk of fatal pulmonary embolism in patients with treated venous thromboembolism. JAMA. 1998;279:458–62.

    Article  CAS  Google Scholar 

  24. Brooks RL, Winslow MC, Kenmore PI. The week-old hip fracture: indication for prophylactic use of a vena cava filter? Report of two cases. Orthopedics. 1987;10:1287–8.

    CAS  PubMed  Google Scholar 

  25. Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. Antithrombotic therapy for VTE disease. Chest. 2012;141:e419S–496S.

    Article  CAS  Google Scholar 

  26. Baglin TP, Brush J, Streiff M. Guidelines on use of vena cava filters. Br J Haematol. 2006;134:590–5.

    Article  CAS  Google Scholar 

  27. Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension. Circulation. 2011;123:1788–830.

    Article  Google Scholar 

  28. Langan EM, Miller RS, Casey WJ, Carsten CG, Graham RM, Taylor SM. Prophylactic inferior vena cava filters in trauma patients at high risk: follow-up examination and risk/benefit assessment. J Vasc Surg. 1999;30:484–8.

    Article  Google Scholar 

Download references

Funding

No funding was received for the development of this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Diagonal Paraguay 362, Tercer Piso, Santiago, Chile

    Francisco Bengoa, Daniel Schweitzer, Maria Jesus Lira, Tomás Zamora & Ianiv Klaber

  2. School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile

    Gerardo Vicencio

Authors
  1. Francisco Bengoa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gerardo Vicencio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniel Schweitzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria Jesus Lira
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomás Zamora
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ianiv Klaber
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

FB, DS, MJL and IK contributed with study design and development. FB, GV, MJL and IK contributed with data collection, interpretation and analysis. Document writing was done by FB and critically analyzed and revised by GV, DS, MJL, TZ and IK. All authors approved the final state of this manuscript.

Corresponding author

Correspondence to Ianiv Klaber.

Ethics declarations

Conflict of interest

Francisco Bengoa MD, Gerardo Vicencio MD, María Jesús Lira, Tomás Zamora MD and Ianiv Klaber MD declare that they have no conflict of interest. Dr. Daniel Schweitzer has received a speaker honorarium from Zimmer Biomet and DePuy Synthes.

Ethical approval

This study was approved by the institutional review board (No. 170628010).

Informed consent

Informed consent was dispensed by the review board.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bengoa, F., Vicencio, G., Schweitzer, D. et al. High prevalence of deep vein thrombosis in elderly hip fracture patients with delayed hospital admission. Eur J Trauma Emerg Surg 46, 913–917 (2020). https://doi.org/10.1007/s00068-018-1059-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-018-1059-8

Keywords

Search

Navigation