Perioperative Deep Vein Thrombosis in Elderly Patients with Lower Extremity Fracture: A Comprehensive Review of Anesthetic Management Strategies.

Objectives:To explore the preventive effect of the FOCUS-PDCA management model on deep vein thrombosis (DVT) in elderly orthopedic patients after surgery.Methods:A total of 229 elderly patients who underwent orthopedic surgery in our hospital between January 2021 and December 2023 were divided into two groups: the control group (n=104) and the intervention group (n=125), based on their admission order. The control group received routine intervention, while the intervention group was treated with the FOCUS-PDCA model. Coagulation function, DVT risk symptoms, incidence of DVT, intervention quality, and patient satisfaction were compared between the two groups.Results:After the intervention, the PT and APTT/s levels in the intervention group were significantly better than those in the control group, while the Fibrinogen (FIB) level was significantly lower (P < 0.05). The DVT risk symptoms and incidence of DVT were also lower in the intervention group (P < 0.05). Additionally, the intervention quality and patient satisfaction were higher in the intervention group compared to the control group (P < 0.05).Conclusions:The FOCUS-PDCA management model improves coagulation function and reduces the incidence of deep vein thrombosis in elderly orthopedic patients after surgery.

Development and prospective validation of a novel risk score for predicting the risk of lower extremity deep vein thrombosis among multiple trauma patients

Is it useful to also image the asymptomatic leg in patients with suspected deep vein thrombosis?: comment

Current assessment of preoperative deep vein thrombosis (DVT) in elderly patients with femoral neck fracture is limited. We aimed to identify independent risk factors for preoperative DVT in patients with femoral neck fracture and to develop and validate a predictive nomogram. Patients diagnosed with femoral neck fracture from October 2014 to April 2019 were retrospectively analyzed. Baseline data, treatment information and laboratory test results were collected, and the occurrence of DVT in the preoperative period was regarded as the study outcome event. Multivariable logistic regression identified independent risk factors associated with a higher incidence of preoperative DVT. The predictive nomogram was constructed based on the analysis results. The stability of the model was further assessed in this study using patients from May 2019 to September 2022 as an external validation set. A total of 921 patients were enrolled in the study, of which 639 were used in the training cohort and the other 282 for the validation cohort. Multivariate analysis revealed age (OR 1.100, 95% CI 1.042–1.162), BMI ≥ 28 (OR 3.969, 95% CI 1.792–8.793), smoking (OR 2.998, 95% CI 1.255–7.165), LDL-C > 3.4 mmol/L (OR 2.628, 95% CI 1.316–5.250), and d-dimer > 0.475 mg/L (OR 3.157, 95% CI 1.565–6.368) were the independent risk factors of preoperative DVT. The concordance index (C-index) of the nomogram were 0.832 in the training set, and the corrected values after internal validation were 0.759. The receiver-operating characteristic (ROC) curve, the calibration curve, the Hosmer–Lemeshow test and the decision curve analysis (DCA) performed well in both the training and validation cohorts. In this study, we developed a personalised predictive nomogram containing five high-risk factors, which can help surgeons stratify the risk of preoperative DVT in elderly patients with femoral necks and guide high-risk patients to ultrasound scans or prophylactic anticoagulation as soon as possible.

