Influencing factors and prevention of perioperative venous thromboembolism in patients with lower extremity fractures

Abstract

Objective To analyze the influencing factors of perioperative venous thromboembolism (VTE) in patients with lower extremity fractures and to propose feasible preventive measures.Methods A retrospective analysis was conducted of the medical records of 329 patients with lower extremity fracture who had been admitted to our hospital between January 2009 and December 2010.They were 141 men and 188 women,with a mean age of 65.2 years (from 16 to 96 years).There were 190 hip fractures,10 femoral shaft fractures,46 peri-knee fractures,8 tibiofibular fractures,27 ankle fractures,6 pelvic fractures,and 42 multiple fractures.The patients were divided into a VTE group and a non-VTE group.The 2 groups were compared in general clinical data.A multiple logistic regression analysis was used for factors with P ≤ 0.1 by single factor analysis.Results The overall incidence of perioperative VTE in this cohort was 29.8％ (98/329).There were statistically significant differences (P ＜ 0.05) between the 2 groups in age,presence of concomitant disease impairing the function of vascular endothelium (such as hypertension,diabetes,coronary heart disease,cerebral vascular disease and hyperlipidemia) and usage of prophylactic anticoagulants.Logistic regression analysis revealed the following risks related to lower extremity VTE:age ≥ 60 years,duration from injury to operation ≥ 3 days,concomitant disease leading to vascular endothelium dysfunction and absence of prophylactic anticoagulants.This regression model was able to predict 75.7％ of the VTE events in patients with lower extremity fracture.Conclusions Patients with lower extremity fracture are a high-risk group of VTE,especially for those older than 60 years old,receiving surgery after longer than 3 days,having comorbidity that endangers vascular endothelium function and having fracture at pelvis,hip and multiple sites,and around the knee.Prophylactic anticoagulation is of great significance to these patients. Key words: Lower extremity; Fractures, bone; Venous thromboembolism; Risk factors