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Erschienen in:

07.12.2018 | Original Article

High prevalence of deep vein thrombosis in elderly hip fracture patients with delayed hospital admission

verfasst von: Francisco Bengoa, Gerardo Vicencio, Daniel Schweitzer, Maria Jesus Lira, Tomás Zamora, Ianiv Klaber

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 4/2020

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Abstract

Purpose

Deep vein thrombosis (DVT) is a common complication in hip fracture patients, associated with significant morbidity and mortality. Research has focused on postoperative DVT, with scant reports on preoperative prevalence. The aim of this study was to describe the prevalence of preoperative DVT in patients accessing medical care ≥ 48 h after a hip fracture.

Methods

We included elderly patients admitted ≥ 48 h after sustaining a hip fracture, between September 2015 and October 2017. Patients with a previous episode of DVT, undergoing anticoagulation therapy, with pathologic fractures or undergoing cancer treatment were excluded. Of 273 patients, 59 were admitted at least 48 h after the fracture. DVT screening by Doppler ultrasound of both lower extremities was carried upon hospital admission. We recorded age, sex, Charlson comorbidity index and ASA score, fracture type, time since injury, time from admission to surgery and total length of hospital stay.

Results

We studied 41 patients, 79 (± 10.34) years old. The delay from injury to admission was 120 h (48–696 h). Seven patients (17.1%) had a DVT upon admission. There were no significant differences between patients with and without DVT, regarding time from admission to surgery or the total length of the hospital stay.

