Postoperative venous thromboembolism in Asia: a critical appraisal of its incidence

OBJECTIVES: Venous thromboembolism (VTE) has historically been perceived to be a rare disorder in Asia. However, new evidence has emerged recently that contradicts this perception. The question of routine VTE prophylaxis has been hotly debated in Asia due to disagreement on its incidence. We reviewed and analysed studies on postoperative VTE in Asian patients to determine if the condition was indeed rare and if the routine prophylactic measures as recommended by internationally accepted guidelines should be adopted in Asia. METHODS: A review of published reports, from 1966 to December 2002, on deep vein thrombosis (DVT) and pulmonary embolism (PE) in the Asian population was made. A literature search of studies published in English was conducted via a detailed MEDLINE search. Studies had to attain a minimum inclusion and quality criteria to be accepted for the review, including the diagnostic modality used for the diagnosis of VTE. The appraisal was carried out independently and accepted by at least two of the three authors. The study population was classified into orthopaedic and general surgical/colorectal groups. RESULTS: Twelve orthopaedic publications reviewed revealed an incidence of postoperative DVT of 10% to 63%. Six general and colorectal surgical publications reported an incidence of DVT ranging from 3% to 28%. The incidence was slightly lower than the reported incidence of 40% to 80% following orthopaedic surgery and 28% to 44% following general surgical operations in studies reporting on Caucasian populations. CONCLUSION: While there is a wide variation in the incidence of DVT and VTE as reported in the Asian population, these diseases are by no means rare. The wide variation could be due to the study designs, heterogeneity of the procedures performed and the application of different diagnostic criteria. Results based on prospective studies with objective diagnostic criteria confirm the incidence of VTE as common. Routine chemoprophylaxis must be seriously considered in high-risk patients.     

Upper extremity deep vein thrombosis in orthopaedic and trauma surgery: a systematic review

Upper extremity deep venous thrombosis (DVT) is considered a rare phenomenon. Little is known as to what factors may contribute to the development of upper extremity DVT following trauma or elective orthopaedic surgery. The incidence of pulmonary embolism (PE) related to upper extremity thrombosis is reported as 12 to 36%, where up to 16% of cases are fatal. The purpose of this paper was to systematically review the literature to assess all cases of upper extremity DVT presented in the literature in order to determine epidemiology and outcome. A review of EMBASE, Medline, CINAHL and AMED from their inception to November 2009, sources of grey literature and a pertinent hand search of specialist orthopaedic journals was undertaken. A total of 38 cases of upper extremity DVT and 19 cases with PE were identified from 20 publications. The incidence of upper extremity DVT and PE was greatest in cases following shoulder surgery. There did not appear to be any greater risk in patients with diabetes or obesity. In total, one patient died after a PE following shoulder surgery. Although a relatively uncommon complication, the literature suggests that upper extremity DVT can lead to PE, which should be considered by orthopaedic clinicians in patients following upper extremity surgery or trauma.     

Combined pharmacological and mechanical prophylaxis for DVT following hip and knee arthroplasty

Intermittent pneumatic compression (IPC) is an attractive method for prophylaxis of deep venous thromboembolism (DVT) because there is no risk of haemorrhagic complications. However, IPC has not been studied as thoroughly as other methods in orthopaedic and traumatologic surgery. We monitored 328 patients undergoing total hip or knee arthroplasty (THA, TKA) treated with combined pharmacological and mechanical prophylaxis or with pharmacological prophylaxis alone, with pre- and postoperative colour Doppler ultrasound. Prevalences of DVT after THA (4.0%) and TKA (3.2%) were similar, even if the absolute prevalence was lower in the groups given combined prophylaxis. IPC has an important role in preventing postoperative DVTin these patients and reduces the progression from post-thrombotic syndrome (PTS) to DVT. Received: 20 March 2002, Accepted: 4 April 2002 Correspondence to: B. Moretti     

Systematic preoperative phlebography in patients with leg injuries, surgically treated after a delay

Post-traumatic preoperative deep vein thrombosis (DVT) was studied by routine bilateral venography in 98 orthopaedic patients admitted more than 48 h (mean: 7 days) after the limb trauma, who had not been given prophylactic anticoagulation. All these patients had undergone long distance travel under medical supervision, having been injured a long way from the medical centre. Ages ranged from 15 to 77 years (mean age: 38 years). 85 patients had been previously free of any of the usual risk factors for DVT. Routine venography showed up DVT in 39 patients (40%). Four DVT were bilateral; only seven were symptomatic. When DVT was proved, heparin treatment by infusion pump was given for 15 days before surgery was performed.     

