Abstract
ObjectiveTo investigate the incidence of deep venous thrombosis (DVT) of the lower extremities following surgeries of tibial plateau fractures.MethodsRetrospective analysis of the prospectively collected data on patients undergoing surgeries of tibial plateau fractures between October 2014 and December 2018 was conducted. Duplex ultrasonography (DUS) was used to screen for postoperative DVT of the bilateral lower extremities. Data on demographics, comorbidities, injury, surgery, and laboratory biomarkers at admission were collected. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors associated with DVT.ResultsAmong 987 patients included, 46 (4.7%) had postoperative DVT, with incidence rate of 1.0% for proximal and 3.7% for distal DVT. The average interval between operation and DVT was 8.3 days (median, 5.8 days), ranging from 2 to 42 days. DVT involved the injured extremity in 39 (84.8%) patients, both the injured and uninjured extremity in 2 patients (4.3%) and only the uninjured extremity in 5 patients (10.9%). Five risk factors were identified to be associated with postoperative DVT, including age (≥ 41 vs < 41 years) (OR 3.08; 95% CI 1.43–6.61; p = 0.004), anesthesia (general vs regional) (OR 2.08; 95% CI 1.12–3.85; p = 0.021), hyponatremia (OR 2.21; 95% CI 1.21–4.06; p = 0.010), prolonged surgical time (OR 1.04; 95% CI 1.01–1.07; p = 0.017) and elevated D-dimer level (OR 2.79; 95% CI 1.34–4.83; p = 0.004).ConclusionThese epidemiologic data may be helpful in individualized assessment, risk stratification, and development of targeted prevention programs.
Highlights
As is well known, deep venous thrombosis (DVT) is a significant cause of morbidity, pulmonary embolism, and even mortality in all hospitalized patients, especially in the setting of trauma [1, 2]
Extensive and deep understanding of the related risk factors is critical for prevention of occurrence of DVT, and it is of more clinical significance to distinguish between proximal and distal venous thrombosis, which allows more accurate diagnose and a more aggressive therapy for the proximal DVT
DVT localized in the popliteal vein or proximally was defined as proximal DVT, and those distal to popliteal vein were defined as distal DVT; if both distal and proximal DVT were present in one patient, he was classified in the proximal DVT group [10]
Summary
Deep venous thrombosis (DVT) is a significant cause of morbidity, pulmonary embolism, and even mortality in all hospitalized patients, especially in the setting of trauma [1, 2]. Extensive and deep understanding of the related risk factors is critical for prevention of occurrence of DVT, and it is of more clinical significance to distinguish between proximal and distal venous thrombosis, which allows more accurate diagnose and a more aggressive therapy for the proximal DVT. The confounding covariables from multi-aspects as trauma stress, patient comorbidities, or injury itself could affect the occurrence of DVT, and their respective role has not been definitely illuminated
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