Risk factors of perioperative deep venous thrombosis of lower extremities in elderly patients with femoral neck fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Yonggang ¹ , FU Kai ² , ZHENG Wei ³ , CAI Qianying ² , CHEN Shengbao ² , ZHANG Changqing ² ,  ZHENG Xianyou ²

1. Department of Orthopedics, Tongxiang First People’s Hospital, Tongxiang Zhejiang, 314599, P. R. China;
2. Department of Orthopedics, the Sixth People’s Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, 200235, P. R. China;
3. Department of Orthopedics, the Fourth Affiliated Hospital of Nanchang University, Nanchang Jiangxi, 330009, P. R. China;

Corresponding author：

ZHENG Xianyou, Email: zhengxianyou@126.com

Keywords：

Femoral neck fracture; deep venous thrombosis of lower extremities; perioperative period; risk factor

DOI：

10.7507/1002-1892.202403072

Video：

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Objective To investigate the incidence of perioperative deep venous thrombosis (DVT) of lower extremities and its risk factors in elderly patients with femoral neck fracture. Methods The clinical data of 4 109 elderly patients with femoral neck fracture admitted between August 2012 and November 2020 and met the selection criteria were retrospectively analyzed. Among them, there were 1 137 males and 2 972 females; their ages ranged from 65 to 101 years, with an average of 77.0 years. The time from fracture to admission ranged from 1 to 360 hours, with an average of 35.2 hours. There were 1 858 cases of hemiarthroplasty, 1 617 cases of total hip arthroplasty, and 634 cases of internal fixation surgery. The preoperative age-adjusted Charlson comorbidity index (aCCI) was 4 (3, 5). Perioperative DVT occurred in 857 cases (20.9%). Univariate analysis was performed on age, gender, body mass index, fracture side, time from fracture to admission, operation type, anesthesia type, blood transfusion, blood pressure after admission, and preoperative aCCI in patients with and without perioperative DVT, and logistic regression analysis was used to screen the risk factors of perioperative DVT in elderly patients with femoral neck fracture. Results Univariate analysis showed that there were significant differences in age, gender, time from fracture to admission, operation type, and preoperative aCCI between the two groups (P<0.05). Further logistic regression analysis showed that age>75 years, female patients, time from fracture to admission>24 hours, and preoperative aCCI>5 were risk factors for perioperative DVT (P<0.05). Conclusion Elderly patients with femoral neck fracture have a higher incidence of perioperative DVT. The advanced aged and female patients, patients with longer fracture time and more comorbidities need to pay special attention to the prevention of perioperative DVT to minimize the occurrence of DVT during femoral neck fractures.

Citation： WANG Yonggang, FU Kai, ZHENG Wei, CAI Qianying, CHEN Shengbao, ZHANG Changqing, ZHENG Xianyou. Risk factors of perioperative deep venous thrombosis of lower extremities in elderly patients with femoral neck fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(11): 1336-1339. doi: 10.7507/1002-1892.202403072 Copy