Is it necessary to use chemoprophylaxis in Indian patients after hip surgery?

AimTo know the incidence of postoperative deep vein thrombosis after hip surgery in Indian patients.MethodOur study comprises 108 patients undergoing major lower limb orthopaedic surgery. Evaluation by colour Doppler ultrasonography to detect DVT was performed on both lower limbs between seventh and 14th postoperative day. There were 15 total hip replacements (THR), 50 bipolar hemiarthroplasties and 43 proximal femoral fixations by intra-/extra-medullary implant. Only 17 (15.74%) patients showed Colour Doppler evidence of DVT without any complication.ResultsIn THR patients, incidence of DVT is 20%; in bipolar hemiarthoplasty, it is 16%; and in the proximal femoral fixation, it is 13.95%. No case developed pulmonary embolism, and the current figure for the incidence of DVT is 15.74%.ConclusionsFrom our study, it appears to be the difference in incidence of DVT in our country and in western countries, but incidence is not rare. Hence, chemoprophylaxis is necessary in Indian patients.     

成人膝部骨肿瘤术后下肢深静脉血栓形成的临床危险因素分析

目的探讨影响成人膝部骨肿瘤术后下肢深静脉血栓（DVT）形成的危险因素及统计DVT的发生率。方法对2011年2月至2012年1月75例成人膝部骨肿瘤患者术后DVT发生情况进行分析。75例患者均未采取任何药物抗凝措施。男45例,女30例,平均年龄（35.55±16.75）岁。其中,良性肿瘤39例,恶性肿瘤36例;26例行肿瘤刮除植骨（或未植骨）内固定术,49例行肿瘤切除肿瘤型膝关节置换术（或膝关节假体翻修术）。术前及术后14d均采用彩色多普勒超声检查双下肢深静脉血流通畅情况及DVT的发生。对15项临床因素与膝部手术后DVT形成的相关性进行分析。结果术后发生DVT的患者为21例,总发生率为28%（21/75）。经Logistic多因素回归分析,DVT形成的危险因素有2个：年龄≥40岁、术前存在深静脉返流。两者使术后DVT形成的风险分别增加到13.337、13.538倍（P〈0.05）。结论年龄≥40岁和术前存在下肢深静脉返流是成人膝部骨肿瘤术后DVT发生的独立危险因素。肿瘤本身因素、是否采取过抗肿瘤治疗（化疗及放疗）、手术方式、是否使用骨水泥或异体骨等因素与DVT的形成无显著相关性。术前行下肢静脉彩色多普勒超声检查意义重大;应对年龄≥40岁或术前存在深静脉返流的患者积极采取药物抗凝措施以预防DVT的形成。     

A systematic review of the incidence of and risk factors for postoperative atrial fibrillation following general surgery

Atrial fibrillation is a common cardiac arrhythmia and can occur de novo following a surgical procedure. It is associated with increased inpatient and long‐term mortality. There is limited evidence concerning new‐onset atrial fibrillation following abdominal surgery. This study aimed to identify the prevalence of and risk factors for postoperative atrial fibrillation in the general surgical population. A systematic search of the Embase, MEDLINE and Cochrane (CENTRAL) databases was conducted. Studies were included in the review if they reported cases of new‐onset atrial fibrillation within 30 days of the index operation. Results were evaluated qualitatively due to substantial clinical heterogeneity. Incidence rates were pooled using a weighted random‐effects meta‐analysis model. A total of 835 records were initially identified, from which 32 full texts were retrieved. Following review, 13 studies were included that involved 52,959 patients, of whom 10.94% (95%CI 7.22–15.33) developed atrial fibrillation. Five studies of patients undergoing oesophagectomy (n = 376/1923) had a weighted average rate of 17.66% (95%CI 12.16–21.47), compared with 7.63% (95%CI 4.39–11.98) from eight studies of non‐oesophageal surgery (n = 2927/51,036). Identified risk factors included: increasing age; history of cardiac disease; postoperative complications, particularly, sepsis, pneumonia and pleural effusions. New‐onset postoperative atrial fibrillation is common, and is more frequent after surgery involving the thorax. Future work should focus on stratifying risk to allow targeted prophylaxis of atrial fibrillation and other peri‐operative complications.     

