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. 2020 Jun:190:1-7.
doi: 10.1016/j.thromres.2020.03.019. Epub 2020 Mar 27.

Venous thromboembolism in patients hospitalized for hip joint replacement surgery

Karsten Keller  1 , Lukas Hobohm  2 , Stefano Barco  3 , Irene Schmidtmann  4 , Thomas Münzel  5 , Martin Engelhardt  6 , Markus Goldhofer  7 , Stavros V Konstantinides  8 , Philipp Drees  7
Affiliations

Venous thromboembolism in patients hospitalized for hip joint replacement surgery

Karsten Keller et al. Thromb Res. 2020 Jun.

Abstract

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.

Keywords: Deep venous thrombosis; Hip joint; Hip replacement; Pulmonary embolism; Venous thromboembolism.

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Conflict of interest statement

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.

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