Symptomatic pulmonary embolism following hip fracture: A nationwide study

Abstract

IntroductionThis study evaluated the incidence of symptomatic pulmonary embolism (PE), subsequent mortality, risk factors, and the effects of pharmacological thromboprophylactic intervention following hip fracture surgery in Taiwan. Materials and methodsA nationwide study was conducted from February 2004 to September 2013. Hip fracture patients were placed into two groups: without symptomatic PE (control group) and with symptomatic PE (PE group). We analyzed the incidence of and risk factors for symptomatic PE, post-operative mortality rate, and effects of pharmacological thromboprophylactic intervention. ResultsWe identified 165,748 hip fracture patients. The 3-month cumulative incidence of post-operative symptomatic PE was 0.24% (n = 392). The cumulative 1-, 3-, and 6-month mortality rates were significantly higher in the PE group (16.1%, 23.0%, and 28.6%, respectively) than in the controls (3.3%, 6.7%, and 10.2%, respectively). Increased risk of post-operative symptomatic PE was associated with prior history of PE (adjusted odds ratio [OR], 40.00; 95% CI, 24.75–64.67; P < 0.001), female sex (adjusted OR, 1.33; 95% CI, 1.07–1.65; P = 0.009), older age (>75 years) (adjusted OR, 1.51; 95% CI, 1.20–1.91; P < 0.001), and hemiarthroplasty (adjusted OR, 1.23; 95% CI, 1.01–1.51; P < 0.043). Pharmacological thromboprophylaxis significantly reduced the incidence of post-operative PE (adjusted hazard ratio, 4.54; 95% CI, 2.08–9.88; P < 0.001). ConclusionsThe incidence of symptomatic PE after hip fracture surgery was not low in Asian patients, and PE significantly decreased patient survival rates. Some groups were at higher risk for PE; in these instances, thromboprophylaxis, prompt diagnosis, and subsequent intervention are advised.