Incidence of venous thromboembolism and bleeding events in patients with lower extremity orthopedic surgery: a retrospective analysis of a Japanese healthcare database

Takeshi Fuji,Kei Ibusuki,Yasuyuki Matsushita,Jumpei Kaburagi,Daisuke Matsubayashi,Masafumi Kobayashi,Takuhiro Yamaguchi,Masao Akagi,Eisei Oda,Atsushi Takita,Kaori Ota,Yasuyuki Abe,Mikio Iwashita

doi:10.1186/s13018-017-0549-4

Abstract

BackgroundOrthopedic surgeries of lower extremities such as total knee arthroplasty (TKA), total hip arthroplasty (THA), and hip fracture surgery (HFS) are widely considered to carry a high risk of developing deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE). Growing attention to epidemiological studies using a healthcare database led us to quantify the risks using a Japanese database to reveal recent medical care for such events.MethodsThe study comprised 36,947 patients who had undergone orthopedic surgeries of the lower extremities and whose medical information from April 2008 to September 2013 was available. The source population of the database was derived from 100 acute-care hospitals with Diagnosis Procedure Combination. The events were defined by diagnosis, medication, imaging, and laboratory tests.ResultsA breakdown of patients who underwent orthopedic surgeries by type of surgery showed 13.6% for TKA, 10.4% for THA, 56.8% for HFS, 1.5% for rupture of Achilles tendon, and 18.0% for simple fracture of lower extremities. The incidence for DVT, PTE, and bleeding events by type of surgery was 1.3, 0.2, and 1.0% for TKA; 0.9, 0.2, and 1.1% for THA; and 0.4, 0.1, and 1.8% for HFS, respectively. The population for risk factor analysis consisted of patients with similar background factors who underwent TKA, THA, or HFS. The statistically significant risk factors for PTE analyzed by the backward elimination procedure in a multivariate model were female sex, history of venous thromboembolism (VTE), thrombophilia, and varicose veins of lower extremity.ConclusionsThe incidence of DVT, PTE, and bleeding events and the risk factors for DVT and PTE in patients by type of orthopedic surgeries of lower extremities found in our study are considered to be rational as they reflect evidence from real-world cases.Trial registrationUniversity Hospital Medical Information Network Clinical Trials Registry UMIN000012667

Highlights

Orthopedic surgeries of lower extremities such as total knee arthroplasty (TKA), total hip arthroplasty (THA), and hip fracture surgery (HFS) are widely considered to carry a high risk of developing deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE)
The mean age for HFS was the oldest, and 78.9% of them were older than 75 years
The proportion of women was higher for TKA, THA, and HFS and lower for Achilles tendon rupture surgery (ATRS) and surgery of the lower extremities (SFS)

Summary

Introduction

Orthopedic surgeries of lower extremities such as total knee arthroplasty (TKA), total hip arthroplasty (THA), and hip fracture surgery (HFS) are widely considered to carry a high risk of developing deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE). Growing attention to epidemiological studies using a healthcare database led us to quantify the risks using a Japanese database to reveal recent medical care for such events. It has been evident that these diseases develop in relation to invasive orthopedic surgeries of the lower extremities, such as total knee arthroplasty (TKA), total hip arthroplasty (THA), and hip fracture surgery (HFS). Nationwide large-scale epidemiological data on VTE are still limited, so a true real-world understanding of the disease and treatment remains unclear. In Japan, some databases of medical information have recently become available for this type of epidemiologic study. A healthcare database is increasingly seen as an effective proposition for clinical studies

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