Advertisement

High prevalence of deep vein thrombosis in elderly hip fracture patients with delayed hospital admission

  • Francisco Bengoa
  • Gerardo Vicencio
  • Daniel Schweitzer
  • Maria Jesus Lira
  • Tomás Zamora
  • Ianiv Klaber
Original Article
  • 9 Downloads

Abstract

Purpose

Deep vein thrombosis (DVT) is a common complication in hip fracture patients, associated with significant morbidity and mortality. Research has focused on postoperative DVT, with scant reports on preoperative prevalence. The aim of this study was to describe the prevalence of preoperative DVT in patients accessing medical care ≥ 48 h after a hip fracture.

Methods

We included elderly patients admitted ≥ 48 h after sustaining a hip fracture, between September 2015 and October 2017. Patients with a previous episode of DVT, undergoing anticoagulation therapy, with pathologic fractures or undergoing cancer treatment were excluded. Of 273 patients, 59 were admitted at least 48 h after the fracture. DVT screening by Doppler ultrasound of both lower extremities was carried upon hospital admission. We recorded age, sex, Charlson comorbidity index and ASA score, fracture type, time since injury, time from admission to surgery and total length of hospital stay.

Results

We studied 41 patients, 79 (± 10.34) years old. The delay from injury to admission was 120 h (48–696 h). Seven patients (17.1%) had a DVT upon admission. There were no significant differences between patients with and without DVT, regarding time from admission to surgery or the total length of the hospital stay.

Conclusions

The prevalence of DVT in patients admitted ≥ 48 h after a hip fracture was 17.1%. The diagnosis and management of DVT did not increase time to surgery or hospital stay. Our results suggest routine screening for DVT in patients consulting emergency services ≥ 48 h after injury.

Keywords

Thromboprophylaxis Hip fracture Deep vein thrombosis Orthogeriatrics 

Notes

Author contributions

FB, DS, MJL and IK contributed with study design and development. FB, GV, MJL and IK contributed with data collection, interpretation and analysis. Document writing was done by FB and critically analyzed and revised by GV, DS, MJL, TZ and IK. All authors approved the final state of this manuscript.

Funding

No funding was received for the development of this study.

Compliance with ethical standards

Conflict of interest

Francisco Bengoa MD, Gerardo Vicencio MD, María Jesús Lira, Tomás Zamora MD and Ianiv Klaber MD declare that they have no conflict of interest. Dr. Daniel Schweitzer has received a speaker honorarium from Zimmer Biomet and DePuy Synthes.

Ethical approval

This study was approved by the institutional review board (No. 170628010).

Informed consent

Informed consent was dispensed by the review board.

