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Whiting PS, White-Dzuro GA, Greenberg SE, et al. Risk Factors for Deep Venous Thrombosis Following Orthopaedic Trauma Surgery: An Analysis of 56,000 patients. Arch Trauma Res. 2016;5(1):e32915doi: 10.5812/atr.32915.
Whiting, P. S., White-Dzuro, G. A., Greenberg, S. E., VanHouten, J. P., Avilucea, F. R., Obremskey, W. T., & Sethi, M. K. (2016). Risk Factors for Deep Venous Thrombosis Following Orthopaedic Trauma Surgery: An Analysis of 56,000 patients. Archives of trauma research, 5(1), e32915. https://doi.org/10.5812/atr.32915
Whiting, Paul S, et al. "Risk Factors for Deep Venous Thrombosis Following Orthopaedic Trauma Surgery: An Analysis of 56,000 patients." Archives of trauma research vol. 5,1 (2016): e32915. doi: https://doi.org/10.5812/atr.32915
Whiting PS, White-Dzuro GA, Greenberg SE, VanHouten JP, Avilucea FR, Obremskey WT, Sethi MK. Risk Factors for Deep Venous Thrombosis Following Orthopaedic Trauma Surgery: An Analysis of 56,000 patients. Arch Trauma Res. 2016 Jan 23;5(1):e32915. doi: 10.5812/atr.32915. eCollection 2016 Mar. PMID: 27148502; PMCID: PMC4853595.
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Arch Trauma Res. 2016 Jan 23;5(1):e32915. doi: 10.5812/atr.32915. eCollection 2016 Mar.

Risk Factors for Deep Venous Thrombosis Following Orthopaedic Trauma Surgery: An Analysis of 56,000 patients.

Archives of trauma research

Paul S Whiting, Gabrielle A White-Dzuro, Sarah E Greenberg, Jacob P VanHouten, Frank R Avilucea, William T Obremskey, Manish K Sethi

Affiliations

  1. University of Wisconsin, Madison, WI, United States.
  2. Vanderbilt University, Nashville, TN, United States.
  3. University of Cincinnati, Cincinnati, OH, United States.

PMID: 27148502 PMCID: PMC4853595 DOI: 10.5812/atr.32915

Abstract

BACKGROUND: Deep venous thrombosis (DVT) and pulmonary embolism (PE) are recognized as major causes of morbidity and mortality in orthopaedic trauma patients. Despite the high incidence of these complications following orthopaedic trauma, there is a paucity of literature investigating the clinical risk factors for DVT in this specific population. As our healthcare system increasingly emphasizes quality measures, it is critical for orthopaedic surgeons to understand the clinical factors that increase the risk of DVT following orthopaedic trauma.

OBJECTIVES: Utilizing the ACS-NSQIP database, we sought to determine the incidence and identify independent risk factors for DVT following orthopaedic trauma.

PATIENTS AND METHODS: Using current procedural terminology (CPT) codes for orthopaedic trauma procedures, we identified a prospective cohort of patients from the 2006 to 2013 ACS-NSQIP database. Using Wilcoxon-Mann-Whitney and chi-square tests where appropriate, patient demographics, comorbidities, and operative factors were compared between patients who developed a DVT within 30 days of surgery and those who did not. A multivariate logistic regression analysis was conducted to calculate odds ratios (ORs) and identify independent risk factors for DVT. Significance was set at P < 0.05.

RESULTS: 56,299 orthopaedic trauma patients were included in the analysis, of which 473 (0.84%) developed a DVT within 30 days. In univariate analysis, twenty-five variables were significantly associated with the development of a DVT, including age (P < 0.0001), BMI (P = 0.037), diabetes (P = 0.01), ASA score (P < 0.0001) and anatomic region injured (P < 0.0001). Multivariate analysis identified several independent risk factors for development of a DVT including use of a ventilator (OR = 43.67, P = 0.039), ascites (OR = 41.61, P = 0.0038), steroid use (OR = 4.00, P < 0.001), and alcohol use (OR = 2.98, P = 0.0370). Compared to patients with upper extremity trauma, those with lower extremity injuries had significantly increased odds of developing a DVT (OR = 7.55, P = 0.006). The trend toward increased odds of DVT among patients with injuries to the hip/pelvis did not reach statistical significance (OR = 4.51, P = 0.22). Smoking was not found to be an independent risk factor for developing a DVT (P = 0.1217).

CONCLUSIONS: This is the largest study to date using the NSQIP database to identify risk factors for DVT in orthopaedic trauma patients. Although the incidence of DVT was low in our cohort, the presence of certain risk factors significantly increased the odds of developing a DVT following orthopaedic trauma. These findings will enable orthopaedic surgeons to target at-risk patients and implement post-operative care protocols aimed at reducing the morbidity and mortality associated with DVT in orthopaedic trauma patients.

Keywords: Deep Venous Thrombosis; Orthopaedic Trauma; Pulmonary Embolism; Thromboprophylaxis; Venous Thromboembolism

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