1.	Zuelzer DA, Weaver D, Zuelzer AP, et al. Current strategies in medical management of the geriatric hip fracture patient. J Am Acad Orthop Surg, 2023, 31(12): 620-626.
2.	McDonough CM, Harris-Hayes M, Kristensen MT, et al. Physical therapy management of older adults with hip fracture. J Orthop Sports Phys Ther, 2021, 51(2): CPG1-CPG81.
3.	Tarrant SM, Hardy BM, Byth PL, et al. Preventable mortality in geriatric hip fracture inpatients. Bone Joint J, 2014, 96-B(9): 1178-1184.
4.	Socci AR, Casemyr NE, Leslie MP, et al. Implant options for the treatment of intertrochanteric fractures of the hip: rationale, evidence, and recommendations. Bone Joint J, 2017, 99-B(1): 128-133.
5.	Paradis BE, Klein BJ, Bartlett LE, et al. Goals of care discussions in orthopaedic surgery: Geriatric hip fractures. J Arthroplasty, 2024, 39(5): 1144-1148.
6.	Zhang BF, Wei X, Huang H, et al. Deep vein thrombosis in bilateral lower extremities after hip fracture: a retrospective study of 463 patients. Clin Interv Aging, 2018, 13: 681-689.
7.	Pan S, Zhou S, Ruze XY, et al. Preoperative prevalence and risk factors for calf muscular vein thrombosis in elderly patients with hip fracture. Orthop Surg, 2023, 15(7): 1806-1813.
8.	He R, Wang G, Li T, et al. Factors associated with 90-day acute ischemic stroke in patients ≥70 years old with total hip arthroplasty for hip fracture. BMC Geriatr, 2022, 22(1): 28. doi: 10.1186/s12877-021-02728-3.
9.	Telli TA, Alan O, Demircan NC, et al. Age-adjusted Charlson Comorbidity Index is a valuable prognostic tool in operable soft tissue sarcoma of trunk and extremities. Orthop Traumatol Surg Res, 2023, 109(3): 103491. doi: 10.1016/j.otsr.2022.103491.
10.	Melgaard L, Nielsen PB, Overvad TF, et al. Sex differences in risk of incident venous thromboembolism in heart failure patients. Clin Res Cardiol, 2019, 108(1): 101-109.
11.	Tanizawa Y, Bando E, Kawamura T, et al. Prevalence of deep venous thrombosis detected by ultrasonography before surgery in patients with gastric cancer: a retrospective study of 1140 consecutive patients. Gastric Cancer, 2017, 20(5): 878-886.
12.	Xing F, Li L, Long Y, et al. Admission prevalence of deep vein thrombosis in elderly Chinese patients with hip fracture and a new predictor based on risk factors for thrombosis screening. BMC Musculoskelet Disord, 2018, 19(1): 444. doi: 10.1186/s12891-018-2371-5.
13.	Song K, Yao Y, Rong Z, et al. The preoperative incidence of deep vein thrombosis (DVT) and its correlation with postoperative DVT in patients undergoing elective surgery for femoral neck fractures. Arch Orthop Trauma Surg, 2016, 136(10): 1459-1464.
14.	Niu S, Li J, Zhao Y, et al. Preoperative deep venous thrombosis (DVT) after femoral neck fracture in the elderly, the incidence, timing, location and related risk factors. BMC Musculoskelet Disord, 2021, 22(1): 264. doi: 10.1186/s12891-021-04145-4.
15.	Cong Y, Wang B, Fei C, et al. Dynamic observation and risk factors analysis of deep vein thrombosis after hip fracture. PLoS One, 2024, 19(6): e0304629. doi: 10.1371/journal.pone.0304629.
16.	Wang BH, Sun YD, Fan XC, et al. The admission pH is a risk factor of preoperative deep vein thrombosis in geriatric hip fracture: a retrospective cohort study. Sci Rep, 2023, 13(1): 18392. doi: 10.1038/s41598-023-45712-0.
17.	Lu HY, Liao KM. Increased risk of deep vein thrombosis in end-stage renal disease patients. BMC Nephrol, 2018, 19(1): 204. doi: 10.1186/s12882-018-0989-z.
18.	Hernán MA, Robins JM. Estimating causal effects from epidemiological data. J Epidemiol Community Health, 2006, 60(7): 578-586.

