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Effects of fondaparinux on pulmonary embolism following hemiarthroplasty for femoral neck fracture: a retrospective observational study using the Japanese Diagnosis Procedure Combination database

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

Pulmonary embolism (PE) is recognized as an important complication in patients undergoing hip fracture surgery. However, clinical evidence demonstrating the effectiveness of pharmacological thromboprophylaxis, including fondaparinux, is limited because the occurrence of postoperative PE after hemiarthroplasty is very low. The goal of this study was to analyze the effect of fondaparinux in reducing PE following hemiarthroplasty for femoral neck fracture using large-scale retrospective data.

Methods

Employing data from the Japanese Diagnosis Procedure Combination database from July 1 to December 31 between 2007 and 2010, we retrospectively identified 22,776 patients who underwent hemiarthroplasty for femoral neck fracture; we included those who received mechanical prophylaxis alone (n = 17,984) and those who received both mechanical prophylaxis and pharmacological prophylaxis with fondaparinux (n = 4,792). Logistic regression analysis was performed to compare the occurrence of postoperative PE with adjustment for sex, age, comorbidities, and type and duration of anesthesia.

Results

The mean age of the patients was 79.5 ± 9.4 years. Overall, postoperative PE occurred in 189 (0.83 %) patients. The rate of postoperative PE in the fondaparinux group (0.61 %) was lower than in the control group (0.89 %), although the difference was not significant in the univariate analysis (odds ratio [OR] 0.68; p = 0.055). In the multivariate analysis, the fondaparinux group showed a significantly lower rate of postoperative PE than the group receiving mechanical prophylaxis alone (OR 0.67; p = 0.047). General anesthesia and a longer duration of anesthesia were significant risk factors for postoperative PE.

Conclusions

Fondaparinux combined with mechanical prophylaxis is more effective in preventing postoperative PE following hemiarthroplasty for femoral neck fracture than mechanical prophylaxis alone.

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Acknowledgments

This study was funded by grants from the Ministry of Health, Labour and Welfare, Japan (Research on Policy Planning and Evaluation grant number H22-Policy-031; Research on Intractable Diseases grant number H23-Nanchi-032); the Ministry of Education, Culture, Sports, Science and Technology, Japan (Scientific Research B, No. 22390131); and the Council for Science and Technology Policy, Japan (Funding Program for World-Leading Innovative R&D on Science and Technology FIRST program grant number 0301002001001).

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Musculoskeletal Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 1130021, Japan

    Yusuke Tsuda

  2. Department of Orthopaedic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138655, Japan

    Yusuke Tsuda, Hirotaka Kawano & Sakae Tanaka

  3. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138655, Japan

    Hideo Yasunaga & Hiromasa Horiguchi

  4. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 1130034, Japan

    Kiyohide Fushimi

Authors
  1. Yusuke Tsuda
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  2. Hideo Yasunaga
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  3. Hiromasa Horiguchi
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  4. Kiyohide Fushimi
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  5. Hirotaka Kawano
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  6. Sakae Tanaka
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Corresponding author

Correspondence to Yusuke Tsuda.

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Tsuda, Y., Yasunaga, H., Horiguchi, H. et al. Effects of fondaparinux on pulmonary embolism following hemiarthroplasty for femoral neck fracture: a retrospective observational study using the Japanese Diagnosis Procedure Combination database. J Orthop Sci 19, 991–996 (2014). https://doi.org/10.1007/s00776-014-0607-2

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  • DOI: https://doi.org/10.1007/s00776-014-0607-2

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