Does Surgical Treatment of Varicose Veins Prior to Total Knee Arthroplasty Decrease Rates of Postoperative Venous Thromboembolism? A Matched Cohort Study

Background

Venous thromboembolism (VTE) is a possible complication following total knee arthroplasty (TKA). The presence of varicose veins has been associated with increased risk of VTEs following arthroplasty procedures. The purpose of the present study was to assess the impact of previous varicose vein surgery on the incidence of VTE following TKA.

Methods

A retrospective matched cohort study was performed using the PearlDiver database. Patients undergoing primary TKA with diagnoses of lower extremity varicose veins were identified. Subsequently, patients who underwent varicose vein surgery before TKA (n = 7,730) were matched 1:2 with controls who did not have vein surgery (n = 15,460) across age, sex, Elixhauser comorbidity index, anticoagulation exposure, and comorbidities. Rates of venous thromboembolism (VTE) associated with the index TKA within six months postoperatively were compared between the matched cohorts using multivariable logistic regression.

Results

Patients who had prior varicose vein surgery exhibited significantly lower rates of VTE events during the 0–30 day interval (0.76 % vs. 1.05 %; OR: 0.70), the 31–90 day interval (0.34 % vs. 0.52 %; OR: 0.60), and the 91–180 day interval (0.94 % vs 1.37 %; OR: 0.65). In subgroup analyses of the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE), the varicose vein surgery cohort exhibited significantly lower rates of PE at 31–90 days (0.07 % vs. 0.30 %; OR: 0.42) and 91–180 days (0.48 % vs. 0.80 %; OR: 0.59), while rates of DVT were comparable.

Conclusion

Patients who underwent previous varicose vein surgery exhibited significantly lower rates of VTE within six months after TKA compared to matched controls. The present study suggests operative treatment of varicose veins before TKA may reduce rates of VTE events postoperatively.