Conclusions

The prevalence of DVT in patients admitted ≥ 48 h after a hip fracture was 17.1%. The diagnosis and management of DVT did not increase time to surgery or hospital stay. Our results suggest routine screening for DVT in patients consulting emergency services ≥ 48 h after injury.
Literatur
1.
Zurück zum Zitat Cauley JA, Chalhoub D, Kassem AM, Fuleihan GE-H. Geographic and ethnic disparities in osteoporotic fractures. Nat Rev Endocrinol. 2014;10:338–51.CrossRef Cauley JA, Chalhoub D, Kassem AM, Fuleihan GE-H. Geographic and ethnic disparities in osteoporotic fractures. Nat Rev Endocrinol. 2014;10:338–51.CrossRef
2.
Zurück zum Zitat Zahn HR, Skinner JA, Porteous MJ. The preoperative prevalence of deep vein thrombosis in patients with femoral neck fractures and delayed operation. Injury. 1999;30:605–7.CrossRef Zahn HR, Skinner JA, Porteous MJ. The preoperative prevalence of deep vein thrombosis in patients with femoral neck fractures and delayed operation. Injury. 1999;30:605–7.CrossRef
3.
Zurück zum Zitat Smith EB, Parvizi J, Purtill JJ. Delayed surgery for patients with femur and hip fractures—risk of deep venous thrombosis. J Trauma. 2011;70:E113–6.CrossRef Smith EB, Parvizi J, Purtill JJ. Delayed surgery for patients with femur and hip fractures—risk of deep venous thrombosis. J Trauma. 2011;70:E113–6.CrossRef
4.
Zurück zum Zitat Wolberg AS, Rosendaal FR, Weitz JI, Jaffer IH, Agnelli G, Baglin T, et al. Venous thrombosis. Nat Rev Dis Prim Nat Publ Group. 2015;1:15006.CrossRef Wolberg AS, Rosendaal FR, Weitz JI, Jaffer IH, Agnelli G, Baglin T, et al. Venous thrombosis. Nat Rev Dis Prim Nat Publ Group. 2015;1:15006.CrossRef
5.
Zurück zum Zitat Hefley FG, Nelson CL, Puskarich-May CL. Effect of delayed admission to the hospital on the preoperative prevalence of deep-vein thrombosis associated with fractures about the hip. J Bone Jt Surg Am. 1996;78:581–3.CrossRef Hefley FG, Nelson CL, Puskarich-May CL. Effect of delayed admission to the hospital on the preoperative prevalence of deep-vein thrombosis associated with fractures about the hip. J Bone Jt Surg Am. 1996;78:581–3.CrossRef
6.
Zurück zum Zitat Cho Y-H, Byun Y-S, Jeong D-G, Han I-H, Park Y-B. Preoperative incidence of deep vein thrombosis after hip fractures in Korean. Clin Orthop Surg Korean Orthop Assoc. 2015;7:298–302.CrossRef Cho Y-H, Byun Y-S, Jeong D-G, Han I-H, Park Y-B. Preoperative incidence of deep vein thrombosis after hip fractures in Korean. Clin Orthop Surg Korean Orthop Assoc. 2015;7:298–302.CrossRef
7.
Zurück zum Zitat Mears SC, Kates SL. A guide to improving the care of patients with fragility fractures, 2nd ed. Geriatr Orthop Surg Rehabil, vol 6. Los Angeles: SAGE PublicationsSage; 2015. pp. 58–120. Mears SC, Kates SL. A guide to improving the care of patients with fragility fractures, 2nd ed. Geriatr Orthop Surg Rehabil, vol 6. Los Angeles: SAGE PublicationsSage; 2015. pp. 58–120.
8.
Zurück zum Zitat Zamora T, Klaber I, Urrutia J. Hip fracture in the elderly. Clin Med Insights Geriatr. 2017;10:1–10. Zamora T, Klaber I, Urrutia J. Hip fracture in the elderly. Clin Med Insights Geriatr. 2017;10:1–10.
9.
Zurück zum Zitat Bengoa F, Carrasco M, Amenábar PP, Schweitzer D, Botello E, Klaber I. Optimización perioperatoria del paciente anciano con fractura osteoporótica de cadera. Rev Med Chil. 2017;145:1437–46.CrossRef Bengoa F, Carrasco M, Amenábar PP, Schweitzer D, Botello E, Klaber I. Optimización perioperatoria del paciente anciano con fractura osteoporótica de cadera. Rev Med Chil. 2017;145:1437–46.CrossRef
10.
Zurück zum Zitat Grigoryan KV, Javedan H, Rudolph JL. Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma. 2014;28:e49–55.CrossRef Grigoryan KV, Javedan H, Rudolph JL. Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma. 2014;28:e49–55.CrossRef
11.
Zurück zum Zitat Mears SC, Kates SL. A guide to improving the care of patients with fragility fractures, 2nd ed. Geriatr Orthop Surg Rehabil. 2015;6:58–120.CrossRef Mears SC, Kates SL. A guide to improving the care of patients with fragility fractures, 2nd ed. Geriatr Orthop Surg Rehabil. 2015;6:58–120.CrossRef
12.
Zurück zum Zitat Kates SL, Blake D, Bingham KW, Kates OS, Mendelson DA, Friedman SM. Comparison of an organized geriatric fracture program to united states government data. Geriatr Orthop Surg Rehabil. 2010;1:15–21.CrossRef Kates SL, Blake D, Bingham KW, Kates OS, Mendelson DA, Friedman SM. Comparison of an organized geriatric fracture program to united states government data. Geriatr Orthop Surg Rehabil. 2010;1:15–21.CrossRef
13.
Zurück zum Zitat Friedman SM, Mendelson DA, Bingham KW, Kates SL. Impact of a comanaged geriatric fracture center on short-term hip fracture outcomes. Arch Intern Med. 2009;169:1712–7.CrossRef Friedman SM, Mendelson DA, Bingham KW, Kates SL. Impact of a comanaged geriatric fracture center on short-term hip fracture outcomes. Arch Intern Med. 2009;169:1712–7.CrossRef
14.
Zurück zum Zitat Friedman SM, Mendelson DA, Kates SL, McCann RM. Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population. J Am Geriatr Soc. 2008;56:1349–56.CrossRef Friedman SM, Mendelson DA, Kates SL, McCann RM. Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population. J Am Geriatr Soc. 2008;56:1349–56.CrossRef
15.
Zurück zum Zitat Kates SL, Mendelson DA, Friedman SM. Co-managed care for fragility hip fractures (Rochester model). Osteoporos Int J Establ result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2010;21:621–5.CrossRef Kates SL, Mendelson DA, Friedman SM. Co-managed care for fragility hip fractures (Rochester model). Osteoporos Int J Establ result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2010;21:621–5.CrossRef
