Heart and Vessels

, Volume 34, Issue 5, pp 815–823 | Cite as

Risk of venous thromboembolism after endoprosthetic surgeries: lower versus upper extremity endoprosthetic surgeries

  • Karsten KellerEmail author
  • Lukas Hobohm
  • Martin Engelhardt
Original Article


Venous thromboembolism (VTE) is a potentially fatal disease. Important risk factors of a provoked VTE are trauma, surgery or immobilization. Especially, patients who undergo hip and knee replacements are at high risk for postoperative VTE. We aimed to compare in-hospital VTE burden and other outcomes after upper and lower extremity endoprosthetic surgeries in Germany. The nationwide German inpatient sample of the years 2005–2015 was used for data analysis. Patients who underwent endoprosthetic joint/bone replacements of the extremities (OPS codes 5-820, 5-822, 5-824 and 5-826) were further stratified in those operated on lower (OPS codes 5-820, 5-822 and 5-826) or upper extremity (OPS code 5-824) joints. Patients operated at upper and lower extremity were compared and lower extremity endoprosthetic surgery was investigated as a predictor for adverse outcomes. Overall, 4,134,088 hospitalized patients with extremity joint endoprosthetic surgeries (64.3% females, 54.0% aged > 70 years) were included in our analysis. Of these, 3,950,668 patients (95.6%) undergo lower and 183,420 (4.4%) upper extremity endoprosthetic joint surgery. VTE [RR 2.60 (95% CI 2.41–2.79), P < 0.001] and all-cause death [RR 1.68 (95% CI 1.58–1.77), P < 0.001] were more common in patients with lower extremity joint surgery. Risk for VTE events [OR 2.69 (2.50–2.90), P < 0.001] and in-hospital death [OR 1.65 (1.56–1.75), P < 0.001] were both higher in lower than in upper extremity joint surgeries independently of age, sex and comorbidities. Patients who undergo lower extremity endoprosthetic joint surgeries, bear a higher risk for VTE and in-hospital death compared to those with upper extremity endoprosthetic joint surgeries.


Venous thromboembolism Pulmonary embolism Deep venous thrombosis Hip replacement Knee replacement 



Confidence interval


Deep venous thrombosis or thrombophlebitis


Interquartile range


Lower extremity endoprosthetic joint surgery


Odds ratio


Pulmonary embolism


Relative risk


Upper extremity endoprosthetic joint surgery


Venous thromboembolism



We thank the Federal Statistical Office of Germany (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005–2015, own calculations) for providing the data/results and the kind permission to publish these data/results.

Author contributions

KK, LH and ME contributed in conception and design of the study, and analysis as well as interpretation of data. All authors contributed in writing, revising and drafting the manuscript. They have read and approved the final submitted manuscript version. K.K. takes responsibility for the integrity of the work as a whole, from inception to finished article.


This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1003 and BMBF 01EO1503). The authors are responsible for the contents of this publication.

Compliance with ethical standards

Conflicts of interest

The author(s) declare that they have no competing interests.


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Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Center for Thrombosis and HemostasisUniversity Medical Center Mainz (Johannes Gutenberg-University Mainz)MainzGermany
  2. 2.Center of Cardiology, Cardiology IUniversity Medical Center Mainz (Johannes Gutenberg-University Mainz)MainzGermany
  3. 3.German Bundesliga Club 1. FSV Mainz 05 in the Soccer Season 2014/2015MainzGermany
  4. 4.Department for Orthopedics, Trauma Surgery and Hand SurgeryKlinikum OsnabrückOsnabrückGermany
  5. 5.German Olympic Sports Confederation Responsible for Taking Care of the German Team at the Olympic Summer Games 2004 and 2008AthenaGreece
  6. 6.German Olympic Sports Confederation Responsible for Taking Care of the German Team at the Olympic Summer Games 2004 and 2008BeijingChina
  7. 7.Institute for Applied Training Science LeipzigLeipzigGermany
  8. 8.German Triathlon Federation (DTU)FrankfurtGermany

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