Should patients post-cardiac surgery be given low molecular weight heparin for deep vein thrombosis prophylaxis?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the use of prophylactic postoperative low molecular weight heparin (LMWH) or unfractionated heparin after cardiac surgery would significantly reduce morbidity by reducing the incidence of deep vein thromboses (DVTs) and pulmonary emboli (PEs). Altogether 390 papers were identified on Medline. Relevant major guidelines were also searched together with their reference lists. Sixteen papers represented the best evidence on the topic. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. We conclude that the benefit of heparin prophylaxis for the prevention of DVTs and PEs is well established in non-cardiac surgery with reductions in the incidence of DVTs reported to be of the order of 50-70% in orthopaedic, general and obstetric surgery and in general medicine. No studies have yet been performed in cardiac surgery, but contrary to the view that DVTs are rare, in fact the incidence of DVT post-cardiac surgery is up to 15-20% and the incidence of PE is around 0.5 to 4% although many of these occur after discharge and many may be difficult to detect clinically. This is similar to the incidence of patients undergoing high risk general surgery. There is no evidence that heparin prophylaxis started the day after surgery increases the risk of pericardial effusions and the risk of bleeding complications is estimated to be 4%. Thus, we recommend that all patients post-cardiac surgery be commenced on heparin prophylaxis the day after their surgery and continue this up to discharge even if mobile. The particular regime should be guided by the ACCP recommendations for prophylaxis in high risk general surgical patients.     

Venous thromboembolic events following foot and ankle surgery in the English National Health Service

Diagnostic and operative codes are routinely collected for every patient admitted to hospital in the English NHS. Data on post-operative complications following foot and ankle surgery have not previously been available in large numbers. Data on symptomatic venous thromboembolism events and mortality within 90 days were extracted for patients undergoing fixation of an ankle fracture, first metatarsal osteotomy, hindfoot fusions and total ankle replacement over a period of 42 months. For ankle fracture surgery (45 949 patients), the rates of deep-vein thrombosis (DVT), pulmonary embolism and mortality were 0.12%, 0.17% and 0.37%, respectively. For first metatarsal osteotomy (33 626 patients), DVT, pulmonary embolism and mortality rates were 0.01%, 0.02% and 0.04%, and for hindfoot fusions (7033 patients) the rates were 0.03%, 0.11% and 0.11%, respectively. The rate of pulmonary embolism in 1633 total ankle replacement patients was 0.06%, and there were no recorded DVTs and no deaths. Statistical analysis could only identify risk factors for venous thromboembolic events of increasing age and multiple comorbidities following fracture surgery. Venous thromboembolism following foot and ankle surgery is extremely rare, but this subset of fracture patients is at a higher risk. However, there is no evidence that thromboprophylaxis reduces this risk, and these national data suggest that prophylaxis is not required in most of these patients.     

Detection and Prevention of Post-Operative Deep Vein Thrombosis [DVT] Using Nadroparin Among Patients Undergoing Major Abdominal Operations in India; a Randomised Controlled Trial

Deep vein thrombosis [DVT] is one of the most dreaded complications in post-operative patients as it is associated with considerable morbidity and mortality. Majority of patients with postoperative DVT are asymptomatic. The pulmonary embolism, which is seen in 10% of the cases with proximal DVT, may be fatal. Therefore it becomes imperative to prevent DVT rather than to diagnose and treat. Only one randomized trial has been reported from India to assess the effectiveness of low molecular weight heparin in preventing post-operative DVT. To assess the risk of DVT in North Indian patients following major abdominal operations and to evaluate the effectiveness of Nadroparin, A Low Molecular Weight Heparin (LMWH) therapy in preventing post-operative DVT. Sixty five patients were randomised preoperatively into Group-I; Nadroparin prophylaxis and Group-II: No prophylaxis. The primary outcome was the occurrence of DVT, diagnosed by bilateral lower limb venogram performed, seven to ten days after operation. Secondary outcome measures included adverse effects of radio-opaque dye, intra-operative blood loss, operating time, postoperative platelet count, intraoperative blood transfusion requirements and the total duration of postoperative bed rest. No case of DVT occurred in either group. There was no statistical difference in the risk of secondary outcome measures in the two groups. DVT was not observed in any of the patients, even with several high risk factors indicating a possible protective mechanism in the North Indian population.     