16.
Zurück zum Zitat Geerts WH, Code KI, Jay RM, Chen E, Szalai JP. A prospective study of venous thromboembolism after major trauma. N Engl J Med Mass Med Soc. 1994;331:1601–6.CrossRef Geerts WH, Code KI, Jay RM, Chen E, Szalai JP. A prospective study of venous thromboembolism after major trauma. N Engl J Med Mass Med Soc. 1994;331:1601–6.CrossRef
17.
Zurück zum Zitat McNamara I, Sharma A, Prevost T, Parker M. Symptomatic venous thromboembolism following a hip fracture. Acta Orthop. 2009;80:687–92.CrossRef McNamara I, Sharma A, Prevost T, Parker M. Symptomatic venous thromboembolism following a hip fracture. Acta Orthop. 2009;80:687–92.CrossRef
18.
Zurück zum Zitat Rosencher N, Vielpeau C, Emmerich J, Fagnani F, Samama CM, ESCORTE group. Venous thromboembolism and mortality after hip fracture surgery: the ESCORTE study. J Thromb Haemost. 2005;3:2006–14.CrossRef Rosencher N, Vielpeau C, Emmerich J, Fagnani F, Samama CM, ESCORTE group. Venous thromboembolism and mortality after hip fracture surgery: the ESCORTE study. J Thromb Haemost. 2005;3:2006–14.CrossRef
19.
Zurück zum Zitat O’Brien J, Duncan H, Kirsh G, Allen V, King P, Hargraves R, Mendes L, Perera T, Catto P, Schofield S, Ploschke H. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: pulmonary embolism prevention (PEP) trial. Lancet. 2000;355:1295–302.CrossRef O’Brien J, Duncan H, Kirsh G, Allen V, King P, Hargraves R, Mendes L, Perera T, Catto P, Schofield S, Ploschke H. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: pulmonary embolism prevention (PEP) trial. Lancet. 2000;355:1295–302.CrossRef
20.
Zurück zum Zitat Todd CJ, Freeman CJ, Camilleri-Ferrante C, Palmer CR, Hyder A, Laxton CE, et al. Differences in mortality after fracture of hip: the east Anglian audit. BMJ. 1995;310:904–8.CrossRef Todd CJ, Freeman CJ, Camilleri-Ferrante C, Palmer CR, Hyder A, Laxton CE, et al. Differences in mortality after fracture of hip: the east Anglian audit. BMJ. 1995;310:904–8.CrossRef
21.
Zurück zum Zitat Eriksson BI, Lassen MR, PENTasaccharide in HIp-FRActure Surgery Plus Investigators. Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery: a multicenter, randomized, placebo-controlled, double-blind study. Arch Intern Med. 2003;163:1337.CrossRef Eriksson BI, Lassen MR, PENTasaccharide in HIp-FRActure Surgery Plus Investigators. Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery: a multicenter, randomized, placebo-controlled, double-blind study. Arch Intern Med. 2003;163:1337.CrossRef
22.
Zurück zum Zitat Meignan M, Rosso J, Gauthier H, Brunengo F, Claudel S, Sagnard L, et al. Systematic lung scans reveal a high frequency of silent pulmonary embolism in patients with proximal deep venous thrombosis. Arch Intern Med. 2000;160:159–64.CrossRef Meignan M, Rosso J, Gauthier H, Brunengo F, Claudel S, Sagnard L, et al. Systematic lung scans reveal a high frequency of silent pulmonary embolism in patients with proximal deep venous thrombosis. Arch Intern Med. 2000;160:159–64.CrossRef
23.
Zurück zum Zitat Douketis JD, Kearon C, Bates S, Duku EK, Ginsberg JS. Risk of fatal pulmonary embolism in patients with treated venous thromboembolism. JAMA. 1998;279:458–62.CrossRef Douketis JD, Kearon C, Bates S, Duku EK, Ginsberg JS. Risk of fatal pulmonary embolism in patients with treated venous thromboembolism. JAMA. 1998;279:458–62.CrossRef
24.
Zurück zum Zitat Brooks RL, Winslow MC, Kenmore PI. The week-old hip fracture: indication for prophylactic use of a vena cava filter? Report of two cases. Orthopedics. 1987;10:1287–8.PubMed Brooks RL, Winslow MC, Kenmore PI. The week-old hip fracture: indication for prophylactic use of a vena cava filter? Report of two cases. Orthopedics. 1987;10:1287–8.PubMed
25.
Zurück zum Zitat Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. Antithrombotic therapy for VTE disease. Chest. 2012;141:e419S–496S.CrossRef Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. Antithrombotic therapy for VTE disease. Chest. 2012;141:e419S–496S.CrossRef
26.
Zurück zum Zitat Baglin TP, Brush J, Streiff M. Guidelines on use of vena cava filters. Br J Haematol. 2006;134:590–5.CrossRef Baglin TP, Brush J, Streiff M. Guidelines on use of vena cava filters. Br J Haematol. 2006;134:590–5.CrossRef
27.
Zurück zum Zitat Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension. Circulation. 2011;123:1788–830.CrossRef Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension. Circulation. 2011;123:1788–830.CrossRef
28.
Zurück zum Zitat Langan EM, Miller RS, Casey WJ, Carsten CG, Graham RM, Taylor SM. Prophylactic inferior vena cava filters in trauma patients at high risk: follow-up examination and risk/benefit assessment. J Vasc Surg. 1999;30:484–8.CrossRef Langan EM, Miller RS, Casey WJ, Carsten CG, Graham RM, Taylor SM. Prophylactic inferior vena cava filters in trauma patients at high risk: follow-up examination and risk/benefit assessment. J Vasc Surg. 1999;30:484–8.CrossRef
Metadaten
Titel
High prevalence of deep vein thrombosis in elderly hip fracture patients with delayed hospital admission
verfasst von
Francisco Bengoa
Gerardo Vicencio
Daniel Schweitzer
Maria Jesus Lira
Tomás Zamora
Ianiv Klaber
Publikationsdatum
07.12.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 4/2020
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-018-1059-8

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