Venous thromboembolism in patients hospitalized for hip joint replacement surgery.


Journal

Thrombosis research
ISSN: 1879-2472
Titre abrégé: Thromb Res
Pays: United States
ID NLM: 0326377

Informations de publication

Date de publication:
06 2020
Historique:
received: 08 01 2020
revised: 24 03 2020
accepted: 26 03 2020
pubmed: 6 4 2020
medline: 22 6 2021
entrez: 6 4 2020
Statut: ppublish

Résumé

Venous thromboembolism (VTE) is a potentially life-threatening disease. Major transient risk factors include trauma, surgery, and immobilization. Patients undergoing hip joint replacement (HJR) are characterized by a high risk of postoperative VTE, but data on the time trends of VTE rates in this population are sparse. In an analysis of the German nationwide inpatient sample, we included all hospitalizations for elective primary HJR in Germany from 2005 to 2016. Time trends of the surgical procedure, overall death rates, and VTE rates were analysed, and predictors of VTE identified. Overall, 1,885,839 inpatients with elective primary HJR (59.1% women, 51.4% ≥70 years) were included in the analysis. During hospitalization, VTE was documented in 11,554 (0.6%) patients. While total numbers of primary HJR increased from 145,223 in 2005 to 171,421 in 2016 (β-(slope)-estimate 1818 [95%CI 1083 to 2553], P < 0.001), in-hospital VTE decreased from 1288 (0.9%) to 843 (0.5%) cases (β-estimate -0.71 [95%CI -0.77 to -0.65], P < 0.001), and in-hospital death rate from 0.33% (476 deaths) to 0.29% (498 deaths) (β-estimate -0.11 [95%CI -0.20 to -0.02], P = 0.018). Infections during hospitalization were associated with higher VTE risk than cancer and cardiovascular events. VTE events were independently associated with an increased death risk (OR 15.19 [95%CI 14.19-16.86], P < 0.001). While total numbers of HJR increased significantly in Germany between 2005 and 2016, in-hospital rates of VTE decreased from 0.9% to 0.5%. Patients with perioperative VTE had a 15-fold increase of in-hospital death. Cancer, cardiovascular disease and perioperative infections were associated with higher risk for VTE.

Sections du résumé

BACKGROUND
Venous thromboembolism (VTE) is a potentially life-threatening disease. Major transient risk factors include trauma, surgery, and immobilization. Patients undergoing hip joint replacement (HJR) are characterized by a high risk of postoperative VTE, but data on the time trends of VTE rates in this population are sparse.
METHODS
In an analysis of the German nationwide inpatient sample, we included all hospitalizations for elective primary HJR in Germany from 2005 to 2016. Time trends of the surgical procedure, overall death rates, and VTE rates were analysed, and predictors of VTE identified.
RESULTS
Overall, 1,885,839 inpatients with elective primary HJR (59.1% women, 51.4% ≥70 years) were included in the analysis. During hospitalization, VTE was documented in 11,554 (0.6%) patients. While total numbers of primary HJR increased from 145,223 in 2005 to 171,421 in 2016 (β-(slope)-estimate 1818 [95%CI 1083 to 2553], P < 0.001), in-hospital VTE decreased from 1288 (0.9%) to 843 (0.5%) cases (β-estimate -0.71 [95%CI -0.77 to -0.65], P < 0.001), and in-hospital death rate from 0.33% (476 deaths) to 0.29% (498 deaths) (β-estimate -0.11 [95%CI -0.20 to -0.02], P = 0.018). Infections during hospitalization were associated with higher VTE risk than cancer and cardiovascular events. VTE events were independently associated with an increased death risk (OR 15.19 [95%CI 14.19-16.86], P < 0.001).
CONCLUSIONS
While total numbers of HJR increased significantly in Germany between 2005 and 2016, in-hospital rates of VTE decreased from 0.9% to 0.5%. Patients with perioperative VTE had a 15-fold increase of in-hospital death. Cancer, cardiovascular disease and perioperative infections were associated with higher risk for VTE.

Identifiants

pubmed: 32247912
pii: S0049-3848(20)30101-8
doi: 10.1016/j.thromres.2020.03.019
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1-7

Informations de copyright

Copyright © 2020 Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article. KK, IS, TM, ME and MG report no conflict of interest. LH reports having received lecture honoraria from MSD. SB received lecture or consultant fees from Bayer HealthCare, BTG Pharmaceuticals, and LeoPharma and economical support for travel or congress costs from Daiichi Sankyo and Bayer HealthCare, outside of the submitted work. SK reports having received consultancy and lecture honoraria from Bayer, Boehringer Ingelheim, Daiichi-Sankyo, MSD and Pfizer – Bristol-Myers Squibb; and institutional grants from Actelion, Bayer, Boehringer Ingelheim, Daiichi-Sankyo and Pfizer – Bristol-Myers Squibb. PD received lecture honoraria from ZimmerBiomet and Osartis and research support from GBA and Conformis, outside of the submitted work.

Auteurs

Karsten Keller (K)

Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany. Electronic address: Karsten.Keller@unimedizin-mainz.de.

Lukas Hobohm (L)

Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.

Stefano Barco (S)

Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Clinic for Angiology, University Hospital Zurich, Zurich, Switzerland.

Irene Schmidtmann (I)

Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.

Thomas Münzel (T)

Center for Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Germany.

Martin Engelhardt (M)

Department for Orthopedics, Trauma Surgery and Hand Surgery, Klinikum Osnabrück, Osnabrück, Germany; Institute for Applied Training Science, Leipzig, Germany.

Markus Goldhofer (M)

Center for Orthopaedics and Trauma Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.

Stavros V Konstantinides (SV)

Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.

Philipp Drees (P)

Center for Orthopaedics and Trauma Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.

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