Skip to main content
Top
Published in: European Journal of Trauma and Emergency Surgery 5/2022

21-04-2022 | Phlebothrombosis | Original Article

Optimal preoperative timing for prevention of deep vein thrombosis (DVT) in patients over 60 years of age with intertrochanteric fractures

Authors: ZhiQiang Xue, WangJie Tu, JianQing Gao, ZeTao Dong, JianDong Yuan, JunZhe Lang

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2022

Login to get access

Abstract

Purpose

To investigate the incidence and risk factors of preoperative DVT in elderly patients with intertrochanteric fracture of the femur and determine the optimal preoperative time.

Methods

Electronic medical records of 358 patients over 60 years of age with intertrochanteric fractures from May 1, 2016, to May 1, 2019, were retrospectively analyzed. The preoperative group was divided into DVT and non-DVT. Univariate analysis was used for preliminary comparison, and multivariate logistic regression analysis was used to identify independent risk factors associated with DVT development. ROC curve was drawn to analyze the specificity and sensitivity of risk factors for DVT diagnosis. The diagnostic value of the model was analyzed by the ROC curve of multivariable combined diagnosis.

Results

A total of 358 patients who met the criteria were enrolled. The total prevalence of DVT before surgery was 8.38%. Multivariate logistic regression analysis showed that smoking status, preoperative time, albumin (ALB), D-dimer level, diabetes mellitus, and hypertension were independent risk factors for preoperative DVT. Preoperative time has the best sensitivity and specificity for diagnosing the occurrence of preoperative DVT. The ROC curve analysis model of multivariable combined diagnosis has a better diagnostic value.