Venous thromboembolism in shoulder surgery: a systematic review

Although it is generally believed that venous thromboembolism (VTE) after shoulder surgery is very rare, there are increasing reports of deep venous thrombosis (DVT) and pulmonary embolism (PE) associated with shoulder surgery. To our knowledge only few studies have reviewed the available evidence on the subject. The purpose of this study was to review the available evidence in the published literature regarding incidence, risk factors, diagnosis and management of DVT/PE following shoulder surgery (Level IV evidence).     

新骨科手术风险度评分标准(ORAOS)研究

[目的]建立骨科手术风险度评分标准,并验证其效能。[方法]对本院2001~2008年间768例骨科手术病人的术前、术中临床资料进行单因素对比分析,筛选引起手术并发症的危险因素,建立骨科手术风险度评分标准。运用评分标准对本院2006~2008年160例脊柱外科手术病人进行评估,验证其效能。[结果]通过对危险因素的筛选,提示年龄、心功能、血压、心电图、胸片、肝功、肾功、白蛋白、血糖、四周内手术次数等术前因素,手术级别、术中出血量、手术时间等术中因素是导致术后并发症的危险因素。[结论]在围手术期应用骨科手术风险度评分能够较准确的预测骨科手术后并发症的发生,有并发症组与无并发症组的骨科手术风险度评分有显著差异。     

Endovascular treatment of abdominal aortic aneurysm is associated with a low incidence of deep venous thrombosis

OBJECTIVE: This study was performed to define the incidence of acute deep venous thrombosis (DVT) after endovascular treatment of abdominal aortic aneurysms (AAAs). Because aortic endograft placement requires prolonged femoral vessel instrumentation, it may be hypothesized that these patients are at increased risk for development of an acute DVT. PATIENTS AND METHODS: Fifty consecutive patients (42 men, eight women) ranging in age from 48 to 85 years (mean, 72 years) underwent endovascular treatment of an AAA from January 2000 to August 2001. Clinical examination and bilateral lower extremity duplex ultrasonography for DVT were performed on the first postoperative day and at the 1-month follow-up visit. No patient had a prior DVT or identifiable hypercoagulable state. Seven patients (14%) had concurrent malignant disease. Preoperative antiplatelet agents were administered in 26 patients (52%), and nine (18%) were on warfarin sodium therapy before surgery. No new DVT prophylaxis was initiated perioperatively. Epidural anesthesia was used in 60% of the patients, with general endotracheal anesthesia used in the remainder. Risk factors for DVT were evaluated with univariate statistical analysis. RESULTS: Three patients (6%) had an acute postoperative DVT develop. Two occurred in the femoral veins, and one occurred in the popliteal vein. Of these patients, one had been continued on perioperative anticoagulation therapy, and the remaining two were started on low-molecular weight heparin and warfarin sodium therapy on recognition of the DVT. One patient had an intraoperative injury of the affected common femoral vein, and this individual was the only one to have clinical signs of a DVT. The mean follow-up period was 8 +/- 0.8 months. In this experience, factors that may have placed patients at increased risk for an acute DVT were not identified. CONCLUSION: Six percent of patients undergoing endovascular repair of AAAs had postoperative DVT develop. These patients had a number of risk factors for the development of a DVT; however, no specific factor was identified that predisposed to DVT.     

Anaesthetic practice and postoperative pulmonary complications

The aim of this study was to identify risk factors associated with postoperative pulmonary complications. The influence of the anaesthetic technique was evaluated (i.e. general contra regional anaesthesia and long contra intermediately acting muscle relaxants (pancuronium and atracurium)) taking into account the patient's age, the presence or absence of chronic obstructive lung disease (preoperative risk factors), the type of surgery and the duration of anaesthesia (perioperative risk factors). Seven thousand and twenty-nine patients undergoing abdominal, urological, gynaecological or orthopaedic surgery were included in the study. A total of 290 patients (4.1%) suffered from one or more postoperative pulmonary complications. Six thousand and sixty-two patients received general anaesthesia and 4.5% of these had postoperative pulmonary complications. Of the patients admitted to major surgery receiving pancuronium, 12.7% (135/1062) developed postoperative pulmonary complications, compared to only 5.1% (23/449) receiving atracurium (P < 0.05). When stratified for type of surgery and duration of anaesthesia, conventional statistics showed no difference between pancuronium and atracurium as regard postoperative pulmonary complications. However, a logistic regression analysis indicated that long-lasting procedures involving pancuronium entailed a higher risk of postoperative pulmonary complications than did other procedures. In patients having regional anaesthesia, only 1.9% (18/967) developed postoperative pulmonary complications (P < 0.05 compared to general anaesthesia). However, when stratified for type of surgery there was a significantly higher incidence of postoperative pulmonary complications only in patients undergoing major orthopaedic surgery under general anaesthesia, 11.5% compared to 3.6% in patients given a regional anaesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Anaesthesia for major orthopaedic surgery in the elderly

