Abstract
Summary
Hip fracture patients were at increased excess risk of venous thromboembolism (VTE) up to 1 year following hip fracture. During the first year, interaction between hip fracture and comorbidity was observed among patients with severe and very severe comorbidity.
Introduction
We compared the risk of VTE in hip fracture patients with that in the general population. We also examined whether and to what extent the association between hip fracture and VTE varied by comorbidity level.
Methods
Nationwide cohort study based on Danish health registries, 1995–2015. We identified hip fracture patients (n = 110,563) and sampled a comparison cohort without hip fracture from the general population (n = 552,774). Comorbidity was assessed using the Charlson comorbidity index. We calculated attributable fraction, as the proportion of the VTE rate, among persons exposed to both hip fracture and comorbidity, attributed to exposure interaction.
Results
The cumulative incidences of VTE were 0.73% within 30 days and 0.83% within 31–365 days among hip fracture patients, and 0.05 and 0.43% in the general population. Adjusted hazard ratios (HRs) of VTE among hip fracture patients were 17.29 [95% confidence interval (CI) 14.74–20.28] during the first 30 days and 2.13 (95% CI 1.95–2.32) during 31–365 days following hip fracture. The relative risks of VTE were 1.03 (95% CI 0.96–1.11) and 1.11 (95% CI 1.00–1.23) after 1–5 years and 6–10 years. During the first 30 days and 31–365 days, 14%/28% of VTE rates and 5%/4% of VTE rates were attributable to the interaction between hip fracture and severe/very severe comorbidity, respectively. Mortality risks within 30 days of VTE were 29.4% in hip fracture and 11.0% in general population cohorts.
Conclusions
Hip fracture patients were at increased excess risk of VTE up to 1 year following their fracture. During the first year, interaction between hip fracture and comorbidity was observed among patients with severe and very severe comorbidity.
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The study was approved by the Danish Data Protection Agency. Permission to use the data was obtained from the Danish National Patient Registry and the Civil Registration System (Aarhus University, journal number 2016-051-000001).
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Appendix
Appendix
Hip fracture was defined as the presence of one or more of the following diagnosis codes: ICD-10 codes S72.0, S72.1, or S72.2
Venous thromboembolism: Deep venous thrombosis was defined using ICD-10 codes I801-3 and pulmonary embolism using ICD-10 code I26
Any osteoporotic fracture was defined with one of the following ICD-10 codes: S12.0, S12.1, S12.2, S12.7, S12.9, S22.0, S22.1, T08, S32.x; S42.2, S42.3, S42.4, 42.7, S42.8, S52.x, and S62.x
Surgery codes from Danish National Patient Register: KNFB.0-99 primary hip arthroplasty (total or partial) and KNFJ.4-9 open reduction and internal fixation of the hip fracture Disease categories and the International Classification of Diseases codes, the eighth edition (ICD-8) and the tenth edition (ICD-10), used to calculate the Charlson comorbidity index: Myocardial infarction: 410, I21-I23
Congestive heart failure: 427.09; 427.10; 427.11; 427.19; 428.99; 782.49; I50; I11.0; I13.0; I13.2
Peripheral vascular disease: 440; 441; 442; 443; 444; 445, I70-I74; I77 Cerebrovascular disease: 430-438; I60-I69; G45; G46
Dementia: 290.09-290.19; 293.09; F00-F03; F05.1; G30 Chronic pulmonary disease: 490-493; 515-518; J40-J47; J60-J67; J68.4; J70.1; J70.3; J84.1; J92.0; J96.1; J98.2-J98.3
Connective tissue disease: 712; 716; 734; 446; 135.99; M05; M06; M08; M09; M30-M36; D86 Ulcer disease: 530.91; 530.98; 531-534; K22.1; K25-K28
Mild liver disease: 571; 573.01; 573.04; B18; K70.0-K70.3; K70.9; K71; K73; K74; K76.0 Diabetes: 249.00; 249.06; 249.07; 249.09; 250.00; 250.06; 250.07; 250.09; E10.0; E10.1; E10.9; E11.0; E11.1; E11.9
Hemiplegia: 344; G81; G82
Moderate to severe renal disease: 403; 404; 580-584; 590.09; 593.19; 753.10-753.19; 792; I12; I13; N00-N05; N07; N11; N14; N17-N19; Q61
Diabetes with end organ damage: 249.01-249.05; 249.08; 250.01-250.05; 250.08; E10.2-E10.8; E11.2-E11.8
Any tumor: 140-194; C00-C75
Leukemia: 204-207; C91-C95
Lymphoma: 200-203; 275.59; C81-C85; C88; C90; C96
Moderate to severe liver disease: 070.00; 070.02; 070:04; 070.06; 070.08; 573.00; 456.00-456.09; B15.0; B16.0; B16.2; B19.0; K70.4; K72; K76.6; I85
Metastatic solid tumor: 195-199; C76-C80
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Pedersen, A.B., Ehrenstein, V., Szépligeti, S.K. et al. Excess risk of venous thromboembolism in hip fracture patients and the prognostic impact of comorbidity. Osteoporos Int 28, 3421–3430 (2017). https://doi.org/10.1007/s00198-017-4213-y
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DOI: https://doi.org/10.1007/s00198-017-4213-y