Impact of type of surgery on deep venous thrombi and pulmonary emboli: a look at twenty seven thousand hip fracture patients.

purposeDeep venous thrombi (DVT) and pulmonary emboli (PE) are common complications in hip fracture patients. It is imperative that orthopaedists know the patient risk factors for DVT and PE, including if type of surgery plays a role. To this end, we used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify significant risk factors.

methodsFrom the 2006-2011 ACS NSQIP database, 27,441 patients with hip fractures were identified using a Current Procedural Terminology (CPT) code search. DVT and PE complications, type of surgery based on CPT code, patient demographics, medical comorbidities and operative factors were identified for each patient. Fisher's exact tests were used to (1) determine if rates of DVT and PE significantly differed based on type of surgery and (2) identify significant associations between patient factors and development of DVT/PE. These significant factors were then used as covariates in multivariable analysis to determine which risk factors predicted postoperative DVT/PE.

resultsOf the 27,441 hip fracture patients, 449 (1.6 %) developed DVT/PE. There was a significant difference in rates of DVT/PE based on surgery (p = 0.015): patients undergoing intramedullary nailing of inter-/peri-/subtrochanteric femoral fractures had the highest rates of DVT/PE (2.06 %). After multivariate analysis, renal failure and recent surgery were significant risk factors for DVT/PE.

conclusionsThis study was the first to show through large, multicentre, prospective data that type of hip fracture surgery impacts rates of DVT/PE. We further identified two additional risk factors orthopaedists should be aware of. Knowing these risk factors will help in peri-operative planning to reduce complications.