Nicholas Kusnezov, Avinash Iyer, Mary K Richardson, Amit S Piple, Jennifer C Wang, Kevin C Liu, Alexander B Christ, Jay R Lieberman, Nathanael D Heckmann
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Demographics, comorbidities, hospital factors, perioperative medications, and blood transfusion needs were assessed. A multivariate model was used to identify independent risk factors for VTE. Overall, 847,496 patients were identified, of whom 8,002 (0.94%) developed a VTE postoperatively (3,052 PE, 5,294 DVT).</p><p><strong>Results: </strong>After controlling for confounders, an elevated risk of VTE was associated with increased age (adjusted odds ratio [aOR]: 1.01, 95% confidence interval [CI] = 1.01-1.01, P < 0.001), Black patients (aOR: 1.30, 95% CI=1.28-1.47, P < 0.001), and patients enrolled in Medicare (aOR: 1.18, 95% CI = 1.13-1.24, P < 0.001) or Medicaid (aOR: 1.24, 95% CI = 1.12-1.37, P < 0.001). Independent risk factors for PE included obesity (aOR: 1.25, 95% CI = 1.16-1.35, P < 0.001), pulmonary hypertension (aOR: 3.64, 95% CI = 3.05-4.35, P < 0.001), and history of VTE (aOR: 1.71, 95% CI = 1.54-1.91, P < 0.001). Risk factors associated with an increased risk of DVT included iron deficiency anemia (aOR:1.38, 95% CI = 1.14-1.66, P < 0.001) and abnormal weight loss (aOR: 1.67, 95% CI = 1.07-2.60, P = 0.023).</p><p><strong>Conclusion: </strong>Increasing age, Black race, Medicare, or Medicaid insurance were associated with increased risk of VTE. Obesity, history of VTE, and pulmonary hypertension were risk factors for both PE and DVT. 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This study aimed to identify factors associated with postoperative venous thromboembolism (VTE) following TKA.</p><p><strong>Methods: </strong>A national healthcare database was queried for adults who underwent primary, elective TKA from January 1, 2015 to December 31, 2020. Patients who developed PE or DVT within 90 days postoperatively were compared with patients who did not. Demographics, comorbidities, hospital factors, perioperative medications, and blood transfusion needs were assessed. A multivariate model was used to identify independent risk factors for VTE. Overall, 847,496 patients were identified, of whom 8,002 (0.94%) developed a VTE postoperatively (3,052 PE, 5,294 DVT).</p><p><strong>Results: </strong>After controlling for confounders, an elevated risk of VTE was associated with increased age (adjusted odds ratio [aOR]: 1.01, 95% confidence interval [CI] = 1.01-1.01, P < 0.001), Black patients (aOR: 1.30, 95% CI=1.28-1.47, P < 0.001), and patients enrolled in Medicare (aOR: 1.18, 95% CI = 1.13-1.24, P < 0.001) or Medicaid (aOR: 1.24, 95% CI = 1.12-1.37, P < 0.001). Independent risk factors for PE included obesity (aOR: 1.25, 95% CI = 1.16-1.35, P < 0.001), pulmonary hypertension (aOR: 3.64, 95% CI = 3.05-4.35, P < 0.001), and history of VTE (aOR: 1.71, 95% CI = 1.54-1.91, P < 0.001). Risk factors associated with an increased risk of DVT included iron deficiency anemia (aOR:1.38, 95% CI = 1.14-1.66, P < 0.001) and abnormal weight loss (aOR: 1.67, 95% CI = 1.07-2.60, P = 0.023).</p><p><strong>Conclusion: </strong>Increasing age, Black race, Medicare, or Medicaid insurance were associated with increased risk of VTE. Obesity, history of VTE, and pulmonary hypertension were risk factors for both PE and DVT. 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引用次数: 0
摘要
