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Factors for VTE after hip fracture identified in award-winning study
Extracapsular fractures, high hemoglobin levels are factors for symptomatic venous thromboembolism.
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VIENNA — A British orthopaedic research team reported that patients’ residence status, hemoglobin level at the time of hospital admission, and the type of femoral neck fracture sustained play a vital role in determining their risk for symptomatic venous thromboembolism.
“Venous thromboembolism (VTE) following hip fracture is a huge problem,” Iain McNamara, MRCS, said at the 10th EFORT Congress, held here. “It is a significant cause of morbidity and mortality, and the highest risk groups for VTE need to be identified to the orthopaedic surgeon.”
McNamara and colleagues at the University of Cambridge and Peterborough District Hospital reviewed the records of 5,300 patients who underwent surgery for femoral neck fractures between January 1986 and January 2007 at the hospital. They found a 2.2% overall incidence of symptomatic VTE in the patients, which is comparable to the rates reported in the literature, he said.
Top free paper at EFORT
The study was recognized as the top free paper at the EFORT Congress. In their abstract, the investigators said it was “the largest group of patients to be reviewed for risk factors for developing VTE following surgery for [femoral neck] fractures.”
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Image: Ferraby M, Orthopaedics Today Europe |
Overall, there were 117 thrombotic events in the study population: 79 deep vein thromboses (DVTs) and 38 pulmonary embolisms (PEs). The average age of patients in the group was 80 years old. All patients had received subcutaneous heparin for 2 weeks starting from the day of admission, he said.
Admissions data reviewed included residential status, hemoglobin level at admission, length of time from fall to surgery, length of time from admission to surgery and type of fracture. Operation data included the type of procedure, type of anesthesia and duration of the procedure. Postoperative data collected included time to any type of symptomatic VTE.
Three main factors
“A multivariate logistic regression identified three patient factors that increased the odds ratio for VTE. These were the residence status of the patient, the hemoglobin level at the time of admission, and the type of fracture,” McNamara said.
“The causes of these factors are unclear, and some of our findings were slightly surprising. Fracture type has not been previously identified as an independent risk factor for VTE. Here we see that intertrochanteric and subtrochanteric fractures have an odds ratio more than double that of the intracapsular fractures,” McNamara told Orthopaedics Today Europe.
Other factors for developing VTE included living alone before the fall and a higher mental test score, possibly because the patients are more likely to report their symptoms, he said. Patient age, sex and type of anesthesia or anesthetic grade were not found to be VTE risk factors in the group.
For more information:
- Iain McNamara, MRCS, can be reached at the Orthopaedic Research Unit, University of Cambridge, Box 180, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ, England; +44-1223-217551; e-mail: imcnamara@doctors.org.uk. He has no direct financial interest in any products or companies mentioned in this article.
Reference:
- McNamara I, Parker M, Prevost T, Sharma A. The incidence and risk factors for venous thromboembolism in patients following a femoral neck fracture. Paper F481. Presented at the 10th EFORT Congress. June 3-6, 3009. Vienna.