What is the clinical evidence from this study?

Study design: Case-Control. Population: Deep vein thrombosis after total joint arthroplasty (n=15326). Intervention: Total knee arthroplasty vs. Total hip arthroplasty. Primary outcome: Deep vein thrombosis (DVT) (OR 1.836, 95% CI 1.047-3.222, p=0.034).

June 24, 2019Open Access

A nested case-control study on the risk factors of deep vein thrombosis for Chinese after total joint arthroplasty

HXHong XuSichuan University SZShaoyun ZhangMianyang Third People's Hospital JXJinwei XieSichuan University

Key Result

Total knee arthroplasty was associated with a significantly increased risk of deep vein thrombosis compared to total hip arthroplasty (OR 1.836), along with advanced age, drain use, and delayed ambulation.

Study Design

Type

Case-Control (n=15,326)

Multicenter

Yes

Structured PICO

What are the risk factors for deep vein thrombosis in Chinese patients after total joint arthroplasty?

Population

15,326 Chinese patients undergoing total joint arthroplasty, from which 73 cases of deep vein thrombosis and 292 matched controls were analyzed to identify postoperative risk factors.

Exposure

Presence of potential risk factors including total knee arthroplasty (TKA), advanced age (> 70 years), drain use, and delayed ambulation (≥ 72 h) postoperatively.

Comparator

Absence of these risk factors (e.g., total hip arthroplasty, age ≤ 70 years, no drain use, early ambulation).

Outcome

Occurrence of deep vein thrombosis (DVT) postoperatively.hard clinical

In Chinese patients undergoing total joint arthroplasty, the incidence of DVT is relatively low (0.48%), with TKA, advanced age, drain use, and delayed ambulation identified as key risk factors.

Main Result

Odds Ratio: 1.836 (95% CI 1.047–3.222)

Absolute Event Rate: 0.71% vs 0.24%

p-value: p=0.034

Limitations

Few patients with DVT, preventing separate risk factor analysis for TKA and THA
Multiple diagnoses included, failing to identify differences between rheumatoid arthritis and osteoarthritis
Small number of patients with extreme BMI (>30 kg/m2) and ASA class III-V
Short follow-up time of about 2 months, potentially missing DVT cases occurring after data entry

Abstract

BACKGROUND: Deep vein thrombosis (DVT) is one of the life-threatening complications of total joint arthroplasty (TJA) postoperatively, and its risk factors are still controversial. The aim of this study was to identify the risk factors of DVT after TJA. STUDY DESIGN AND METHODS: A nested case-control study based on a large dataset of 15,326 patients undergoing TJA was performed. Potential risk factors of DVT and demographic information were extracted from the electronic health record. Patients with DVT (73 patients) were treated as study group while non-DVT patients who were matched 1:4 according to the anticoagulant type, were considered as control group (292 patients). These variables of potential risk factors for DVT including age, sex, body mass index (BMI), American Society of Anesthesiologists class, comorbidity, preoperative hemoglobin (HB) level and analgesic use, surgical site (knee or hip) and type, the start time of drug anticoagulation, ambulation time, transfusion, and whether to use tranexamic acid (TXA), drain, human serum albumin, and measures of physical thromboprophylaxis after operation were collected and evaluated by survival analysis and presented as P value and odds ratio with 95% confidence interval. RESULTS: There were 15,326 patients underwent TJA and 73 (0.48%) patients had DVT among them, and the occurrence rates were 0.71% for the patients underwent total knee arthroplasty (TKA) while 0.24% for total hip arthroplasty. The risk factors associated with DVT included TKA (compared with THA), advanced age (> 70 years), drain use, and delayed ambulation (≥ 72 h) postoperatively. CONCLUSION: The present results suggest that the occurrence rate of DVT on the patients underwent TJA was low (0.48%) relatively. And the risk factors associated with increased risk of DVT included TKA (compared with THA), advanced age, drain use, and delayed ambulation postoperatively. Individualized and more efficient risk stratification protocols of anticoagulation after TJA for Chinese may need to be developed in the future.

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