Clin Orthop Surg.  2015 Sep;7(3):298-302. 10.4055/cios.2015.7.3.298.

Preoperative Incidence of Deep Vein Thrombosis after Hip Fractures in Korean

• Cho YH
• Byun YS
• Jeong DG
• Han IH
• Park YB

• KMID: 2234082
• DOI: http://doi.org/10.4055/cios.2015.7.3.298

Abstract

BACKGROUND
The purpose of the current study was to investigate the incidence of preoperative deep vein thrombosis (DVT) after hip fractures in Korea.
METHODS
In this prospective study, we enrolled 152 Korean geriatric patients who had suffered hip fractures due to a simple fall and were hospitalized between January 2013 and December 2013. There were 52 male and 100 female patients, and their mean age was 78.2 years. There were 96 trochanteric fractures and 56 femoral neck fractures. All patients were examined for DVT: 26 by ultrasonography and 126 by computed tomography venography. The patients having DVT underwent inferior vena cava filter insertion before the surgical intervention.
RESULTS
Preoperatively, none of the patients had any signs or symptoms of DVT; however, 4 patients were identified as having asymptomatic DVT. The overall incidence of DVT was 2.6% (4/152). The mean time to arrival at emergency room after injury was 32.6 hours. Mean time elapsed to undergo surgery after hospitalization was 24.9 hours. The average time to hospitalization after injury was 237 hours for patients with DVT versus 27.5 hours for patients without DVT. DVT developed within 72 hours in two of the 137 patients (1.4%) and after 72 hours in two of the remaining 15 patients (13.3%) hospitalized.
CONCLUSIONS
While the preoperative incidence of DVT after hip fractures was relatively low (2.6%) in the Korean geriatric population, we confirmed that getting no treatment within 72 hours after injury increased the incidence of DVT. Thus, we conclude from this study that a workup for DVT should be considered in cases where admission or surgery has been delayed for more than 72 hours after injury.

Keyword

Hip fracture; Preoperative; Deep vein thrombosis; Delayed admission; Delayed operation

MeSH Terms

Aged
Aged, 80 and over
Female
Hip Fractures/*complications/epidemiology/*surgery
Humans
Incidence
Male
Prospective Studies
Republic of Korea/epidemiology
Time-to-Treatment
Venous Thrombosis/diagnosis/*epidemiology/*etiology

Reference

1. Perez JV, Warwick DJ, Case CP, Bannister GC. Death after proximal femoral fracture: an autopsy study. Injury. 1995; 26(4):237–240.

2. Park YS. Guideline for the prophylaxis of venous thromboembolism in hip surgery patients. J Korean Orthop Assoc. 2011; 46(2):95–98.

3. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008; 133:6 Suppl. 381S–453S.

4. National Institute for Health and Clinical Excellence. Venous thromboembolism in adults admitted to hospital: reducing the risk [Internet]. London: National Institute for Health and Clinical Excellence;2015. cited 2015 Jun 14. Available from: http://www.nice.org.uk/guidance/cg92.

5. Salzman EW, Harris WH. Prevention of venous thromboembolism in orthopaedic patients. J Bone Joint Surg Am. 1976; 58(7):903–913.

6. Zahn HR, Skinner JA, Porteous MJ. The preoperative prevalence of deep vein thrombosis in patients with femoral neck fractures and delayed operation. Injury. 1999; 30(9):605–607.

7. Jung JH, Lee KJ, Min BW, Son ES, Koo TW. Incidence of deep vein thrombosis before hip fracture surgery diagnosed by color doppler sonography surveillance. J Korean Orthop Ultrasound Soc. 2014; 7(2):98–104.

8. Powers PJ, Gent M, Jay RM, et al. A randomized trial of less intense postoperative warfarin or aspirin therapy in the prevention of venous thromboembolism after surgery for fractured hip. Arch Intern Med. 1989; 149(4):771–774.

9. Calfon M, Seddighzadeh A, Piazza G, Goldhaber SZ. Deep vein thrombosis in orthopedic surgery. Clin Appl Thromb Hemost. 2009; 15(5):512–516.

10. Clayton RA, Gaston P, Watts AC, Howie CR. Thromboembolic disease after total knee replacement: experience of 5100 cases. Knee. 2009; 16(1):18–21.

11. Samama CM, Ravaud P, Parent F, Barre J, Mertl P, Mismetti P. Epidemiology of venous thromboembolism after lower limb arthroplasty: the FOTO study. J Thromb Haemost. 2007; 5(12):2360–2367.

12. Monreal M, Ruiz J, Olazabal A, Arias A, Roca J. Deep venous thrombosis and the risk of pulmonary embolism: a systematic study. Chest. 1992; 102(3):677–681.

13. Mitra AK, Khoo TK, Ngan CC. Deep-vein thrombosis following hip surgery for fracture of the proximal femur. Singapore Med J. 1989; 30(6):530–534.

14. Chan YK, Chiu KY, Cheng SW, Ho P. The incidence of deep vein thrombosis in elderly Chinese suffering hip fracture is low without prophylaxis: a prospective study using serial duplex ultrasound. J Orthop Surg (Hong Kong). 2004; 12(2):178–183.

15. Hefley FG Jr, Nelson CL, Puskarich-May CL. Effect of delayed admission to the hospital on the preoperative prevalence of deep-vein thrombosis associated with fractures about the hip. J Bone Joint Surg Am. 1996; 78(4):581–583.

16. Smith EB, Parvizi J, Purtill JJ. Delayed surgery for patients with femur and hip fractures-risk of deep venous thrombosis. J Trauma. 2011; 70(6):E113–E116.

17. Leizorovicz A, Turpie AG, Cohen AT, Wong L, Yoo MC, Dans A. Epidemiology of venous thromboembolism in Asian patients undergoing major orthopedic surgery without thromboprophylaxis: the SMART study. J Thromb Haemost. 2005; 3(1):28–34.

18. Piovella F, Wang CJ, Lu H, et al. Deep-vein thrombosis rates after major orthopedic surgery in Asia: an epidemiological study based on postoperative screening with centrally adjudicated bilateral venography. J Thromb Haemost. 2005; 3(12):2664–2670.

19. Goodman LR, Stein PD, Matta F, et al. CT venography and compression sonography are diagnostically equivalent: data from PIOPED II. AJR Am J Roentgenol. 2007; 189(5):1071–1076.

20. Hirsh J, Hoak J. Management of deep vein thrombosis and pulmonary embolism: a statement for healthcare professionals: Council on Thrombosis (in consultation with the Council on Cardiovascular Radiology), American Heart Association. Circulation. 1996; 93(12):2212–2245.

21. Langan EM 3rd, Miller RS, Casey WJ 3rd, Carsten CG 3rd, Graham RM, Taylor SM. Prophylactic inferior vena cava filters in trauma patients at high risk: follow-up examination and risk/benefit assessment. J Vasc Surg. 1999; 30(3):484–488.