Risk factors for preoperative deep venous thrombosis in hip fracture patients: a meta-analysis

Abstract

Study design: A meta-analysis.

Background: Hip fracture (HF), as common geriatric fracture, is related to increased disability and mortality. Preoperative deep vein thrombosis (DVT) is one of the most common complications in patients with hip fractures, affecting 8-34.9% of hip fracture patients. The study aimed to assess the risk factors of preoperative DVT after hip fractures by meta-analysis.

Methods: An extensive search of the literature was performed in the English databases of PubMed, Embase, and the Cochrane Library; and the Chinese databases of CNKI and WAN FANG. We collected possible predictors of preoperative DVT from included studies, and data analysis was conducted with RevMan 5.3 and STATA 12.0.

Results: A total of 26 English articles were included, and the rate of DVT was 16.6% (1627 of 9823 patients) in our study. Our findings showed that advanced age [p = 0.0003, OR = 0.13 95% CI (0.06, 0.21)], female patients [p = 0.0009, OR = 0.82 95% CI (0.72, 0.92)], high-energy injury [p = 0.009, OR = 0.58 95% CI (0.38, 0.87)], prolonged time from injury to admission [p < 0.00001, OR = 0.54 95% CI (0.44, 0.65)], prolonged time from injury to surgery [p < 0.00001, OR = 2.06, 95% CI (1.40, 2.72)], hemoglobin [p < 0.00001, OR = - 0.32 95% CI (- 0.43, - 0.21)], coronary heart disease [p = 0.006, OR = 1.25 95% CI (1.07, 1.47)], dementia [p = 0.02, OR = 1.72 95% CI (1.1, 2.67)], liver and kidney diseases [p = 0.02, OR = 1.91 95% CI (1.12, 3.25)], pulmonary disease [p = 0.02, OR = 1.55 95% CI (1.07, 2.23)], smoking [p = 0.007, OR = 1.45 95% CI (1.11, 1.89)], fibrinogen [p = 0.0005, OR = 0.20 95% CI (0.09, 0.32)], anti-platelet drug [p = 0.01, OR = 0.51 95% CI (0.30, 0.85)], C-reactive protein [p = 0.02, OR = 5.95 95% CI (1.04, 10.85)], < 35 g/l albumin [p = 0.006, OR = 1.42 95% CI (1.1, 1.82)], and thrombosis history [p < 0.00001, OR = 5.28 95% CI (2.85, 9.78)] were risk factors for preoperative DVT.

Conclusions: Many factors, including advanced age, female patients, high-energy injury, prolonged time from injury to admission, prolonged time from injury to surgery, patients with a history of coronary heart disease, dementia, liver and kidney diseases, pulmonary disease, smoking, and thrombosis, fibrinogen, C-reactive protein, and < 35 g/l albumin, were found to be associated with preoperative DVT. Our findings suggested that the patient with above characteristics might have preoperative DVT.

Level of evidence: Level III.

Keywords: Hip fractures; Meta-analysis; Preoperative deep venous thrombosis; Risk factors.

Fig. 1

Flow diagram of study selection

Fig. 2

Forest plot showing age in 2 groups. CI confidence interval, df degrees of freedom, M-H Mantel–Haenszel. a Relationship between age at surgical time and preoperative DVT; b 60–70 years vs > 90 years; c 70–80 years vs > 90 years; d 80–90 years vs > 90 years; e 60–70 years vs 70–80 years; f 60–70 years vs 80–90 years; g 70–80 years vs 80–90 years

Fig. 3

Forest plot showing sex in 2 groups. CI confidence interval, df degrees of freedom, M-H Mantel–Haenszel

Fig. 4

Forest plot showing body mass index in 2 groups. CI confidence interval, df degrees of freedom, M-H Mantel–Haenszel. a Relationship between BMI at surgical time and preoperative DVT; b  < 18.5 kg/m² vs > 28 kg/m²; c 24.0–27.9 kg/m² vs > 28 kg/m²; d  < 25 kg/m² vs > 25 kg/m²; e  < 18.5 kg/m² vs 18.5–23.9 kg/m²; f  < 18.5 kg/m² vs 24.0–27.9; g 18.5–23.9 kg/m² vs 24.0–27.9 kg/m²; h 18.5–23.9 kg/m² vs > 28 kg/m²

Fig. 5

Forest plot showing type of fracture in 2 groups. CI confidence interval, df degrees of freedom, M-H Mantel–Haenszel. a Intertrochanteric fracture vs femur neck fracture; b intertrochanteric fracture vs subtrochanteric fracture; c femur neck fracture vs subtrochanteric fracture

Fig. 6

Forest plot showing prolonged time from injury to admission in 2 groups. CI confidence interval, df degrees of freedom, M-H Mantel–Haenszel. a Prolonged time from injury to admission; b  ≥ 5 days vs < 5 days

Fig. 7

Forest plot showing time from injury to admission in 2 groups. CI confidence interval, df degrees of freedom, M-H Mantel–Haenszel

Fig. 8

Forest plot showing the relationship between the location of living place and preoperative DVT in 2 groups. CI confidence interval, df degrees of freedom, M-H Mantel–Haenszel

Fig. 9

Forest plot showing a history of allergy in 2 groups. CI confidence interval, df degrees of freedom, M-H Mantel–Haenszel

Fig. 10

Forest plot showing a history of smoking in 2 groups. CI confidence interval, df degrees of freedom, M-H Mantel–Haenszel

Fig. 11

Forest plot showing the relationship between patients with a history of thrombosis and preoperative DVT in 2 groups. CI confidence interval, df degrees of freedom, M-H Mantel–Haenszel

Fig. 12

Forest plot showing the relationship between anti-platelet drug and preoperative DVT in 2 groups. CI interval, df degrees of freedom, M-H Mantel–Haenszel

Fig. 13

Forest plot showing the relationship between injury side and mechanism and preoperative DVT in 2 groups. CI confidence interval, df degrees of freedom, M-H Mantel–Haenszel. a Injury side; b injury mechanism

Fig. 14

Forest plot showing ASA class in 2 groups. CI confidence interval, df degrees of freedom, M-H Mantel–Haenszel. a ASA III and ASA IV; b ASA I and ASA II; c ASA I and ASA III; d ASA I and ASA IV; e ASA II and ASA III; f ASA III and ASA IV

Fig. 15

Forest plot showing the relationship between medical history and preoperative DVT in 2 groups. CI confidence interval, df degrees of freedom, M-H Mantel–Haenszel. a Hypertension; b diabetes; c coronary heart disease; d cerebrovascular accident; e cancer; f dementia; g liver and kidney disease; h liver disease; i kidney disease; j pulmonary disease; k arrhythmia; l stroke; m Alzheimer’s disease

Fig. 16

Forest plot showing the relationship between laboratory test and preoperative DVT in 2 groups. CI confidence interval, df degrees of freedom, M-H Mantel–Haenszel. a Hemoglobin; b platelet; c activated partial thromboplastin time (APTT); d activated prothrombin time (PT); e fibrinogen; f D-dimer; g C-reactive protein (CRP); h albumin (< 35 g/l vs ≥ 35 g/l)