Tumor imaging represents an ideal environment for collecting novel biomarkers from different technologies, as patients with tumors often undergo multiple imaging studies.With the aging of the Chinese population, the number of elderly patients with gastric cancer is also increasing. In the past, patients with gastric cancer in the elderly have been conservative in whether surgical treatment can be performed, and advanced age is regarded as a relative contraindication to the effect of surgical treatment on gastric cancer patients. To investigate the clinical characteristics of patients with upper gastrointestinal hemorrhage complicated by deep vein thrombosis in elderly patients with gastric cancer. One patient with upper gastrointestinal hemorrhage complicated by deep venous thrombosis, and elderly gastric cancer patients admitted to our hospital on 11 October 2020, were selected. After anti-shock symptomatic support, filter placement, prevention and treatment of thrombosis, gastric cancer eradication, anticoagulation, immune regulation, etc. Treatment and long-term follow-up observation. Long-term follow-up showed that the patient’s condition was stable, there was no sign of metastasis or recurrence after radical gastrectomy for gastric cancer, and there were no serious pre- and post-operative complications such as upper gastrointestinal bleeding and deep vein thrombosis, and the prognosis was satisfactory. How to choose the appropriate operation timing and method for elderly gastric cancer patients with upper gastrointestinal bleeding and deep vein thrombosis at the same time to maximize benefits, clinical experience in this area is particularly valuable.

ObjectiveThis study aims to explore the clinical correlation between nonspecific ST-segment or T-wave (NS-STT) changes and perioperative deep vein thrombosis (DVT) in patients with lower extremity fractures.MethodsOne thousand four hundred sixty-nine consecutive patients who suffered lower extremity fractures were screened at Xi’an Honghui Hospital between Feb 2016 and Nov 2018. According to the included and excluded criteria, the patients were included in this retrospective study. After collecting the electrocardiogram baseline, the patients were divided into the NS-STT group and the non-NS-STT group. After comparing the demographic and clinical characteristics, multivariate logistic regression models were used to identify the role of NS-STT changes on perioperative DVT. All analyses were performed with R and EmpowerStats software.ResultsNine hundred and sixty-eight patients were included in the study. Ninety-seven patients (10.02%) had NS-STT changes on the electrocardiogram at admission. A total of 303 patients (31.30%) developed perioperative DVT in lower extremities. The univariate analysis showed that NS-STT segment changes were correlated with perioperative DVT significantly (OR = 3.45, 95% CI: 2.25–5.30, P < 0.0001). In addition, age ≥50 (P < 0.0001), female (OR = 1.50, 95% CI: 1.14–1.97, P = 0.0038), hypertension (OR = 1.54, 95% CI: 1.08–2.20, P = 0.0161), blood transfusion (OR = 1.78, 95% CI: 1.34–2.37, P < 0.0001), joint prosthesis (OR = 3.26, 95% CI: 2.21–4.81, P < 0.0001), and blood loss ≥300 mL (OR = 2.12, 95% CI: 1.50–3.01, P < 0.0001) were associated with perioperative DVT in lower extremities. We identified the confounding factors of age, gender, classification of internal implants, operation time, blood loss, and infusion. After adjustment for potential confounding factors, NS-STT changes were associated with perioperative DVT (OR = 2.13, 95% CI: 1.33–3.42; P = 0.0017). The sensitive analysis showed that the result was stable.ConclusionThe NS-STT changes on electrocardiograms are associated with an increase in the incidence of perioperative DVT by 2.13-fold in patients with lower extremity fractures under 75 years old. In clinical practice, surgeons should pay more attention to these patients.

Incidence and prophylaxis of deep vein thrombosis in a high risk trauma population