This article addresses three specific issues related to major hip and knee surgery in the elderly. Firstly, the importance of thorough pre-operative evaluation is discussed. Secondly, the pros and cons in the immediate peri-operative period of major regional (spinal or epidural) anaesthesia versus general anaesthesia are reviewed with respect to blood loss, cardiovascular and respiratory function and immunological and metabolic responses to surgery. Finally, the evidence for an anaesthetic technique effect on outcome parameters, especially thromboembolism, cognitive function and mortality, is presented. Regional anaesthesia is the method of choice for most patients undergoing elective hip surgery since it results in reduced blood loss and transfusion needs, modification of the neuro-endocrine stress response, improved early postoperative oxygenation, and a reduced incidence of deep vein thrombosis (DVT) postoperatively. In the surgery of fractures of the neck of femur, outcome with regional anaesthesia is at least comparable to that with general anaesthesia, but with improved early postoperative oxygenation and a smoother emergence from anaesthesia making initial nursing management easier. Comparative data in other forms of orthopaedic surgery in the elderly are few, but also support the use of regional techniques.     

人工关节置换术与深静脉血栓形成

人工髋关节和膝关节置换术后的深静脉血栓形成(DVT)始发于术中,肺栓塞和DVT有一定的发病率和死亡率,因此,对下肢大关节置换手术应采取预防措施；即便如此,择期关节置换手术的血栓栓塞并发症仍有很高的风险。早期DVT监测以及系统性抗凝预防DVT非常重要,一些高危患者需要延长预防治疗。术后用超声常规监测DVT可能有一定的临床意义。早期联合低分子肝素和机械方式可能比单一方法有效。但是,对一些抗凝药物治疗的效果和安全性仍有争议,血肿形成的发生率和程度应该引起注意。DVT预防治疗的安全性和性价比仍有很多不确定性,所以,按循证医学的观点,要进行多中心的前瞻随机对照研究才能得出有价值的结论。     

Thromboprophylaxis following cast immobilisation for lower limb injuries--survey of current practice in United Kingdom

The risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) is well documented in patients following cast immobilisation for injuries of lower extremities. There are no generally accepted approaches to preventing this complication and hence there remains substantial practice variation amongst surgeons regarding the use of anticoagulation measures. The present survey was conducted to investigate the current chemothromboprophylaxis practice among UK orthopaedic departments for patients immobilised with plasters for lower extremity injuries and establish any variations in practice. A telephone questionnaire survey was conducted on junior doctors (Senior House Officers and Registrars) in orthopaedic departments of 70 randomly selected hospitals in United Kingdom. This survey assessed the thromboprophylaxis practice for lower limb injuries in plaster casts. Our results show substantial variation amongst British orthopaedic surgeons in the use of chemothromboprophylaxis measures. Sixty-two percent of the departments do not use any DVT prophylaxis in this group of trauma. Furthermore, only 11.4% of the departments performed risk stratification on their patients. Ninety-nine percent of the respondents were unaware of any existing guidelines in this regard. Although the incidence of DVT in patients in plaster for lower extremity injuries is low compared to the Hip/Knee arthroplasty group, this is not insignificant. Both over and under treatment with thromboprophylaxis can have implications in terms of side effects and costs. One possible solution is to use risk stratification to identify individuals who are likely to benefit from prophylaxis. There is a substantial variation and inconsistency in practice among orthopaedic departments in United Kingdom due to a lack of clinical guidelines in this group of trauma and it remains underused even in high-risk group.     

Efficacy of pneumatic compression stocking prophylaxis in the prevention of deep venous thrombosis and pulmonary embolism following 139 lumbar laminectomies with instrumented fusions