简介：确定初级全膝关节置换术（TKA）术后肺栓塞（PE）和深静脉血栓形成（DVT）的风险因素可改善风险分层并指导外科医生选择预防措施。本研究旨在确定TKA术后静脉血栓栓塞症（VTE）的相关因素：方法： 我们查询了一个全国医疗保健数据库，该数据库收录了从 2015 年 1 月 1 日至 2020 年 12 月 31 日期间接受初级、择期 TKA 手术的成人患者。将术后 90 天内发生 PE 或深静脉血栓的患者与未发生 PE 或深静脉血栓的患者进行比较。对人口统计学、合并症、医院因素、围手术期用药和输血需求进行了评估。采用多变量模型来确定 VTE 的独立风险因素。总共确定了 847,496 名患者，其中 8,002 人（0.94%）在术后发生了 VTE（3,052 例 PE，5,294 例深静脉血栓）：结果：在控制了混杂因素后，VTE 风险的升高与年龄的增加有关（调整后的几率比 [aOR]：1.01，95% 置信区间：1.01，95% 置信区间 [CI] = 1.01-1.01，P <0.001）、黑人患者（aOR：1.30，95% CI=1.28-1.47，P <0.001）、加入医疗保险（aOR：1.18，95% CI = 1.13-1.24，P <0.001）或医疗补助（aOR：1.24，95% CI = 1.12-1.37，P <0.001）的患者。PE的独立危险因素包括肥胖（aOR：1.25，95% CI = 1.16-1.35，P＜0.001）、肺动脉高压（aOR：3.64，95% CI = 3.05-4.35，P＜0.001）和VTE病史（aOR：1.71，95% CI = 1.54-1.91，P＜0.001）。与深静脉血栓风险增加相关的风险因素包括缺铁性贫血（aOR：1.38，95% CI = 1.14-1.66，P <0.001）和体重异常减轻（aOR：1.67，95% CI = 1.07-2.60，P =0.023）：结论：年龄、黑人、医疗保险或医疗补助保险的增加与 VTE 风险的增加有关。肥胖、VTE 病史和肺动脉高压是 PE 和 DVT 的风险因素。这些数据有助于外科医生在 TKA 术后选择预防方案。
Risk Factors for Venous Thromboembolism Following Total Knee Arthroplasty: An Analysis of 3,052 Pulmonary Emboli.
Introduction: Identifying risk factors for pulmonary embolism (PE) and deep vein thrombosis (DVT) following primary total knee arthroplasty (TKA) may improve risk stratification and guide surgeons in prophylaxis selection. This study aimed to identify factors associated with postoperative venous thromboembolism (VTE) following TKA.
Methods: A national healthcare database was queried for adults who underwent primary, elective TKA from January 1, 2015 to December 31, 2020. Patients who developed PE or DVT within 90 days postoperatively were compared with patients who did not. Demographics, comorbidities, hospital factors, perioperative medications, and blood transfusion needs were assessed. A multivariate model was used to identify independent risk factors for VTE. Overall, 847,496 patients were identified, of whom 8,002 (0.94%) developed a VTE postoperatively (3,052 PE, 5,294 DVT).
Results: After controlling for confounders, an elevated risk of VTE was associated with increased age (adjusted odds ratio [aOR]: 1.01, 95% confidence interval [CI] = 1.01-1.01, P < 0.001), Black patients (aOR: 1.30, 95% CI=1.28-1.47, P < 0.001), and patients enrolled in Medicare (aOR: 1.18, 95% CI = 1.13-1.24, P < 0.001) or Medicaid (aOR: 1.24, 95% CI = 1.12-1.37, P < 0.001). Independent risk factors for PE included obesity (aOR: 1.25, 95% CI = 1.16-1.35, P < 0.001), pulmonary hypertension (aOR: 3.64, 95% CI = 3.05-4.35, P < 0.001), and history of VTE (aOR: 1.71, 95% CI = 1.54-1.91, P < 0.001). Risk factors associated with an increased risk of DVT included iron deficiency anemia (aOR:1.38, 95% CI = 1.14-1.66, P < 0.001) and abnormal weight loss (aOR: 1.67, 95% CI = 1.07-2.60, P = 0.023).
Conclusion: Increasing age, Black race, Medicare, or Medicaid insurance were associated with increased risk of VTE. Obesity, history of VTE, and pulmonary hypertension were risk factors for both PE and DVT. These data can assist surgeons in the selection of a prophylactic regimen after TKA.
期刊介绍：
The Journal of the American Academy of Orthopaedic Surgeons was established in the fall of 1993 by the Academy in response to its membership’s demand for a clinical review journal. Two issues were published the first year, followed by six issues yearly from 1994 through 2004. In September 2005, JAAOS began publishing monthly issues.
Each issue includes richly illustrated peer-reviewed articles focused on clinical diagnosis and management. Special features in each issue provide commentary on developments in pharmacotherapeutics, materials and techniques, and computer applications.
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