This study aimed to investigate the incidence of deep vein thrombosis (DVT) in patients with pelvic or lower-extremity fractures in the emergency intensive care unit (EICU), explore the independent risk factors for DVT, and investigate the predictive value of the Autar scale for DVT in these patients. The clinical data of patients with single fractures of the pelvis, femur, or tibia in the EICU from August 2016 to August 2019 were retrospectively examined. The incidence of DVT was statistically analyzed. Logistic regression was used to analyze the independent risk factors for DVT in these patients. The receiver-operating characteristic (ROC) curve was used to evaluate the predictive value of the Autar scale for the risk of DVT. A total of 817 patients were enrolled in this study; of these, 142 (17.38%) had DVT. Significant differences were found in the incidence of DVT among the pelvic fractures, femoral fractures, and tibial fractures (P < 0.001). The multivariate logistic regression analysis showed multiple injuries (OR = 2.210, 95% CI: 1.166-4.187, P = 0.015), fracture site (compared with tibia fracture group, femur fracture group OR = 4.839, 95% CI: 2.688-8.711, P < 0.001; pelvic fracture group OR = 2.210, 95% CI: 1.225-3.988, P = 0.008), and Autar score (OR = 1.198, 95% CI: 1.016-1.353, P = 0.004) were independent risk factors for DVT in patients with pelvic or lower-extremity fractures in the EICU. The area under the ROC curve (AUROC) of the Autar score for predicting DVT was 0.606. When the Autar score was set as the cutoff value of 15.5, the sensitivity and specificity for predicting DVT in patients with pelvic or lower-extremity fractures were 45.1% and 70.7%, respectively. Fracture is a high-risk factor for DVT. Patients with a femoral fracture or multiple injuries have a higher risk of DVT. In the case of no contraindications, DVT prevention measures should be taken for patients with pelvic or lower-extremity fractures. Autar scale has a certain predictive value for the occurrence of DVT in patients with pelvic or lower-extremity fractures, but it is not ideal.

Objective To investigate the clinical value of bedside ultrasound in detection of deep vein thrombosis in elderly patients with femoral neck fracture. Methods A retrospective study was performed in patients with femoral neck fractures who underwent bilateral ultrasound in department of Sports Medicine and Adult Reconstructive Surgery of Drum Tower Hospital Affiliated to Medical School of Nanjing University from January 2016 to March 2017. The diameter of blood vessel, location, echo and blood flow were evaluated. Postoperative ultrasound were conducted routinely during hospitalization and after discharge. Results A total of 135 patients were enrolled in this study. There were 45 males and 90 females. The average age was 76±8 years old and the average body mass index was 22±3 kg/m2. Forty-five cases were diagnosed DVT. Seven cases were proximal DVT and thirty eight were distal. According to the anatomical location, one located in the iliac vein, four located in the femoral veins, four located in the popliteal veins, five cases located in the peroneal veins and three cases located in the posterior tibia veins, forty one cases located in the muscular vein. Surgeries were postponed in 13 DVT patients and all of them received thrombosis treatment and ultrasound screening every other day. Results showed that 10 cases were significantly improved, two cases had no improvement and one case aggravated, two cases received inferior vena cava filters. During postoperative screening, three preoperative DVTs were found to progress into other veins and all of them received treatment and the follow-up screening showed that no DVT failed off and no pulmonary embolism happened. Conclusion Bedside ultrasound can be used in the diagnosis, monitoring and follow up of DVT in patients with femoral neck fracture. Key words: Thrombosis; Ultrasonography; Femoral neck fractures; Arthroplasty, replacement, hip

To determine the effect of ulinastatin on plasma thromboxane B(2) and deep vein thrombosis(DVT) in elderly patients after hip joint replacement. Eighty ASAI-IIpatients aged 65-81 years undergoing hip joint replacement were randomly divided into 4 groups (n=20): Group U1 (ulinastatin 5 000 U/kg);Group U2 (ulinastatin 10 000 U/kg); Group U3 (ulinastatin 20 000 U/kg); and Group C (the same volume of saline as control).The blood samples were collected at 5 time points: preoperation (T(1)), immediately after the operation (T(2)), 1 d (T(3)), 2 d (T(4)) and 3 d after the operation (T(5)), respectively. Thromboxane B(2) was detected, and DVT was also examined through color Doppler ultrasonography 3 d after the operation. Compared with T(1), the level of thromboxane B(2) significantly increased in Group C at T(2)-5, in Group U1 at T(2-4), in Group U2 and U3 at T(2) (P<0.01). Compared with Group C, the concentration of thromboxane B(2) decreased in Group U1 at T(2-3), in Group U2 and U3 at T(2-4) (P<0.01). Compared with Group U1, thromboxane B(2) significantly decreased in Group U2 and U3 at T(2-4) (P<0.01).The incidence rate of DVT was 40% in Group C, 10% in Group U1. There was no incidence of DVT in the Group U2 and U3 (P>0.05). Ulinastatin can inhibit blood thromboxane B(2) level in dose dependent manner and prevent DVT in elderly patients after hip joint replacement.

