A study about prevalence rate and risk factors of preoperative deep venous thrombosis of osteoporotic hip fracture in senile patients

Abstract

Objective To census the preoperative prevalence rate of deep venous thrombosis(DVT) and to evaluate the risk factors of DVT in senile osteoporotic hip fractured patients. Methods The object of study were patients aged 60 and above, and osteoporotic hip fracture by low energy injury in 2013. Based on medical records, all the patients with osteoporotic hip fracture were evaluated the signs and symptoms of DVT in 24 h, D-dimer test and underwent Doppler ultrasound screening of bilateral venous system in lower extremity after admission, and all the patients received preoperative prophylactic anticoagulation. Patients with popliteal and proximal level thrombus or floating thrombus underwent inferior vena cava(IVC) filter insertion. Outcome measures: age, gender, fracture type, D-dimer value in 24 h preoperatively, occurrence time of DVT and region, grade of preoperative American Society of Anesthesiologists, preoperative medical diseases. Results 702 of 946 hip fracture inpatients were comprised in this retrospective study. All were not founded any symptom or signs of DVT. All patients were took preoperative Doppler ultrasound screening and the results as follows: 36 of 302 patients(11.9%) with femoral neck fracture were proved preoperative thrombosis(13 male, 23 female), the average age was 72.7 year-old(range from 62-90 year-old), on the same side as the fractured hip in 31 patients, bilateral thrombosis in 5 patients. 74 of 400 patients(18.5%) with intertrochanteric fracture were proved preoperative thrombosis(38 male, 36 female), the average age was 76 year-old(range from 60-95 year-old), on the same side as the fractured hip in 68 patients, bilateral thrombosis in 6 patients. The most prevalence rate of DVT were in the first day after osteoporotic hip fracture, 15 patients(41.7%) with femoral neck fracture and 38 patients(51.40%) with intertrochanteric fracture. There were more proximal level and multiple level involment thrombosis over 5 days after injury. The most thrombosis were proven at calf and popliteal vein. Conclusion The prophylaxis of DVT should be started even in the emergency department in senile patient with osteoporotic hip fracture. To avoid the risk factors, early surgery and early postoperative mobilization will be effective. Key words: Hip fractures; Aged; Osteoporosis; Venous thrombosis; Perioperative Period; Risk factors