References

  1. 1.
    Cauley JA, Chalhoub D, Kassem AM, Fuleihan GE-H. Geographic and ethnic disparities in osteoporotic fractures. Nat Rev Endocrinol. 2014;10:338–51.CrossRefGoogle Scholar
  2. 2.
    Zahn HR, Skinner JA, Porteous MJ. The preoperative prevalence of deep vein thrombosis in patients with femoral neck fractures and delayed operation. Injury. 1999;30:605–7.CrossRefGoogle Scholar
  3. 3.
    Smith EB, Parvizi J, Purtill JJ. Delayed surgery for patients with femur and hip fractures—risk of deep venous thrombosis. J Trauma. 2011;70:E113–6.CrossRefGoogle Scholar
  4. 4.
    Wolberg AS, Rosendaal FR, Weitz JI, Jaffer IH, Agnelli G, Baglin T, et al. Venous thrombosis. Nat Rev Dis Prim Nat Publ Group. 2015;1:15006.CrossRefGoogle Scholar
  5. 5.
    Hefley FG, Nelson CL, Puskarich-May CL. Effect of delayed admission to the hospital on the preoperative prevalence of deep-vein thrombosis associated with fractures about the hip. J Bone Jt Surg Am. 1996;78:581–3.CrossRefGoogle Scholar
  6. 6.
    Cho Y-H, Byun Y-S, Jeong D-G, Han I-H, Park Y-B. Preoperative incidence of deep vein thrombosis after hip fractures in Korean. Clin Orthop Surg Korean Orthop Assoc. 2015;7:298–302.CrossRefGoogle Scholar
  7. 7.
    Mears SC, Kates SL. A guide to improving the care of patients with fragility fractures, 2nd ed. Geriatr Orthop Surg Rehabil, vol 6. Los Angeles: SAGE PublicationsSage; 2015. pp. 58–120.Google Scholar
  8. 8.
    Zamora T, Klaber I, Urrutia J. Hip fracture in the elderly. Clin Med Insights Geriatr. 2017;10:1–10.Google Scholar
  9. 9.
    Bengoa F, Carrasco M, Amenábar PP, Schweitzer D, Botello E, Klaber I. Optimización perioperatoria del paciente anciano con fractura osteoporótica de cadera. Rev Med Chil. 2017;145:1437–46.CrossRefGoogle Scholar
  10. 10.
    Grigoryan KV, Javedan H, Rudolph JL. Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma. 2014;28:e49–55.CrossRefPubMedGoogle Scholar
  11. 11.
    Mears SC, Kates SL. A guide to improving the care of patients with fragility fractures, 2nd ed. Geriatr Orthop Surg Rehabil. 2015;6:58–120.CrossRefPubMedGoogle Scholar
  12. 12.
    Kates SL, Blake D, Bingham KW, Kates OS, Mendelson DA, Friedman SM. Comparison of an organized geriatric fracture program to united states government data. Geriatr Orthop Surg Rehabil. 2010;1:15–21.CrossRefPubMedGoogle Scholar
  13. 13.
    Friedman SM, Mendelson DA, Bingham KW, Kates SL. Impact of a comanaged geriatric fracture center on short-term hip fracture outcomes. Arch Intern Med. 2009;169:1712–7.CrossRefGoogle Scholar
  14. 14.
    Friedman SM, Mendelson DA, Kates SL, McCann RM. Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population. J Am Geriatr Soc. 2008;56:1349–56.CrossRefGoogle Scholar
  15. 15.
    Kates SL, Mendelson DA, Friedman SM. Co-managed care for fragility hip fractures (Rochester model). Osteoporos Int J Establ result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2010;21:621–5.CrossRefGoogle Scholar
  16. 16.
    Geerts WH, Code KI, Jay RM, Chen E, Szalai JP. A prospective study of venous thromboembolism after major trauma. N Engl J Med Mass Med Soc. 1994;331:1601–6.CrossRefGoogle Scholar
  17. 17.
    McNamara I, Sharma A, Prevost T, Parker M. Symptomatic venous thromboembolism following a hip fracture. Acta Orthop. 2009;80:687–92.CrossRefPubMedGoogle Scholar
  18. 18.
    Rosencher N, Vielpeau C, Emmerich J, Fagnani F, Samama CM, ESCORTE group. Venous thromboembolism and mortality after hip fracture surgery: the ESCORTE study. J Thromb Haemost. 2005;3:2006–14.CrossRefGoogle Scholar
  19. 19.
    O’Brien J, Duncan H, Kirsh G, Allen V, King P, Hargraves R, Mendes L, Perera T, Catto P, Schofield S, Ploschke H. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: pulmonary embolism prevention (PEP) trial. Lancet. 2000;355:1295–302.CrossRefGoogle Scholar
  20. 20.
    Todd CJ, Freeman CJ, Camilleri-Ferrante C, Palmer CR, Hyder A, Laxton CE, et al. Differences in mortality after fracture of hip: the east Anglian audit. BMJ. 1995;310:904–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Eriksson BI, Lassen MR, PENTasaccharide in HIp-FRActure Surgery Plus Investigators. Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery: a multicenter, randomized, placebo-controlled, double-blind study. Arch Intern Med. 2003;163:1337.CrossRefGoogle Scholar
  22. 22.
    Meignan M, Rosso J, Gauthier H, Brunengo F, Claudel S, Sagnard L, et al. Systematic lung scans reveal a high frequency of silent pulmonary embolism in patients with proximal deep venous thrombosis. Arch Intern Med. 2000;160:159–64.CrossRefGoogle Scholar
  23. 23.
    Douketis JD, Kearon C, Bates S, Duku EK, Ginsberg JS. Risk of fatal pulmonary embolism in patients with treated venous thromboembolism. JAMA. 1998;279:458–62.CrossRefGoogle Scholar
  24. 24.
    Brooks RL, Winslow MC, Kenmore PI. The week-old hip fracture: indication for prophylactic use of a vena cava filter? Report of two cases. Orthopedics. 1987;10:1287–8.Google Scholar
  25. 25.
    Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. Antithrombotic therapy for VTE disease. Chest. 2012;141:e419S–496S.CrossRefPubMedGoogle Scholar
  26. 26.
    Baglin TP, Brush J, Streiff M. Guidelines on use of vena cava filters. Br J Haematol. 2006;134:590–5.CrossRefGoogle Scholar
  27. 27.
    Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension. Circulation. 2011;123:1788–830.CrossRefGoogle Scholar
  28. 28.
    Langan EM, Miller RS, Casey WJ, Carsten CG, Graham RM, Taylor SM. Prophylactic inferior vena cava filters in trauma patients at high risk: follow-up examination and risk/benefit assessment. J Vasc Surg. 1999;30:484–8.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, School of MedicinePontificia Universidad Catolica de ChileSantiagoChile
  2. 2.School of MedicinePontificia Universidad Catolica de ChileSantiagoChile

Personalised recommendations