Key result
Chronic obstructive pulmonary disease was associated with a 25% greater risk of postoperative venous thromboembolism (OR 1.25; 95% CI 1.06-1.48) in older adults undergoing joint replacement.
Why the study?
Do specific cardiopulmonary comorbidities, diabetes, or poor functional status increase the risk of postoperative VTE in older male veterans undergoing joint replacement?
Cohort (n=23,326)
Do specific cardiopulmonary comorbidities, diabetes, or poor functional status increase the risk of postoperative VTE in older male veterans undergoing joint replacement?
In older male veterans undergoing joint replacement, COPD is associated with a slightly increased risk of postoperative VTE, highlighting the need for tailored risk assessment in this population.
Answers are grounded in this paper and cite their sources.
Supports individualized VTE risk assessment incorporating COPD status after joint replacement; hypothesis-generating for targeted prophylaxis trials in veterans.
OBJECTIVES: To identify older adults with comorbidities or poor functional status at high risk of postoperative venous thromboembolism (VTE). DESIGN: Retrospective cohort study. SETTING: Veterans Affairs Medical Center (VAMC). PARTICIPANTS: Older adults who underwent total hip and knee replacement (THR and TKR) from 2002 to 2009. MEASUREMENTS: Using multivariate logistic regression, the independent effect of cardiopulmonary comorbidities and diabetes on VTE was analyzed. Functional status expressed in a summary physical component score (PCS) was also analyzed in a subset of individuals in whom information on it was available. RESULTS: There were 23,326 THR and TKR surgeries performed at the VAMC during the study period. Individuals with chronic obstructive pulmonary disease (COPD) had a 25% greater risk of VTE (odds ratio (OR) = 1.25, 95% confidence interval (CI) = 1.06-1.48), whereas those with coronary artery disease, congestive heart failure, and cerebrovascular disease did not have a greater risk of VTE. Individuals with diabetes mellitus had a lower risk of VTE (OR = 0.77, 95% CI = 0.64-0.92). Individuals with low PCS, which were available for 3,169 patients, had a 62% greater risk, although the effect did not reach statistical significance (lowest vs highest quartile OR = 1.62, 95% CI = 0.93-2.80). CONCLUSION: Individuals with COPD had slightly greater risk of VTE, whereas low functional status had a larger effect that did not reach statistical significance. The constraints of administrative data analysis and sample size available for PCS limit conclusions about the role of these comorbidities and functional status.
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Kapoor et al. (2013) conducted a cohort in Total hip and knee replacement (n=23,326). Chronic obstructive pulmonary disease (COPD) was evaluated on Postoperative venous thromboembolism (VTE) (OR 1.25, 95% CI 1.06-1.48). Chronic obstructive pulmonary disease was associated with a 25% greater risk of postoperative venous thromboembolism (OR 1.25; 95% CI 1.06-1.48) in older adults undergoing joint replacement.
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