Abstract
Background Deep vein thrombosis (DVT) has been independently associated with both malignant diseases and orthopaedic surgery. Therefore, orthopaedic oncology patients may be at a high risk for thromboembolic events. However, less emphasis is given to this group of patients compared to the patients undergoing total hip and knee replacement. The objective of this study is to determine the incidence of DVT and their risk factors in patients undergoing orthopaedic oncology lower limb surgery without prophylaxis.Questions/purposes(1) What is the incidence of DVT in patients who underwent orthopaedic oncology surgery for the lower limb? (2) What are the risk factors related to DVT in patients who underwent oncology surgery of the lower limb surgery? (3) This is a pilot study to determine if further trial is warranted.MethodsThis is a prospective study. All sequential patients undergoing orthopaedic oncology operations from the period of 1st October 2013 till 30th September 2014 were recruited for the study with their consent. Their demographic data, diagnosis and surgery were documented. Thirty-eight patients who underwent lower limb surgeries for orthopaedic oncology indications were included in the study. No tourniquet was used in these lower limb surgeries. There were 24 men and 14 women with a mean age of 36 years (11–75). All potential risk factors were also identified and documented. All patients were not given any form of DVT prophylaxis (mechanical and chemical) before and after operation as this is a standard protocol in our center and a Medical Ethics Committee approval was taken for this study. DVT surveillance was performed 1 day before operation and 2 weeks after operation with ultrasound Doppler. Patients diagnosed with DVT via ultrasound Doppler were subsequently scheduled for CTPA to look for pulmonary embolism (PE).ResultsDVT was detected in two patients (5 %). Both patients were asymptomatic and they both had proximal thrombosis. One patient (2.6 %) was diagnosed with non-fatal PE and was asymptomatic. PE was detected incidentally by staging computed tomography scan and the patient had negative ultrasound Doppler of the operated and non-operated limb for DVT. We did not carry out a statistical analysis as the study population with DVT and pulmonary embolism is small.ConclusionsThe incidence of DVT in patients after undergoing orthopaedic oncology lower limb surgery was low even without prophylaxis at our center. Further investigation with larger sample size is needed to validate our results and identify the risk factors.Level of evidenceLevel III descriptive study.
Highlights
Deep vein thrombosis (DVT) has been independently associated with both malignant diseases and orthopaedic surgery
Patients diagnosed with DVT via ultrasound Doppler were subsequently scheduled for Computed Tomographic Pulmonary Angiography (CTPA) to look for pulmonary embolism (PE)
Of the population which is newly diagnosed to have deep vein thrombosis, one-fifth of the patients diagnosed with DVT are oncology patients and the risk of a post-operative DVT is twice higher for oncology patients who undergo surgery, compared to patients without cancer while the risk of fatal pulmonary embolism (PE) is three fold higher for patients having malignant diseases compared to patients having surgery for benign conditions (Gallus and Hirsh 1976; Geerts et al 2008; White et al 2003)
Summary
Deep vein thrombosis (DVT) has been independently associated with both malignant diseases and orthopaedic surgery. The objective of this study is to determine the incidence of DVT and their risk factors in patients undergoing orthopaedic oncology lower limb surgery without prophylaxis. The incidence of DVT increased from six to seven folds among patients with malignancy, who received chemotherapy as part of their treatment compared to those with no malignancy (Heit et al 2000). We conducted this pilot study to determine incidence of DVT in orthopaedic oncology patients who did not receive any form of DVT prophylaxis to see if further investigation is warranted
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