Analysis of prevalence and risk factors of perioperative deep venous thrombosis in patients with intertrochanteric femur fractures / 中华创伤杂志

ABSTRACT

Objective:To explore the incidence and risk factors of perioperative deep vein thrombosis (DVT) in patients with intertrochanteric femur fractures.Methods:A retrospective case-control study was used to analyze the clinical data of 485 patients with intertrochanteric femur fracture treated from June 2014 to September 2018 in Honghui Hospital affiliated to Xi'an Jiaotong University Medical College. There were 196 males and 289 females, aged 16 to 102 years, with an average of 74.6 years. All patients were divided into preoperative DVT group, non-DVT group, and postoperative DVT group and non-DVT group according to the results of preoperative and postoperative lower limb vein color Doppler ultrasound. The preoperative and postoperative incidence of DVT was counted and the preoperative to postoperative changes of the DVT was detected. The risk factors related to the preoperative and postoperative DVT were evaluated, including general patient information, operation time, intraoperative blood loss, intraoperative infusion volume, Surgical methods, intraoperative blood transfusion, serological indicators, etc. Single factor analysis was used to screen for risk factors, and then multivariate logistic regression analysis was used to determine the main independent risk factors.Results:The incidence of DVT before and after operation was 36.5%, 57.1%, respectively ( P<0.05). The incidence of unilateral DVT before and after operation was 30.5%, 37.1%, respectively ( P<0.05). The incidence of bilateral DVT before and after operation was 6.0%, 20.0% ( P<0.05). The preoperative rates of proximal, mixed, and distal DVT were 2.8%, 6.8% and 90.4%, respectively. The postoperative rates of proximal, mixed, and distal DVT were 2.2%, 4.7% and 93.1%, respectively. There were 293 patients (60.4%) showing no change in thrombosis, 164 patients (33.8%) aggravation, and 28 patients (5.8%) reduction. Univariate analysis showed the preoperative DVT group and non-DVT group had significant differences in gender, age, time from injury to operation, hemoglobin, hematocrit, D-dimer, previous history of venous thromboembolism (VTE), combination with injuries in other sites ( P<0.05), while not in fracture side, American Society of Anesthesiologists (ASA) score, time from injury to admission, fibrinogen, fracture AO classification, combination with medical disease, and combination with multiple medical diseases ( P>0.05). Postoperative DVT group and non-DVT group were significantly different in gender, operation method, time from injury to operation, and previous history of VTE ( P<0.05), while not in age, fracture side, operation time, intraoperative blood loss, intraoprative blood transfusion, ASA score, time from injury to admission, time from injury to operation, fracture AO classification, combination with medical disease, combination with multiple medical diseases, and combination with injuries in other sites ( P>0.05). Preoperative multivariate logistic regression analysis showed that gender, hemoglobin, hematocrit, previous history of VTE, and combination with injuries in other sites were significantly associated with preoperative DVT ( P<0.05). Postoperative multivariate logistic regression analysis showed gender, time from injury to operation and previous history of VTE were significantly associated with postoperative DVT ( P<0.05). Conclusion:The incidence of DVT is high in patients with intertrochanteric femur fractures, with a significant increase after operation. The type of thrombosis is mainly distal thrombosis and the effect of preventive anticoagulation is not satisfactory. Female, hemoglobin, hematocrit, previous history of VTE, and combination with injuries in other sites are independent risk factors for DVT before operation. Female, time from injury to operation, and previous history of VTE are independent risk factors for DVT after operation.