Abstract
Purpose
Deep venous thrombi (DVT) and pulmonary emboli (PE) are common complications in hip fracture patients. It is imperative that orthopaedists know the patient risk factors for DVT and PE, including if type of surgery plays a role. To this end, we used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify significant risk factors.
Methods
From the 2006–2011 ACS NSQIP database, 27,441 patients with hip fractures were identified using a Current Procedural Terminology (CPT) code search. DVT and PE complications, type of surgery based on CPT code, patient demographics, medical comorbidities and operative factors were identified for each patient. Fisher’s exact tests were used to (1) determine if rates of DVT and PE significantly differed based on type of surgery and (2) identify significant associations between patient factors and development of DVT/PE. These significant factors were then used as covariates in multivariable analysis to determine which risk factors predicted postoperative DVT/PE.
Results
Of the 27,441 hip fracture patients, 449 (1.6 %) developed DVT/PE. There was a significant difference in rates of DVT/PE based on surgery (p = 0.015): patients undergoing intramedullary nailing of inter-/peri-/subtrochanteric femoral fractures had the highest rates of DVT/PE (2.06 %). After multivariate analysis, renal failure and recent surgery were significant risk factors for DVT/PE.
Conclusions
This study was the first to show through large, multicentre, prospective data that type of hip fracture surgery impacts rates of DVT/PE. We further identified two additional risk factors orthopaedists should be aware of. Knowing these risk factors will help in peri-operative planning to reduce complications.
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Conflicts of interest and source of funding
Author William Obremskey has previously consulted for biometrics, done expert testimony in legal matters, has a grant from the Department of Defense and has been a Board Member of the OTA and SEFC. For the remaining authors no conflicts of interest were declared.
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This study used no previously copyrighted materials or signed patient consent forms.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Institutional Review Board approval
This study has approval from the Vanderbilt Institutional Review Board.
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Sathiyakumar, V., Greenberg, S.E., Jahangir, A.A. et al. Impact of type of surgery on deep venous thrombi and pulmonary emboli: a look at twenty seven thousand hip fracture patients. International Orthopaedics (SICOT) 39, 2017–2022 (2015). https://doi.org/10.1007/s00264-015-2866-8
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DOI: https://doi.org/10.1007/s00264-015-2866-8