A nested case-control study on the risk factors of deep vein thrombosis for Chinese after total joint arthroplasty
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(2019) 14:188
RESEARCH ARTICLE
Open Access
A nested case-control study on the risk factors of deep vein thrombosis for Chinese after total joint arthroplasty Hong Xu1, Shaoyun Zhang2†, Jinwei Xie1†, Yiting Lei1, Guorui Cao1, Guo Chen1 and Fuxing Pei1*
Abstract Background: Deep vein thrombosis (DVT) is one of the life-threatening complications of total joint arthroplasty (TJA) postoperatively, and its risk factors are still controversial. The aim of this study was to identify the risk factors of DVT after TJA. Study design and methods: A nested case-control study based on a large dataset of 15,326 patients undergoing TJA was performed. Potential risk factors of DVT and demographic information were extracted from the electronic health record. Patients with DVT (73 patients) were treated as study group while non-DVT patients who were matched 1:4 according to the anticoagulant type, were considered as control group (292 patients). These variables of potential risk factors for DVT including age, sex, body mass index (BMI), American Society of Anesthesiologists class, comorbidity, preoperative hemoglobin (HB) level and analgesic use, surgical site (knee or hip) and type, the start time of drug anticoagulation, ambulation time, transfusion, and whether to use tranexamic acid (TXA), drain, human serum albumin, and measures of physical thromboprophylaxis after operation were collected and evaluated by survival analysis and presented as P value and odds ratio with 95% confidence interval. Results: There were 15,326 patients underwent TJA and 73 (0.48%) patients had DVT among them, and the occurrence rates were 0.71% for the patients underwent total knee arthroplasty (TKA) while 0.24% for total hip arthroplasty. The risk factors associated with DVT included TKA (compared with THA), advanced age (> 70 years), drain use, and delayed ambulation (≥ 72 h) postoperatively. Conclusion: The present results suggest that the occurrence rate of DVT on the patients underwent TJA was low (0.48%) relatively. And the risk factors associated with increased risk of DVT included TKA (compared with THA), advanced age, drain use, and delayed ambulation postoperatively. Individualized and more efficient risk stratification protocols of anticoagulation after TJA for Chinese may need to be developed in the future. Keywords: Deep vein thrombosis, Total knee and hip arthroplasty, Risk factor
Introduction TJA is a successful surgical treatment for end-stage knee or hip diseases due to that it can relieve pain, improve function, and elevate the quality of patients, life [1, 2]. With the advancement of the Enhanced Recovery After Surgery program, the number of patients undergoing TJA has significantly increased in recent years. However, postoperative DVT is still one of the most severe complications after * Correspondence: [email protected] † Shaoyun Zhang and Jinwei Xie, co-first author, the author contributed to this article equally. 1 Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu 610041, People’s Republi
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