Conclusions

In this study, elderly patients with intertrochanteric femur fracture had a higher incidence of deep vein thrombosis before surgery. Early identification of DVT-related risk factors may contribute to individualized risk assessment and preventing adverse outcomes in patients with intertrochanteric fractures.
Literature
1.
go back to reference Cauley JA, Chalhoub D, Kassem AM, Fuleihan Gel H. Geographic and ethnic disparities in osteoporotic fractures. Nat Rev Endocrinol. 2014;10(6):338–51.CrossRef Cauley JA, Chalhoub D, Kassem AM, Fuleihan Gel H. Geographic and ethnic disparities in osteoporotic fractures. Nat Rev Endocrinol. 2014;10(6):338–51.CrossRef
2.
go back to reference Drescher FS, Sirovich BE, Lee A, Morrison DH, Chiang WH, Larson RJ. Aspirin versus anticoagulation for prevention of venous thromboembolism major lower extremity orthopedic surgery: a systematic review and meta-analysis. J Hosp Med. 2014;9(9):579–85.CrossRef Drescher FS, Sirovich BE, Lee A, Morrison DH, Chiang WH, Larson RJ. Aspirin versus anticoagulation for prevention of venous thromboembolism major lower extremity orthopedic surgery: a systematic review and meta-analysis. J Hosp Med. 2014;9(9):579–85.CrossRef
3.
go back to reference Forster R, Stewart M. Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair. Cochrane Database Syst Rev. 2016;3: Cd004179.PubMed Forster R, Stewart M. Anticoagulants (extended duration) for prevention of venous thromboembolism following total hip or knee replacement or hip fracture repair. Cochrane Database Syst Rev. 2016;3: Cd004179.PubMed
4.
go back to reference Marsland D, Mears SC, Kates SL. Venous thromboembolic prophylaxis for hip fractures. Osteoporos Int. 2010;21(Suppl 4):S593-604.CrossRef Marsland D, Mears SC, Kates SL. Venous thromboembolic prophylaxis for hip fractures. Osteoporos Int. 2010;21(Suppl 4):S593-604.CrossRef
5.
go back to reference Rodriguez-Fernandez P, Adarraga-Cansino D, Carpintero P. Effects of delayed hip fracture surgery on mortality and morbidity in elderly patients®. Clin Orthop Relat Res. 2011;469(11):3218–21.CrossRef Rodriguez-Fernandez P, Adarraga-Cansino D, Carpintero P. Effects of delayed hip fracture surgery on mortality and morbidity in elderly patients®. Clin Orthop Relat Res. 2011;469(11):3218–21.CrossRef
6.
go back to reference Auer R, Riehl J. The incidence of deep vein thrombosis and pulmonary embolism after fracture of the tibia: an analysis of the National Trauma Databank. J Clin Orthop Trauma. 2017;8(1):38–44.CrossRef Auer R, Riehl J. The incidence of deep vein thrombosis and pulmonary embolism after fracture of the tibia: an analysis of the National Trauma Databank. J Clin Orthop Trauma. 2017;8(1):38–44.CrossRef
7.
go back to reference Cho YH, Byun YS, Jeong DG, Han IH, Park YB. Preoperative incidence of deep vein thrombosis after hip fractures in Korean. Clin Orthop Surg. 2015;7(3):298–302.CrossRef Cho YH, Byun YS, Jeong DG, Han IH, Park YB. Preoperative incidence of deep vein thrombosis after hip fractures in Korean. Clin Orthop Surg. 2015;7(3):298–302.CrossRef
8.
go back to reference Vidán MT, Sánchez E, Gracia Y, Maranón E, Vaquero J, Serra JA. Causes and effects of surgical delay in patients with hip fracture: a cohort study. Ann Intern Med. 2011;155(4):226–33.CrossRef Vidán MT, Sánchez E, Gracia Y, Maranón E, Vaquero J, Serra JA. Causes and effects of surgical delay in patients with hip fracture: a cohort study. Ann Intern Med. 2011;155(4):226–33.CrossRef
9.
go back to reference Fantini M, Fabbri G, Laus M, Carretta E, Mimmi S, Franchino G, Favero L, Rucci P. Determinants of surgical delay for hip fracture. The Surgeon. 2011;9(3):130–4.CrossRef Fantini M, Fabbri G, Laus M, Carretta E, Mimmi S, Franchino G, Favero L, Rucci P. Determinants of surgical delay for hip fracture. The Surgeon. 2011;9(3):130–4.CrossRef
10.
go back to reference Kuo HK, Jones RN, Milberg WP, Tennstedt S, Talbot L, Morris JN, Lipsitz LA. Effect of blood pressure and diabetes mellitus on cognitive and physical functions in older adults: a longitudinal analysis of the advanced cognitive training for independent and vital elderly cohort. J Am Geriatr Soc. 2005;53(7):1154–61.CrossRef Kuo HK, Jones RN, Milberg WP, Tennstedt S, Talbot L, Morris JN, Lipsitz LA. Effect of blood pressure and diabetes mellitus on cognitive and physical functions in older adults: a longitudinal analysis of the advanced cognitive training for independent and vital elderly cohort. J Am Geriatr Soc. 2005;53(7):1154–61.CrossRef
11.
go back to reference Bulger CM, Jacobs C, Patel NH. Epidemiology of acute deep vein thrombosis. Tech Vasc Interv Radiol. 2004;7(2):50–4.CrossRef Bulger CM, Jacobs C, Patel NH. Epidemiology of acute deep vein thrombosis. Tech Vasc Interv Radiol. 2004;7(2):50–4.CrossRef
12.
