Original Article
Incidence and Risk Factor Analysis of Symptomatic Venous Thromboembolism After Knee Arthroscopy

https://doi.org/10.1016/j.arthro.2015.04.091Get rights and content

Purpose

To (1) determine the incidence of symptomatic venous thromboembolic events (VTEs) after knee arthroscopy and arthroscopy-assisted procedures at a single institution and (2) determine associated risk factors for VTEs in these patients.

Methods

The records of patients who underwent knee arthroscopy at a single institution between 1988 and 2008 were reviewed. Chemoprophylaxis was not routinely used. Confirmed VTEs occurring within 4 weeks after the index arthroscopy procedure were included. A 2:1 matched control group was generated to include patients in whom knee arthroscopy was performed by the same surgeon either on the same day or immediately before each case resulting in a VTE. Preoperative and perioperative data were collected with respect to demographic data, medical history, medications, and surgical and anesthesia data. Univariate and multivariate analyses were performed.

Results

During the study period, 12,595 patients underwent knee arthroscopy. Among these patients, 43 cases of VTEs (35 deep venous thromboses [DVTs], 5 pulmonary embolisms [PEs], and 3 DVTs that progressed to PEs) occurred, resulting in an incidence of 0.30% (95% confidence interval [CI], 0.22% to 0.41%) for DVT, 0.06% (95% CI, 0.03% to 0.12%) for PE, and 0.34% (95% CI, 0.25% to 0.46%) for VTEs overall. Factors associated with an elevated risk of symptomatic postoperative VTEs included a history of malignancy (P = .01; odds ratio [OR], 6.3), a history of VTEs (P = .02; OR, 5.2), or the presence of more than 2 classic risk factors for VTEs (P = .01; OR, 13.6).

Conclusions

In this study, symptomatic VTEs were rare and occurred infrequently, with an incidence of 0.34% (95% CI, 0.25% to 0.46%), after knee arthroscopy and arthroscopy-assisted cases in the absence of routine chemoprophylaxis. Patients with a history of VTEs, a history of malignancy, or 2 or more classic risk factors are at increased risk of VTEs after knee arthroscopy, and chemoprophylaxis should be considered in these select patients.

Level of Evidence

Level III, case-control study.

Section snippets

Methods

Patients were retrospectively identified from a comprehensive surgical database at our institution based on International Classification of Diseases, Ninth Revision10 procedural codes for various arthroscopic procedures of the knee performed between March 23, 1988, and July 17, 2008 (Table 1), and institutional review board approval was obtained. Beginning in 2009, the prophylaxis protocol significantly changed, with the adoption of more rigorous guidelines for high-risk patients. When the

Results

Of the 12,595 knee arthroscopies performed during the study period, 43 cases of VTEs (35 DVTs, 5 PEs, and 3 DVTs that progressed to PEs) occurred, resulting in an incidence of 0.30% (95% CI, 0.22% to 0.41%) for DVT, 0.06% (95% CI, 0.03% to 0.12%) for PE, and 0.34% (95% CI, 0.25% to 0.46%) for VTEs overall. The incidence rate of VTEs was similar among each of the specific arthroscopic procedures (Table 1).

The mean time to VTEs after surgery was 10.3 days (range, 2 to 25 days). Twenty-three

Discussion

In this study we reviewed cases of symptomatic VTEs after 12,595 knee arthroscopies at a single institution and found a low rate of symptomatic VTEs after knee arthroscopy and arthroscopy-assisted procedures of 0.34%. In addition, a history of malignancy, a history of VTEs, and the presence of multiple risk factors were associated with a significant increase in the incidence of VTEs. Although knee arthroscopy is common, data are still lacking on the incidence and risk factors for thromboembolic

Conclusions

In this study, symptomatic VTEs were rare and occurred infrequently (0.34%; 95% CI, 0.25% to 0.46%) after knee arthroscopy and arthroscopy-assisted cases in the absence of routine chemoprophylaxis. Patients with a history of VTEs, a history of malignancy, or 2 or more classic risk factors are at increased risk of VTEs after knee arthroscopy, and chemoprophylaxis should be considered in these select patients.

References (25)

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The authors report that they have no conflicts of interest in the authorship and publication of this article.

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