Risk factors for symptomatic venous thromboembolism following surgery for closed ankle fractures: A case-control study |
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| Institution: | 1. Institute of Clinical Medicine, University of Oslo, Norway;2. Health Services Research Unit, Akershus University Hospital, Norway;3. Department of Pulmonary Medicine, Medical Division, Akershus University Hospital, Norway;4. Section for Orthopaedic Emergency, Orthopaedic Department, Oslo University Hospital, Norway;5. Department of Vascular Surgery, Oslo University Hospital, Aker, Norway;6. Department of Orthopaedics, Østfold Hospital, Norway;7. Department of Orthopaedics, Akershus University Hospital, Norway;8. Department of Medicine, Østfold Hospital, Norway;1. Department of Trauma Surgery, Otto-von-Guericke University, Leipziger Str. 44 Magdeburg, Germany;2. Gesellschaft für klinische und Versorgungsforschung mbH, Halberstädter Str. 40a, Magdeburg, Germany;1. Department of Orthopaedics and Traumatology, St. Claraspital, Kleinriehenstrasse 30, 4016 Basel, Switzerland;2. Department of Orthopaedics and Traumatology, Siloah AG, Worbstrasse 316, 3073 Gümligen, Switzerland;1. Department of Trauma & Orthopaedics, Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, United Kingdom;2. Department of Radiology, Altnagelvin Hospital, Glenshane Road, Londonderry BT47 6SB, Northern Ireland, United Kingdom;1. Colorado Center of Orthopaedic Excellence, 2446 Research Parkway, #200, Colorado Springs, CO 80920, USA;2. Department of Orthopaedics and Sports Medicine, University of Washington, Box 359798, Seattle, WA 98195-9798, USA;3. Orthopedic Trauma, Orthopedic Surgery, Michigan Orthopedic Center, Sparrow Hospital, 2815 South Pennsylvania Avenue, #204, Lansing, MI 48190, USA |
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| Abstract: | BackgroundWe analyzed risk factors for venous thromboembolism (VTE) within 6 months after surgery for closed ankle fractures.MethodsThis was a case-control study based on data from chart review in a cohort of patients having open reduction and internal fixation (ORIF) for closed ankle fractures in two large general hospitals 2009–2011. Cases with symptomatic VTE (pulmonary embolism or deep venous thrombosis) were identified in the cohort, and additional cases of VTE were identified by computerized search of discharge diagnoses in the same hospitals in 2004–2008 and 2012–2016. In total, we identified 60 cases with VTE and compared with 240 randomly selected controls among 998 patients without VTE in the cohort. Risk factors were assessed using logistic regression analysis.ResultsAmong cases, 27 (45%) had pulmonary embolism, 33 (55%) deep venous thrombosis. Those with VTE were older, had higher BMI, had more often a family history of VTE, and more often had antibiotic prophylaxis during surgery than controls. In multivariable logistic regression analysis age/10 (OR 25.75, 95%CI 3.52–188.44, p = 0.001), (age/10)2 (OR 0.77, 95%CI 0.65–0.93, p = 0.005), BMI (1.15 per kg/m2, 95%CI 1.07–1.24, p < 0.001) and Charlson comorbidity index ≥2 vs.0 (OR 0.27, 95%CI 0.08–0.92, p = 0.036) and 1 vs. 0 (OR 0.27, 95%CI 0.09–0.86, p = 0.026) were associated with VTE within 6 months of surgery.ConclusionsThe odds of symptomatic VTE within 6 months of ORIF increased with increasing age and BMI, but were lower with increasing comorbidity. |
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| Keywords: | Ankle fracture ORIF Venous thromboembolism Deep venous thrombosis Lung embolism Case-control Risk factors |
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