European Guidelines on perioperative venous thromboembolism prophylaxis: Executive summary.

Venous thromboembolism (VTE) is a growing public health threat whose prevalence imposes a significant burden on patients and the economy. It mostly affects the lower limbs and is more prevalent in patients who have fractures or who are bedridden for long periods of time. Deep vein thrombosis (DVT) is more common and advances more quickly in cases of traumatizing lower extremity fractures. This study aims to develop a nomogram to predict the risk of deep vein thrombosis (DVT) progression following lower limb fracture surgery, providing a theoretical foundation for preoperative prevention. This retrospective study analyzed 500 patients who underwent lower limb fracture surgery at the Third Hospital of Hebei Medical University. The mean age was 54 years, and 65.8% were male. Thrombotic progression occurred in 30.2% of patients. Data collected included demographics, comorbidities, surgical details, and laboratory parameters. Independent risk factors for postoperative DVT progression were identified using logistic regression. A nomogram prediction model was developed and evaluated using the area under the ROC curve (AUC), calibration curves, and decision curve analysis (DCA). Results showed 5 significant (P < .05) independent risk factors for thrombosis progression: age (45–59 years), blood transfusion, short time from fracture to surgery, elevated d-dimer levels, and preoperative thrombosis location (intermuscular vein thrombosis). Using these 5 independent criteria, a risk prediction model for DVT progression in patients following lower extremity fracture surgery exhibited good performance with an AUC value of 0.691 (95% CI: 0.642–0.740). Internal validation of the model revealed that the calibration curves were near the ideal curves. The developed and validated prediction model demonstrated good accuracy in identifying high-risk patients and provided key insights into DVT pathogenesis. This reliable tool informs clinical strategies for targeted interventions, ultimately improving patient outcomes.

Whether fracture site has any effect on perioperative deep vein thrombosis (DVT) in elderly patients with hip fractures undergoing arthroplasty is still controversial. This study aimed to evaluate the association between fracture site and perioperative DVT in elderly patients undergoing hip arthroplasty. A retrospective cohort analysis was conducted on elderly hip fracture patients who underwent hip arthroplasty and were admitted between January 2015 and December 2021. Patient data, including demographics, comorbidities, injury-related information, laboratory test results at admission, and surgery-related information, were collected. Univariate and multivariate regression analyses, along with subgroup analyses and sensitive analysis, were performed to identify the association between fracture site and DVT. The study included 593 patients, consisting of 353 patients with intracapsular hip fractures (ICF) and 240 patients with extracapsular hip fractures (ECF), with an average age of 80.7 ± 7.6. The incidence of DVT diagnosed by ultrasonography was 16.9% in all patients. The prevalence of DVT for ECF patients and ICF patients was 22.5% and 13.0%, respectively. In all adjusted multivariate regression analysis model, ECF patients exhibited an increased risk of DVT compared to ICF patients (OR 2.03; 95% CI 1.19-3.47, p = 0.009). Subgroup analyses revealed that female patients with ECF had a higher likelihood of DVT than those with ICF (OR 2.25; 95% CI 1.22-4.13), as did patients aged 65 to 80years (OR 4.06; 95% CI 1.44-11.41), patients with hemoglobin levels above 110g/L (OR 2.30; 95% CI 1.08-4.92), and patients with albumin levels above 35g/L (OR 2.47; 95% CI 1.29-4.73). Sensitivity analysis found similar results. The findings indicate a significant association between fracture site and perioperative DVT in elderly hip fracture patients undergoing hip arthroplasty, with ECF patients demonstrating a higher likelihood of developing DVT than ICF patients.