OBJECTIVE: Low-dose heparin (LDH) regimens reduce the frequency of deep venous thrombosis (DVT) and pulmonary embolism (PE) in spinal surgery but pose a risk of postoperative hemorrhage threatening neurologic function. Pneumatic compression stocking (CS) could provide an alternative means of mechanical prophylaxis alone against DVT and PE and would possibly avoid its hemorrhagic complications. METHODS: The efficacy of CS alone in preventing DVT and PE was evaluated in 139 patients undergoing multilevel lumbar laminectomies (average 3.8 levels) with instrumented fusions (average 1.4 levels). All patients received CS stocking prophylaxis intraoperatively and throughout the average 5-day postoperative course including following ambulation. Doppler screening for DVT was routinely performed 2 days postoperatively. Subsequent Doppler studies or computed tomography angiograms were selectively performed in symptomatic patients with potential DVT/PE. RESULTS: Four (2.8%) patients developed DVT 2-6 days postoperatively and required inferior vena cava (IVC) filters. One of the four had a positive routine screening Doppler study performed the second postoperative day. Two developed DVT the fourth postoperative day. The fourth patient developed DVT 6 days postoperatively but 3 weeks later embolized around the IVC filter. This patient, the only one to develop a PE, tested positive for Factor V Leiden mutation (hypercoagulable syndrome) and remains on long-term warfarin. CONCLUSIONS: Pneumatic compression stocking prophylaxis effectively reduced the incidence of DVT (2.8%) and PE (0.7%) in 139 patients undergoing multilevel lumbar laminectomies with instrumented fusions. These rates compared favorably with those reported in spinal series employing LDH prophylaxis.     

Utility of portable continuous-wave Doppler examination in screening for postoperative deep vein thrombosis

BACKGROUND: Early and accurate diagnosis of post-surgical deep vein thrombosis (DVT) can be difficult and time-consuming, even with duplex ultrasonography. Portable continuous-wave Doppler ultrasonography may be useful in screening patients for postoperative DVT. Further confirmation of Doppler-positive cases by duplex ultrasound might then be more cost-effective. METHODS: All major post-surgical patients from the departments of general surgery, orthopaedic surgery and colorectal surgery were screened on the third postoperative day for DVT by assessing the quality of the flow signal ("whoosh") obtained by placing the probe over the femoral vein and subsequently over the popliteal vein, both with a distal squeeze, as well as assessment of phasic flow with respiration. An absent or attenuated "whoosh" was judged to be suspicious for DVT and required formal duplex ultrasonography. The first 800 consecutive patients were studied to determine the sensitivity, specificity and accuracy of portable Doppler ultrasonography for DVT screening. RESULTS: Twenty-four cases of DVT were diagnosed, comprising seven cases in the proximal veins and 17 cases in the calf veins. The sensitivity of Doppler ultrasonography was 12.5% and the specificity was 96.8%. The positive and negative predictive values were 10.7% and 97.3%, respectively. CONCLUSIONS: Portable Doppler ultrasonography does not have adequate accuracy to be used as a quick screening tool for DVT.     

The incidence and risk factor of deep venous thrombosis after arthroscopically assisted anterior cruciate ligament reconstruction

PurposeTo retrospectively analyze the incidence and risk factors of deep venous thrombosis (DVT) detected by ultrasonography after arthroscopically assisted Anterior Cruciate Ligament Reconstruction (ACLR).MethodsWe retrospectively reviewed medical records of arthroscopically assisted ACLR surgery performed at our institution between 2012 and 2015. Revision ACLR, bone patella tendon bone (BTB) graft reconstruction, and concomitant multiple ligament reconstructions were excluded. We performed a standardized double-bundle reconstruction procedure using hamstrings graft for ACLR. All patients routinely received DVT screening by using venous ultrasonography on postoperative day 7 from 2012 to 2013, and postoperative days 7 and 14 from 2014 to 2015. The prevalence of DVT was calculated and clinical factors such as age, gender, Body Mass Index (BMI), operative time, and duration of tourniquet application were evaluated in relation to the risk factor of DVT.ResultsTwo hundred and fifty-six patients (129 men and 127 women) with a mean age of 28.9 were enrolled. Sixteen patients (6.6%) were detected with DVT on postoperative day 7. Among 146 patients who received venous ultrasonography on both postoperative days 7 and 14, DVT were detected in five additional patients on postoperative day 14. In a total of 21 patients who were diagnosed with DVT, two were proximal, the remaining 19 were distal, and no patient had progressed to pulmonary embolism (PE). In terms of predisposing factors for developing DVT on postoperative day 7, only age ≥30 showed a statistically significant higher risk of DVT (P = 0.03).ConclusionIncidence of DVT after ACLR detected by ultrasonography on postoperative day 7 was 6.6%. Patients aged ≥30 years have a potentially higher risk for developing DVT. Great care for DVT should be taken if prolonged immobilization is applied after ACLR surgery.Level of evidenceLevel Ⅳ