1. Zuelzer DA, Weaver D, Zuelzer AP, et al. Current strategies in medical management of the geriatric hip fracture patient. J Am Acad Orthop Surg, 2023, 31(12): 620-626.
2. McDonough CM, Harris-Hayes M, Kristensen MT, et al. Physical therapy management of older adults with hip fracture. J Orthop Sports Phys Ther, 2021, 51(2): CPG1-CPG81.
3. Tarrant SM, Hardy BM, Byth PL, et al. Preventable mortality in geriatric hip fracture inpatients. Bone Joint J, 2014, 96-B(9): 1178-1184.
4. Socci AR, Casemyr NE, Leslie MP, et al. Implant options for the treatment of intertrochanteric fractures of the hip: rationale, evidence, and recommendations. Bone Joint J, 2017, 99-B(1): 128-133.
5. Paradis BE, Klein BJ, Bartlett LE, et al. Goals of care discussions in orthopaedic surgery: Geriatric hip fractures. J Arthroplasty, 2024, 39(5): 1144-1148.
6. Zhang BF, Wei X, Huang H, et al. Deep vein thrombosis in bilateral lower extremities after hip fracture: a retrospective study of 463 patients. Clin Interv Aging, 2018, 13: 681-689.
7. Pan S, Zhou S, Ruze XY, et al. Preoperative prevalence and risk factors for calf muscular vein thrombosis in elderly patients with hip fracture. Orthop Surg, 2023, 15(7): 1806-1813.
8. He R, Wang G, Li T, et al. Factors associated with 90-day acute ischemic stroke in patients ≥70 years old with total hip arthroplasty for hip fracture. BMC Geriatr, 2022, 22(1): 28. doi: 10.1186/s12877-021-02728-3.
9. Telli TA, Alan O, Demircan NC, et al. Age-adjusted Charlson Comorbidity Index is a valuable prognostic tool in operable soft tissue sarcoma of trunk and extremities. Orthop Traumatol Surg Res, 2023, 109(3): 103491. doi: 10.1016/j.otsr.2022.103491.
10. Melgaard L, Nielsen PB, Overvad TF, et al. Sex differences in risk of incident venous thromboembolism in heart failure patients. Clin Res Cardiol, 2019, 108(1): 101-109.
11. Tanizawa Y, Bando E, Kawamura T, et al. Prevalence of deep venous thrombosis detected by ultrasonography before surgery in patients with gastric cancer: a retrospective study of 1140 consecutive patients. Gastric Cancer, 2017, 20(5): 878-886.
12. Xing F, Li L, Long Y, et al. Admission prevalence of deep vein thrombosis in elderly Chinese patients with hip fracture and a new predictor based on risk factors for thrombosis screening. BMC Musculoskelet Disord, 2018, 19(1): 444. doi: 10.1186/s12891-018-2371-5.
13. Song K, Yao Y, Rong Z, et al. The preoperative incidence of deep vein thrombosis (DVT) and its correlation with postoperative DVT in patients undergoing elective surgery for femoral neck fractures. Arch Orthop Trauma Surg, 2016, 136(10): 1459-1464.
14. Niu S, Li J, Zhao Y, et al. Preoperative deep venous thrombosis (DVT) after femoral neck fracture in the elderly, the incidence, timing, location and related risk factors. BMC Musculoskelet Disord, 2021, 22(1): 264. doi: 10.1186/s12891-021-04145-4.
15. Cong Y, Wang B, Fei C, et al. Dynamic observation and risk factors analysis of deep vein thrombosis after hip fracture. PLoS One, 2024, 19(6): e0304629. doi: 10.1371/journal.pone.0304629.
16. Wang BH, Sun YD, Fan XC, et al. The admission pH is a risk factor of preoperative deep vein thrombosis in geriatric hip fracture: a retrospective cohort study. Sci Rep, 2023, 13(1): 18392. doi: 10.1038/s41598-023-45712-0.
17. Lu HY, Liao KM. Increased risk of deep vein thrombosis in end-stage renal disease patients. BMC Nephrol, 2018, 19(1): 204. doi: 10.1186/s12882-018-0989-z.
18. Hernán MA, Robins JM. Estimating causal effects from epidemiological data. J Epidemiol Community Health, 2006, 60(7): 578-586.

Chinese Journal of Reparative and Reconstructive Surgery

Risk factors of perioperative deep venous thrombosis of lower extremities in elderly patients with femoral neck fracture

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