Abstract
Background
Venous thromboembolism (VTE) is a major cause of morbidity, mortality, and healthcare
costs in arthroplasty patients. In an effort to reduce VTEs, numerous strategies and
guidelines have been implemented, but their impact remains unclear. The purpose of
this study is to compare annual trends in 30-day VTE, deep vein thrombosis (DVT),
pulmonary embolism (PE), and all-cause mortality in (1) total hip arthroplasty (THA)
and (2) total knee arthroplasty (TKA).
Methods
The American College of Surgeons National Surgical Quality Improvement Program (NSQIP)
database identified 363,530 patients who received a TKA or THA from 2008 to 2016.
Bivariate analysis was performed to assess the association between the year in which
surgery was performed and demographics and comorbidities. Bimodal multivariate logistic
regression models for THA and TKA were developed for 2009-2016 using 2008 as a reference.
Results
Overall incidence of VTE, DVT, PE, and mortality for THA were 0.6%, 0.4%, 0.3%, and
0.2%, respectively. Based off of multivariate regression VTE, DVT, PE, and mortality
rates have shown no significant (P > .05) change from 2008 to 2016 in THA patients. Overall incidence of VTE, DVT, PE,
and mortality for TKA were 1.4%, 0.9%, 0.6%, and 0.1%, respectively. Multivariate
regression revealed reductions when compared to 2008 for VTEs and DVTs from 2009 to
2016 (P < .05) for TKA patients. A significant reduction in PEs (P = .002) was discovered for 2016, while no significant change was observed in mortality
(P > .05).
Conclusion
Approximately 1 in 71 patient undergoing TKA, and 1 in 167 undergoing THA developed
a VTE within 30 days after surgery. Our study demonstrated that VTE incidence rates
have decreased in TKA, while remaining stable in THA over the past 8 years. Further
research to determine the optimal prophylaxis algorithm that would allow for a personalized,
efficacious, and safe thromboprophylaxis regimen is needed.
Level of Evidence
III.
Keywords
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Article Info
Publication History
Published online: August 29, 2019
Accepted:
August 22,
2019
Received in revised form:
August 13,
2019
Received:
June 11,
2019
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.08.049.
Financial Support: No financial support was used for the conductance of this study.
The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
Identification
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