Incidence and Factors Predicting Venous Thromboembolism After Surgical Treatment of Fractures Below the Hip.

OBJECTIVES

This study was designed to investigate the incidence and risk factors of postoperative venous thromboembolism (VTE) in a series of patients with fractures below the hip. In addition, we sought to examine the rates of VTE before and after introduction of thromboprophylaxis.

DESIGN

Retrospective review.

SETTING

University-based academic medical center.

PATIENTS: Nine hundred one consecutive patients met the inclusion criteria. Of the 901 patients, 337 (37.4%) were treated before the initiation of institutional guidelines for thromboprophylaxis and 564 (62.6%) received thromboprophylaxis in accordance with our hospitalization protocol.

INTERVENTION: Surgical intervention for fractures occurring in the lower extremity below the hip.

MAIN OUTCOME MEASUREMENTS: Symptomatic thromboembolic events within 90 days of surgery and risk factors of postoperative VTE.

RESULTS

Of the 901 patients, 25 (2.7%) had confirmed symptomatic deep vein thrombosis and 13 (1.4%) had symptomatic pulmonary embolism. The overall incidence of symptomatic VTE was significantly different between the patients not receiving thromboprophylaxis (6.8%; 23 of 337) and those receiving thromboprophylaxis (2.3%; 13 of 564). Of the 31 variables tested for an association with VTE, an advanced age of more than 60 years, cardiovascular disease, and chronic lung disease were independent risk factors.

CONCLUSIONS

Clinically detectable VTE in fractures of the lower extremity below the hip are not uncommon, and thromboprophylaxis seemed to decrease the incidence of postoperative VTE.

LEVEL OF EVIDENCE: Prognostic Level II. See the guidelines for authors for a complete description of levels of evidence.