Deep vein thrombosis (DVT) is a major complication after lower extremity traumatic fractures. Current nursing assessment is largely postoperative-centered and may overlook risk evolution during the preoperative waiting period. In this prospective observational cohort study, 948 patients with lower extremity traumatic fractures were enrolled between January 2019 and January 2026. Serial color Doppler ultrasound examinations were performed at five timepoints: admission, preoperative, postoperative day 1, postoperative day 3, and discharge. Univariate and multivariate logistic regression analyses were used to identify predictors of preoperative DVT. A dynamic nomogram was developed and evaluated using receiver operating characteristic analysis, calibration, decision curve analysis, and SHAP-based interpretation. The overall incidence of perioperative DVT was 32.9% (312/948). DVT showed a distinct "twin-peak" temporal pattern, with the highest incidence during the preoperative waiting period and a second peak on postoperative day 3. Thrombi also shifted from predominantly distal veins at admission to greater proximal involvement after surgery. Independent predictors of preoperative DVT were age >65 years, preoperative waiting time >3 days, D-dimer >1.85 mg/L, albumin <35 g/L, and time from injury to admission >12h. The nomogram showed good discrimination (AUC 0.905, 95% CI 0.882-0.928), outperforming individual predictors such as D-dimer (AUC 0.796). Decision curve analysis demonstrated clinical net benefit, and SHAP analysis identified D-dimer and albumin as the most influential variables. Perioperative DVT after lower extremity fractures follows a dynamic pattern with a critical preoperative risk window. The proposed nomogram may support stage-specific nursing assessment and targeted interventions, particularly by reducing preoperative delay and optimizing nutritional status.

Patients who undergo neurosurgical procedures are at high risk for perioperative deep vein thrombosis (DVT) and pulmonary embolism (PE), which have been reported in 6% to 43% of these patients. To (1) determine the utility of prospective DVT surveillance in patients who undergo neurosurgical procedures by using venous duplex ultrasound scanning (VDUS), (2) assess the efficacy of DVT prophylaxis (elastic stockings and intermittent pneumatic compression), (3) identify subgroups of patients who are at higher risk, and (4) determine whether DVT surveillance would reduce the incidence of fatal PE. All patients had undergone preoperative VDUS of both lower extremities, and postoperative VDUS was performed on days 3 and 7, and weekly thereafter until patients were ambulatory or discharged. During a 5-year period, 2643 patients who underwent neurosurgical procedures were enrolled in prospective DVT surveillance. University-affiliated community hospital. Acute DVT was diagnosed in 147 (5.6%) of the 2643 patients. Eighty-one percent of the patients with acute DVT were asymptomatic at the time of diagnosis. Deep vein thrombosis developed de novo in the proximal veins in 98% of the patients. Patients in whom a craniotomy was done had a significantly higher risk for DVT (7.7%, P = .006), and patients who underwent cervical or lumbar spinal surgical procedures had a significantly lower risk (1.5%, P < .001). Among those patients in whom a craniotomy was performed for treatment of a tumor and who had DVT, 87% had malignant neoplasms. Significant lower-extremity neuromotor dysfunction was present in 69% of all patients with DVT, and this finding predominated among patients with DVT in the subgroups with a lower risk. A PE was diagnosed in 5 patients (0.19%) while they were hospitalized, and a PE was fatal in 2 (0.07% of all patients). Most perioperative DVTs were clinically silent and formed spontaneously in proximal venous segments where there would be a risk for a PE. The overall incidence of DVT (5.6%) was low, suggesting effective DVT prophylaxis. Patients who underwent spinal surgical procedures were at a significantly lower risk for DVT, and future surveillance is not indicated in this patient group unless other conditions exist (paralysis, malignancy). Patients in whom a craniotomy was performed had a significantly higher risk of DVT, particularly when other risk factors existed. The low incidence of a fatal PE (0.07%) reflected that early detection and treatment of proximal DVT were facilitated by prospective VDUS surveillance in these patients.