Abstract
BackgroundLittle information exists on the presentation of symptomatic venous thromboembolism (VTE) in orthopaedic surgery when a defined protocol for thromboprophylaxis is used. The objective with this study was to establish the VTE rate and mortality rate in orthopaedic surgery.MethodsWe performed a prospective, single centre observational cohort study of 45 968 consecutive procedures in 36 388 patients over a 10 year period. Follow-up was successful in 99.3%. The primary study outcome was the incidence of symptomatic deep vein thrombosis (DVT), symptomatic pulmonary embolism (PE) and mortality at 6 weeks, specified for different surgical procedures. The secondary outcome was to describe the DVT distribution in proximal and distal veins and the proportion of VTEs diagnosed after hospital discharge. For validation purposes, a retrospective review of VTEs diagnosed 7–12 weeks postoperatively was also performed.ResultsIn total, 514 VTEs were diagnosed (1.1%; 95% CI: 1.10-1.14), the majority (84%) after hospital discharge (432 out of 514).With thromboprophylaxis, high incidence of VTE was found after internal fixation (IF) of pelvic fracture (12%; 95% CI: 5–26), knee replacement surgery (3.7%; 95% CI: 2.8-5.0), after internal fixation (IF) of proximal tibia fracture (3.8%; 95% CI: 2.3-6.3) and after IF of ankle fracture (3.6%; 95% CI: 2.9-4.4). Without thromboprophylaxis, high incidence of VTE was found after Achilles tendon repair (7.2%; 95% CI: 5.5-9.4). In total 1094 patients deceased (2.4%; 95% confidence interval (CI): 2.33- 2.44) within 6 weeks of surgery. Highest mortality was seen after lower limb amputation (16.3%, CI: 13.8-19.1) and after hip hemiarthroplasty due to hip fracture (9.6%, CI; 7.6-12.1).ConclusionThe overall incidence of VTE is low after orthopaedic surgery but our study highlights surgical procedures after which the risk for VTE remains high and improved thromboprophylaxis is needed.
Highlights
Little information exists on the presentation of symptomatic venous thromboembolism (VTE) in orthopaedic surgery when a defined protocol for thromboprophylaxis is used
Validation of surgical procedures and VTEs The accuracy of the surgical procedure codes in our register was compared against the patient medical record database (Pasett®) for all cases coded as “internal fixation (IF) of femur fracture” (NFJ) in the Swedish version of NCSP 96 (Nomesco Classification of Surgical Procedures) between the years 1999 and 2003 (n = 4586)
In this analysis we found 14 more patients that had been treated for VTE (11 for deep vein thrombosis (DVT) and 3 for pulmonary embolism (PE)) within 6 week after surgery
Summary
Little information exists on the presentation of symptomatic venous thromboembolism (VTE) in orthopaedic surgery when a defined protocol for thromboprophylaxis is used. While a large number of reports have found a high incidence of VTE in screening studies, mostly asymptomatic, little information exists on the clinical presentation and the time-course of postoperative symptomatic VTE when a defined protocol for thromboprophylaxis has been used, after lower limb fractures. The late occurrence of postoperative VTEs [3,4,5] and the widespread tradition with internist diagnosing and treating VTEs could reduce the awareness of thromboembolic complications among orthopaedic surgeons This prospective study was performed in order to present the VTE outcome of a defined protocol for thromboprophylaxis and update the epidemiological data on VTE complications and mortality following a wide range of different orthopaedic procedures in large cohort of consecutive patients. Diagnostic investigations where performed only when the clinical suspicion of VTE was high
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
