Read more

January 08, 2025
1 min read
Save

Surgery at high altitude may be a risk factor for venous thromboembolism in patients

Key takeaways:

  • Knee arthroplasty performed at an elevation of 4,000 feet or higher may increase cardiovascular complication risks in patients.
  • Results were compared with patients who underwent surgery at lower elevations.

Published results showed patients who undergo total knee arthroplasty at an altitude of 4,000 feet or higher may be at increased risk for postoperative venous thromboembolism compared with patients who undergo surgery at lower altitudes.

“Deep vein thrombosis and pulmonary embolism are known complications after TKA. Understanding that higher altitudes may increase this risk is important for the surgeon to appropriately manage these patients,” Kevin D. Plancher, MD, MPH, from Plancher Orthopaedics and Sports Medicine, told Healio. “Living at or undergoing surgery at high altitudes, where oxygen levels are lower, may lead to changes in the body’s ability to clot. Hypoxia can increase the production of clotting factors such as fibrinogen and factor VIII, activate platelets and impair circulation, leading to venous stasis and resultant blood clot formation.”

25Plancher_Graphic_01
Data were derived from Plancher KD, et al. J Arthroplasty. 2024;doi:10.1016/j.arth.2024.12.022.

Plancher and colleagues performed a retrospective review of the PearlDiver Mariner database to analyze the effect of altitude on 306,281 patients who underwent primary TKA between 2011 and 2022.

Kevin D. Plancher
Kevin D. Plancher

After matching, Plancher and colleagues compared outcomes between 57,135 patients who underwent surgery at an elevation of 4,000 feet or higher and 171,322 patients who underwent surgery at an elevation of 100 feet or lower.

According to the study, outcome measures included venous thromboembolism (VTE), deep vein thrombosis (DVT) and pulmonary embolism (PE) at 30-day and 90-day follow-ups.

Plancher and colleagues found patients in the high-altitude group were at significantly increased risk for VTE at 30 days (OR = 1.15; 95% CI, 1.02-1.3) and 90 days (OR = 1.2; 95% CI, 1.08-1.34), as well as DVT at 30 days (OR = 1.3; 95% CI, 1.1-1.54) and 90 days (OR = 1.36 ; 95% CI, 1.18-1.57), compared with the patients in the low-altitude group. They found no significant difference in incidence of PE between the high- and low-altitude groups at 30 days or 90 days.

“These findings underscore the need for risk assessment and preoperative screening and planning. The health care team should consider the altitude of the patient’s residence and/or location of the hospital or surgery center to create more individualized plans of care,” Plancher said. “Consideration of additional prophylactic measures would be important in these patients as well as consideration of changing postoperative protocols to allow for additional postoperative monitoring for patients living in or undergoing surgery in high-altitude regions.”