Incidence and Factors Predicting Venous Thromboembolism After Surgical Treatment of Fractures Below the Hip

OBJECTIVES: This study was designed to investigate the incidence and risk factors of postoperative venous thromboembolism (VTE) in a series of patients with fractures below the hip. In addition, we sought to examine the rates of VTE before and after introduction of thromboprophylaxis. DESIGN: Retrospective review. SETTING: University-based academic medical center. PATIENTS: Nine hundred one consecutive patients met the inclusion criteria. Of the 901 patients, 337 (37.4%) were treated before the initiation of institutional guidelines for thromboprophylaxis and 564 (62.6%) received thromboprophylaxis in accordance with our hospitalization protocol. INTERVENTION: Surgical intervention for fractures occurring in the lower extremity below the hip. MAIN OUTCOME MEASUREMENTS: Symptomatic thromboembolic events within 90 days of surgery and risk factors of postoperative VTE. RESULTS: Of the 901 patients, 25 (2.7%) had confirmed symptomatic deep vein thrombosis and 13 (1.4%) had symptomatic pulmonary embolism. The overall incidence of symptomatic VTE was significantly different between the patients not receiving thromboprophylaxis (6.8%; 23 of 337) and those receiving thromboprophylaxis (2.3%; 13 of 564). Of the 31 variables tested for an association with VTE, an advanced age of more than 60 years, cardiovascular disease, and chronic lung disease were independent risk factors. CONCLUSIONS: Clinically detectable VTE in fractures of the lower extremity below the hip are not uncommon, and thromboprophylaxis seemed to decrease the incidence of postoperative VTE. LEVEL OF EVIDENCE: Prognostic Level II. See the guidelines for authors for a complete description of levels of evidence.