Beauchamp-Chalifour Philippe, Belzile Étienne L, Michael Reinemary, Langevin Valérie, Gaudreau Noémie, Normandeau Nicolas, Bédard Luc, Pelet Stéphane
Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre de recherche FRQS, CHU de Québec, Hôpital Enfant-Jésus, 18(e), rue, Québec, 1401 Québec, Canada.
Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Laval University, Quebec, QC, Canada; Department of Orthopedic Surgery, CHU de Québec, Hôpital Enfant-Jésus, 18(e), rue, Québec, 1401 Québec, Canada; Centre de recherche FRQS, CHU de Québec, Hôpital Enfant-Jésus, 18(e), rue, Québec, 1401 Québec, Canada.
Orthop Traumatol Surg Res. 2022 Feb;108(1):103142. doi: 10.1016/j.otsr.2021.103142. Epub 2021 Nov 11.
Elderly patients undergoing surgery for a hip fracture are at risk of venous thromboembolism (VTE). The known risk of VTE is low due to thromboprophylaxis (1.8-2.5% at three months). Most previous studies have ignored the high mortality in that population when calculating the risk of VTE. Hip fracture treatment has also evolved over the last decade. The real risk of VTE today is unknown. We asked what was the risk of symptomatic VTE following surgery for a hip fracture in an elderly population. We also asked what kind of bleeding events were associated with thromboprophylaxis.
The risk of VTE will be lower than previously described due to modern postoperative care.
Retrospective cohort study of all patients≥65-years-old undergoing surgery for a hip fracture in two Canadian academic centers, between January 1, 2008, and January 1, 2019. Symptomatic VTE (pulmonary embolism or deep venous thrombosis) confirmed by imagery were assessed. The follow-up was fixed at 3 months. The cumulated risks of VTE and bleeding events were calculated using the Kaplan-Meier estimator and a logistic regression model was used to determine risk factors.
The cohort included 5184 patients. The mean age was 83±8 years old and 76% of patients were female. In total, 98.8% of this cohort received postoperative thromboprophylaxis. Low-molecular-weight heparin was given for 35 days in 87% of this cohort. The risk of venous thromboembolism was 4.7±0.5% at 3 months (n=144). Chronic obstructive pulmonary disease (odds ratio 1.6 [1.0-2.4]) and the use of warfarin as extended thromboprophylaxis (odds ratio 2.1 [1.3-3.6]) were associated with venous thromboembolism. The risk of bleeding was 5.9% (n=179) at 3 months. In total, 78% (n=141) of bleeding events were hematomas, of which only 12% (n=16) needed reoperation. The use of direct oral anticoagulant was associated with an increased risk of bleeding events (odds ratio, 2.8 [1.5-5.0]). Mortality at 3 months was 8.4%.
The risk of venous thromboembolism is higher than expected in a population treated for this condition (4.7% vs. 1.8-2.5% at 3 months as previously described). Bleeding events were mostly hematomas and few needed reoperations for wound complication. Future research should focus on the management of thromboprophylaxis in that population.
III; retrospective cohort study.
接受髋部骨折手术的老年患者存在静脉血栓栓塞（VTE）风险。由于采取了血栓预防措施，已知的VTE风险较低（三个月时为1.8 - 2.5%）。以往大多数研究在计算VTE风险时忽略了该人群的高死亡率。在过去十年中，髋部骨折的治疗方法也有所发展。目前VTE的实际风险尚不清楚。我们想了解老年人群髋部骨折手术后出现症状性VTE的风险是多少。我们还想知道哪些出血事件与血栓预防有关。
由于现代术后护理，VTE风险将低于先前描述的风险。
对2008年1月1日至2019年1月1日期间在加拿大两个学术中心接受髋部骨折手术的所有≥65岁患者进行回顾性队列研究。评估通过影像学确诊的症状性VTE（肺栓塞或深静脉血栓形成）。随访固定为3个月。使用Kaplan-Meier估计器计算VTE和出血事件的累积风险，并使用逻辑回归模型确定风险因素。
该队列包括5184名患者。平均年龄为83±8岁，76%的患者为女性。该队列中总共98.8%的患者接受了术后血栓预防。87%的该队列患者接受了35天的低分子量肝素治疗。3个月时静脉血栓栓塞的风险为4.7±0.5%（n = 144）。慢性阻塞性肺疾病（比值比1.6 [1.0 - 2.4]）和使用华法林进行延长血栓预防（比值比2.1 [1.3 - 3.6]）与静脉血栓栓塞有关。3个月时出血风险为5.9%（n = 179）。总共78%（n = 141）的出血事件为血肿，其中只有12%（n = 16）需要再次手术。使用直接口服抗凝剂与出血事件风险增加有关（比值比，2.8 [1.5 - 5.0]）。3个月时的死亡率为8.4%。
在接受这种疾病治疗的人群中，静脉血栓栓塞的风险高于预期（3个月时为4.7%，而先前描述的为1.8 - 2.5%）。出血事件大多为血肿，很少因伤口并发症需要再次手术。未来的研究应集中在该人群的血栓预防管理上。
III；回顾性队列研究。