go back to reference Barnes RW, Wu KK, Hoak JC. Fallibility of the clinical diagnosis of venous thrombosis. JAMA. 1975;234(6):605–7.CrossRef Barnes RW, Wu KK, Hoak JC. Fallibility of the clinical diagnosis of venous thrombosis. JAMA. 1975;234(6):605–7.CrossRef
13.
go back to reference Tovey C, Wyatt S. Diagnosis, investigation, and management of deep vein thrombosis. BMJ. 2003;326(7400):1180–4.CrossRef Tovey C, Wyatt S. Diagnosis, investigation, and management of deep vein thrombosis. BMJ. 2003;326(7400):1180–4.CrossRef
14.
go back to reference Yang Y, Zan P, Gong J, Cai M. D-dimer as a screening marker for venous thromboembolism after surgery among patients younger than 50 with lower limb fractures. Clin Appl Thromb Hemost. 2017;23(1):78–83.CrossRef Yang Y, Zan P, Gong J, Cai M. D-dimer as a screening marker for venous thromboembolism after surgery among patients younger than 50 with lower limb fractures. Clin Appl Thromb Hemost. 2017;23(1):78–83.CrossRef
15.
go back to reference Kutcher ME, Cripps MW, McCreery RC, Crane IM, Greenberg MD, Cachola LM, Redick BJ, Nelson MF, Cohen MJ. Criteria for empiric treatment of hyperfibrinolysis after trauma. J Trauma Acute Care Surg. 2012;73(1):87.CrossRef Kutcher ME, Cripps MW, McCreery RC, Crane IM, Greenberg MD, Cachola LM, Redick BJ, Nelson MF, Cohen MJ. Criteria for empiric treatment of hyperfibrinolysis after trauma. J Trauma Acute Care Surg. 2012;73(1):87.CrossRef
16.
go back to reference Bartlett MA, Mauck KF, Stephenson CR, Ganesh R, Daniels PR. Perioperative venous thromboembolism prophylaxis. Mayo Clin Proc. 2020;95(12):2775–98.CrossRef Bartlett MA, Mauck KF, Stephenson CR, Ganesh R, Daniels PR. Perioperative venous thromboembolism prophylaxis. Mayo Clin Proc. 2020;95(12):2775–98.CrossRef
17.
18.
go back to reference Harper KD, Navo P, Ramsey F, Jallow S, Rehman S. “Hidden” preoperative blood loss with extracapsular versus intracapsular hip fractures: what is the difference? Geriatric Orthop Surg Rehabil. 2017;8(4):202–7.CrossRef Harper KD, Navo P, Ramsey F, Jallow S, Rehman S. “Hidden” preoperative blood loss with extracapsular versus intracapsular hip fractures: what is the difference? Geriatric Orthop Surg Rehabil. 2017;8(4):202–7.CrossRef
19.
go back to reference Fan J, Zhou F, Xu X, Zhang Z, Tian Y, Ji H, Guo Y, Lv Y, Yang Z, Hou G. Clinical predictors for deep vein thrombosis on admission in patients with intertrochanteric fractures: a retrospective study. BMC Musculoskelet Disord. 2021;22(1):1–8.CrossRef Fan J, Zhou F, Xu X, Zhang Z, Tian Y, Ji H, Guo Y, Lv Y, Yang Z, Hou G. Clinical predictors for deep vein thrombosis on admission in patients with intertrochanteric fractures: a retrospective study. BMC Musculoskelet Disord. 2021;22(1):1–8.CrossRef
20.
go back to reference Xia Z-N, Xiao K, Zhu W, Feng B, Zhang B-Z, Lin J, Qian W-W, Jin J, Gao N, Qiu G-X. Risk assessment and management of preoperative venous thromboembolism following femoral neck fracture. J Orthop Surg Res. 2018;13(1):1–9.CrossRef Xia Z-N, Xiao K, Zhu W, Feng B, Zhang B-Z, Lin J, Qian W-W, Jin J, Gao N, Qiu G-X. Risk assessment and management of preoperative venous thromboembolism following femoral neck fracture. J Orthop Surg Res. 2018;13(1):1–9.CrossRef
21.
go back to reference Fu Y-H, Liu P, Xu X, Wang P-F, Shang K, Ke C, Fei C, Yang K, Zhang B-F, Zhuang Y. Deep vein thrombosis in the lower extremities after femoral neck fracture: a retrospective observational study. J Orthop Surg. 2020;28(1):2309499019901172.CrossRef Fu Y-H, Liu P, Xu X, Wang P-F, Shang K, Ke C, Fei C, Yang K, Zhang B-F, Zhuang Y. Deep vein thrombosis in the lower extremities after femoral neck fracture: a retrospective observational study. J Orthop Surg. 2020;28(1):2309499019901172.CrossRef
22.
go back to reference Zuo J, Hu Y. Admission deep venous thrombosis of lower extremity after intertrochanteric fracture in the elderly: a retrospective cohort study. J Orthop Surg Res. 2020;15(1):1–7.CrossRef Zuo J, Hu Y. Admission deep venous thrombosis of lower extremity after intertrochanteric fracture in the elderly: a retrospective cohort study. J Orthop Surg Res. 2020;15(1):1–7.CrossRef
23.
go back to reference Le Gal G, Righini M. Controversies in the diagnosis of venous thromboembolism. J Thromb Haemost. 2015;13:S259–65.CrossRef Le Gal G, Righini M. Controversies in the diagnosis of venous thromboembolism. J Thromb Haemost. 2015;13:S259–65.CrossRef
24.
go back to reference Malafarina V, Reginster JY, Cabrerizo S, Bruyère O, Kanis JA, Martinez JA, Zulet MA. Nutritional status and nutritional treatment are related to outcomes and mortality in older adults with hip fracture. Nutrients. 2018;10(5):555.CrossRef Malafarina V, Reginster JY, Cabrerizo S, Bruyère O, Kanis JA, Martinez JA, Zulet MA. Nutritional status and nutritional treatment are related to outcomes and mortality in older adults with hip fracture. Nutrients. 2018;10(5):555.CrossRef
