Incidence and factors predicting venous thromboembolism after surgical treatment of fractures below the hip

Objectives: This study was designed to investigate the incidence and risk factors of postoperative venous thromboembolism (VTE) in a series of patients with fractures below the hip. In addition, we sought to examine the rates of VTE before and after introduction of thromboprophylaxis. Design: Retrospective review. Setting: University-based academic medical center. Patients: Nine hundred one consecutive patients met the inclusion criteria. Of the 901 patients, 337 (37.4%) were treated before the initiation of institutional guidelines for thromboprophylaxis and 564 (62.6%) received thromboprophylaxis in accordance with our hospitalization protocol. Intervention: Surgical intervention for fractures occurring in the lower extremity below the hip. Main Outcome Measurements: Symptomatic thromboembolic events within 90 days of surgery and risk factors of postoperative VTE. Results: Of the 901 patients, 25 (2.7%) had confirmed symptomatic deep vein thrombosis and 13 (1.4%) had symptomatic pulmonary embolism. The overall incidence of symptomatic VTE was significantly different between the patients not receiving thromboprophylaxis (6.8%; 23 of 337) and those receiving thromboprophylaxis (2.3%; 13 of 564). Of the 31 variables tested for an association with VTE, an advanced age of more than 60 years, cardiovascular disease, and chronic lung disease were independent risk factors. Conclusions: Clinically detectable VTE in fractures of the lower extremity below the hip are not uncommon, and thromboprophylaxis seemed to decrease the incidence of postoperative VTE.