Jones Corey A, Broggi Matthew S, Holmes Jeffrey S, Gerlach Erik B, Goedderz Cody J, Ibnamasud Shadman H, Hernandez-Irizarry Roberto, Schenker Mara L
Department of Orthopaedic Surgery, Emory University, Atlanta, USA.
Department of Orthopaedics, Northwestern University Feinberg School of Medicine, Chicago, USA.
Cureus. 2022 Apr 22;14(4):e24388. doi: 10.7759/cureus.24388. eCollection 2022 Apr.
Background Tibial plateau fractures are often significant injuries that can require complex surgical interventions with prolonged perioperative immobilization, thereby increasing the risk of developing venous thromboembolic (VTE) events, specifically, deep vein thrombosis (DVT) and pulmonary embolism (PE). Risk stratification is paramount for guiding VTE prophylaxis. Although high altitude has been suggested to create a prothrombotic state, virtually no studies have explored its clinical effects in lower extremity trauma. The purpose of this study was to compare surgical fixation of tibial plateau fractures at high and low altitudes and its effects on post-operative VTE development. Methods The Truven MarketScan claims database was used to retrospectively identify patients who underwent surgical fixation of isolated and closed tibial plateau fractures using Current Procedural Terminology (CPT) codes over a 10-year period. Extraneous injuries were excluded using the International Classification of Diseases, 10 edition (ICD-10), and CPT codes. Patient demographics, comorbidities, and DVT chemoprophylaxis prescriptions were obtained. Patients were partitioned into high altitude (>4000 feet) or low altitude (<100 feet) cohorts based on the zip codes of their surgery locations. One-to-one matching and univariate analysis were used to assess and control any baseline discrepancies between cohorts; multivariate regression was then performed between cohorts to determine the odds ratios (OR) for developing VTEs post-operatively. Results There were 7,832 patients included for analysis. There was no statistical difference between high and low altitude cohorts in developing VTEs within 30 days post-operatively. Higher altitudes were associated with increased odds of developing DVT (OR 1.21, p = 0.043) and PE (OR 1.27, p = 0.037) within 90 days post-operatively. Conclusions Surgical fixation of tibial plateau fractures is associated with an increased risk of developing VTEs at high altitudes within 90 days post-operatively. Understanding such risk factors in specific orthopaedic patient populations is essential for optimizing DVT prophylaxis protocols. Further studies should investigate this relationship and the role of DVT prophylaxis regimens in this population.
胫骨平台骨折通常是严重损伤，可能需要复杂的手术干预及长时间的围手术期固定，从而增加发生静脉血栓栓塞（VTE）事件的风险，尤其是深静脉血栓形成（DVT）和肺栓塞（PE）。风险分层对于指导VTE预防至关重要。尽管有人提出高海拔会导致血栓形成倾向，但实际上几乎没有研究探讨其在下肢创伤中的临床影响。本研究的目的是比较高海拔和低海拔地区胫骨平台骨折的手术固定及其对术后VTE发生的影响。方法：使用Truven MarketScan理赔数据库，回顾性识别在10年期间使用现行程序术语（CPT）编码接受孤立性和闭合性胫骨平台骨折手术固定的患者。使用国际疾病分类第10版（ICD-10）和CPT编码排除无关损伤。获取患者人口统计学资料、合并症和DVT化学预防处方。根据手术地点的邮政编码将患者分为高海拔（>4000英尺）或低海拔（<100英尺）队列。采用一对一匹配和单因素分析评估和控制队列之间的任何基线差异；然后在队列之间进行多因素回归，以确定术后发生VTE的比值比（OR）。结果：纳入7832例患者进行分析。高海拔和低海拔队列术后30天内发生VTE的情况无统计学差异。高海拔地区与术后90天内发生DVT（OR 1.21，p = 0.043）和PE（OR 1.27，p = 0.037）的几率增加相关。结论：胫骨平台骨折手术固定与术后90天内高海拔地区发生VTE的风险增加相关。了解特定骨科患者群体中的此类风险因素对于优化DVT预防方案至关重要。进一步的研究应调查这种关系以及DVT预防方案在该人群中的作用。