25.
go back to reference Okada K, Yamagami H, Sawada S, Nakanishi M, Tamaki M, Ohnaka M, Sakamoto S, Niwa Y, Nakaya Y. The nutritional status of elderly bed-ridden patients receiving tube feeding. J Nutr Sci Vitaminol (Tokyo). 2001;47(3):236–41.CrossRef Okada K, Yamagami H, Sawada S, Nakanishi M, Tamaki M, Ohnaka M, Sakamoto S, Niwa Y, Nakaya Y. The nutritional status of elderly bed-ridden patients receiving tube feeding. J Nutr Sci Vitaminol (Tokyo). 2001;47(3):236–41.CrossRef
26.
go back to reference Rodríguez-Bocanegra JC, Cañavate-Solano C, Cruz-Cobo C, Bibiloni MM, Tur JA, Santi-Cano MJ. In-hospital dietary intake and the course of mobilization among older patients with hip fracture in the post-surgical period. Eur Geriatr Med. 2020;11(4):535–43.CrossRef Rodríguez-Bocanegra JC, Cañavate-Solano C, Cruz-Cobo C, Bibiloni MM, Tur JA, Santi-Cano MJ. In-hospital dietary intake and the course of mobilization among older patients with hip fracture in the post-surgical period. Eur Geriatr Med. 2020;11(4):535–43.CrossRef
27.
go back to reference Choi JW, Park JS, Lee CH. Genetically determined hypoalbuminemia as a risk factor for hypertension: instrumental variable analysis. Sci Rep. 2021;11(1):11290.CrossRef Choi JW, Park JS, Lee CH. Genetically determined hypoalbuminemia as a risk factor for hypertension: instrumental variable analysis. Sci Rep. 2021;11(1):11290.CrossRef
28.
go back to reference Ding C, Wang H, Huang X, Hu L, Shi Y, Li M, Yu Y, Zhou W, Wang T, Zhu L, et al. Association between serum albumin and peripheral arterial disease in hypertensive patients. J Clin Hypertens (Greenwich). 2020;22(12):2250–7.CrossRef Ding C, Wang H, Huang X, Hu L, Shi Y, Li M, Yu Y, Zhou W, Wang T, Zhu L, et al. Association between serum albumin and peripheral arterial disease in hypertensive patients. J Clin Hypertens (Greenwich). 2020;22(12):2250–7.CrossRef
29.
go back to reference Miyamoto M, McClure DE, Schertel ER, Andrews PJ, Jones GA, Pratt JW, Ross P, Myerowitz PD. Effects of hypoproteinemia-induced myocardial edema on left ventricular function. Am J Physiol. 1998;274(3):H937-944.PubMed Miyamoto M, McClure DE, Schertel ER, Andrews PJ, Jones GA, Pratt JW, Ross P, Myerowitz PD. Effects of hypoproteinemia-induced myocardial edema on left ventricular function. Am J Physiol. 1998;274(3):H937-944.PubMed
30.
go back to reference Huang L, Li J, Jiang Y. Association between hypertension and deep vein thrombosis after orthopedic surgery: a meta-analysis. Eur J Med Res. 2016;21(1):1–7.CrossRef Huang L, Li J, Jiang Y. Association between hypertension and deep vein thrombosis after orthopedic surgery: a meta-analysis. Eur J Med Res. 2016;21(1):1–7.CrossRef
31.
go back to reference Goldhaber SZ, Tapson VF, Committee DFS. A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol. 2004;93(2):259–62.CrossRef Goldhaber SZ, Tapson VF, Committee DFS. A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol. 2004;93(2):259–62.CrossRef
32.
go back to reference Chaichana KL, Pendleton C, Jackson C, Martinez-Gutierrez JC, Diaz-Stransky A, Aguayo J, Olivi A, Weingart J, Gallia G, Lim M, et al. Deep venous thrombosis and pulmonary embolisms in adult patients undergoing craniotomy for brain tumors. Neurol Res. 2013;35(2):206–11.CrossRef Chaichana KL, Pendleton C, Jackson C, Martinez-Gutierrez JC, Diaz-Stransky A, Aguayo J, Olivi A, Weingart J, Gallia G, Lim M, et al. Deep venous thrombosis and pulmonary embolisms in adult patients undergoing craniotomy for brain tumors. Neurol Res. 2013;35(2):206–11.CrossRef
33.
go back to reference Yang Z, Liu H, Xie X, Tan Z, Qin T, Kang P. The influence of diabetes mellitus on the post-operative outcome of elective primary total knee replacement: a systematic review and meta-analysis. The Bone Joint J. 2014;96(12):1637–43.CrossRef Yang Z, Liu H, Xie X, Tan Z, Qin T, Kang P. The influence of diabetes mellitus on the post-operative outcome of elective primary total knee replacement: a systematic review and meta-analysis. The Bone Joint J. 2014;96(12):1637–43.CrossRef
34.
go back to reference Sreedharan R, Abdelmalak B. Diabetes mellitus: Preoperative concerns and evaluation. Anesthesiol Clin. 2018;36(4):581–97.CrossRef Sreedharan R, Abdelmalak B. Diabetes mellitus: Preoperative concerns and evaluation. Anesthesiol Clin. 2018;36(4):581–97.CrossRef
Metadata
Title
Optimal preoperative timing for prevention of deep vein thrombosis (DVT) in patients over 60 years of age with intertrochanteric fractures
Authors
ZhiQiang Xue
WangJie Tu
JianQing Gao
ZeTao Dong
JianDong Yuan
JunZhe Lang
Publication date
21-04-2022
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 5/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-022-01969-0

Other articles of this Issue 5/2022

European Journal of Trauma and Emergency Surgery 5/2022 Go to the issue