Abstract
BackgroundThere is still a lack of data on deep vein thrombosis (DVT) following surgically treated femoral shaft fracture (FSF). The goal of this study was to investigate the characteristics of postoperative DVT and the association between the occurrence of DVT and risk factors in patients undergoing surgical treatment for FSF.MethodsThis observational retrospective case-control study reviewed 308 patients who received surgical treatment of FSF between January 2016 and October 2020 at a university hospital. Univariate analyses were performed on the data of demographics, comorbidities, laboratory biomarkers, and operation-related indexes. The receiver operating characteristic (ROC) curve analysis, univariate analyses, and multivariate logistic regression analysis were employed to identify the independent risk factors associated with DVT.ResultsIn total, 308 patients with surgically treated FSF were included, among whom 48 (15.6%) patients had postoperative DVTs. The univariate analyses showing significant differences regarding DVT were American Society of Anesthesiologists (ASA) classification, diabetes mellitus, current smoking, aspartate transaminase (AST), and very-low-density lipoprotein (VLDL) level among the 34 factors. According to the ROC results, the optimal cutoff values for intraoperative blood loss, d-dimer, and age were 350 ml, 1.08 μg/ml, and 35 years, respectively. The multivariable model demonstrated 4 significantly independent associations with postoperative DVT, including current smoking, intraoperative blood loss (> 550 ml), age (> 35 years), and d-dimer > 1.09 μg/ml.ConclusionThese risk factors as screening tools contribute to risk stratification of the occurrence of thromboembolic events. In addition, our findings would help orthopedic surgeons make a cross-specialty decision and implement targeted precaution measures for patients with FSF.
Highlights
There is still a lack of data on deep vein thrombosis (DVT) following surgically treated femoral shaft fracture (FSF)
Apart from the incidence and characteristics of DVT developed in this population, we evaluated the independent risk factors that were closely associated with DVT, including current smoking, intraoperative blood loss (> 550 ml), age older than > 35 years, and plasma D-dimer > 1.09 μg/ml
We found no significant link in the univariate analysis between current smoking and postoperative DVT (p = 0.095), this association was strengthened with further adjustment for potential confounders in the multivariate logistics regression model, which suggested that smoking was independently associated with DVT in patients undergoing surgery for FSF, with a 2.9-fold elevated risk of DVT in smokers compared with nonsmokers
Summary
There is still a lack of data on deep vein thrombosis (DVT) following surgically treated femoral shaft fracture (FSF). Risk factors for the formation of DVT have been extensively reported including multiple systemic injuries, advanced age, immobilization, post-injury systemic inflammatory response, and inappropriate use of prophylactic and major orthopedic trauma (spinal injury, pelvic and hip fracture, etc.) [2,3,4,5]. These findings shed some light on the epidemiologic information that was applicable in certain scope but could hardly generalize to various populations. It is required to elucidate the contribution of isolated FSF to the first 3-month DVT following internal fixation
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