Current Rates and Trends of Venous Thromboembolism After Total Hip and Knee Arthroplasty: An Updated Analysis Utilizing the NSQIP Database.

BACKGROUND

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedure volumes are increasing. Venous thromboembolism (VTE) remains a significant complication, with incidence rates between 0.45% and 5.30%. Enhanced rapid-recovery pathways and chemoprophylaxis evolution may correlate with decreased VTE events over time. This study analyzes recent trends of VTE after THA and TKA.

METHODS

Adults undergoing THA or TKA between 2009 and 2022 were identified from the National Quality Surgical Improvement Program database using Current Procedural Terminology codes. VTE was defined as the occurrence of a deep vein thrombosis (DVT) and/or pulmonary embolism (PE) event in the same patient. The 30-day incidence data of VTE, DVT, and PE were trended over time. Multivariate regression analyses estimated the adjusted risk of events by year of surgery relative to 2009 and identified associated risk factors.

RESULTS

A total of 382,515 THAs and 593,060 TKAs were included with 5713 DVTs and 3807 PEs observed. Trends of 30-day VTE decreased over the study period in THA (0.8%-0.5%, < .001) and TKA (1.8%-0.9%, < .001). Significant decreasing trends were observed for both DVT and PE following TKA (both < .001) and for DVT ( < .001) following THA. Adjusted regression showed significantly lower odds of 30-day DVT (odds ratio 0.68, < .01) and PE (odds ratio 0.59, < .01) after TKA in 2022 compared to 2009.

CONCLUSIONS

The 30-day VTE incidence following THA and TKA has significantly decreased since 2009. Both DVT and PE have decreased in the TKA population, likely due to improved preoperative patient optimization and enhanced recovery pathways, despite shifts toward more selective antiplatelet chemoprophylaxis.