Background
Methods
Search strategy
Exclusion criteria | Example or explanation |
---|---|
No living human subjects |
e.g. mice model
|
Focus on wrong procedure | e.g. unicompartmental knee replace-ment |
Focus on risk factors for other complications |
e.g. limb swelling
|
Focus on other thrombo-related factors |
e.g. bleeding or blood transfusion
|
Focus on fat embolism |
e.g. fat embolism after femoral head resection
|
Have not mentioned any risk factor |
e.g. prevelance studied alone
|
Not primary clinical research |
e.g. literature review or guidline
|
Level III prognostic study | e.g. case–control |
Level IV prognostic study |
e.g. case series
|
Level V prognostic study |
e.g. expert opinion
|
Diagnostic study |
e.g. spiral CT for the detection of pulmonary embolism
|
Economic and decision analyses | e.g. cost-effectiveness of extended-duration thromboprophylaxis after THA |
Indispensable data missing or not available | e.g. no p-value |
Article could not be retrieved |
e.g. not available in electronic or print archives
|
Duplicate publication | e.g. Similar title, sample size ,and outcome data |
Validation
Data abstraction
Analysis
Ethical compliance
Results
Screening results
NOS | Percentages of studies N(n%)* | References of studies |
---|---|---|
8☆ | 14 (26%) | |
7☆ | 22 (41%) | |
6☆ | 18 (33%) |
Endpoint | VTE* |
---|---|
Total of the endpoint | 54 |
Risk factors
|
N
†
(%)
|
Demographic factors
| |
Age | 12 (22%) |
Gender | 13 (24%) |
BMI | 6 (11%) |
Race | 1 (2%) |
ASA physical status | 3 (6%) |
Clinical factors
| |
Underlying diagnosis | 3 (6%) |
Comorbidity (Charlson index) | 3 (6%) |
Cardiovascular disease | 10 (19%) |
Respiratory disease | 2 (4%) |
Neurological disease | 1 (2%) |
Liver and kidney disease | 2 (4%) |
Metabolic disease | 7 (13%) |
Hematological disease | 2 (4%) |
Endocrine disease | 2 (4%) |
Malignancy | 4 (8%) |
Medication (hormone replacement/herbal) | 3 (6%) |
Laboratory indexes
| |
Preoperative laboratory index | 2 (4%) |
Postoperative laboratory index | 2 (4%) |
Health care provider-
related factors
| |
Surgery type | 12 (22%) |
Surgical technic | 5 (9%) |
Operating time | 4 (8%) |
Anesthesia | 5 (9%) |
Bleeding | 1 (2%) |
Hospital volume | 2 (4%) |
Insurance type | 1 (2%) |
Thromboprophylaxes
| |
Chemoprophylaxis | 28 (52%) |
Initiating and lasting of the prophylaxis | 4 (8%) |
Mechanical and physical prophylaxis | 5 (9%) |
Risk factors | Reference number’s for papers |
---|---|
Demographic factors
| |
Age | |
Gender | |
BMI | |
Race | [23] |
ASA physical status | |
Clinical factors
| |
Underlying diagnosis | |
Comorbidity (Charlson index) | |
Cardiovascular disease | |
Respiratory disease | |
Neurological disease | [35] |
Liver and kidney disease | |
Metabolic disease | |
Hematological disease | |
Endocrine disease | |
Malignancy | |
Medication (hormone replacement/herbal) | |
Laboratory indexes
| |
Preoperative laboratory index | |
Postoperative laboratory index | |
Health care provider-
related factors
| |
Surgery type | |
Surgical technic | |
Operating time | |
Anesthesia | |
Bleeding | [28] |
Hospital volume | |
Insurance type | [23] |
Thromboprophylaxes
| |
Chemoprophylaxis | |
Initiating and lasting of the prophylaxis | |
Mechanical and physical prophylaxis |
Risk factors(demographic factors) | Studies reporting on a risk factor for THA or TKA:total number,number reporting a significant (p ≤ .05)increased(+)or decreased (−) risk,and number with no significant association (p > .05) | |||||||
---|---|---|---|---|---|---|---|---|
THA | TKA | |||||||
N | p ≤ .05 | p > .05 | N | p ≤ .05 | p > .05 | |||
+ | - | + | - | |||||
Older age | 8 | 6 | 0 | 2 | 9 | 3 | 0 | 6 |
Female sex | 9 | 2 | 1 | 6 | 9 | 2 | 0 | 7 |
Higher BMI* | 3 | 1 | 0 | 2 | 6 | 1 | 0 | 5 |
Black race (vs. white) | - | - | - | - | 1 | 1 | 0 | 0 |
Hispanic race (vs. white) | - | - | - | - | 1 | 0 | 0 | 1 |
Higher ASA score† | 3 | 0 | 0 | 3 | 2 | 0 | 0 | 2 |
Risk factors(clinical factors) | Studies reporting on a risk factor for THA or TKA:total number,number reporting a significant (p ≤ .05) increased (+)or decreased (−)risk,and number with no significant association (p >. 05) | |||||||
---|---|---|---|---|---|---|---|---|
THA | TKA | |||||||
N | p ≤ .05 | p > .05 | N | p ≤ .05 | p > .05 | |||
+ | - | + | - | |||||
Underlying diagnosis
| ||||||||
RA (vs. without RA) | - | - | - | - | 1 | 1 | 0 | 0 |
RA (vs. OA)* | 1 | 0 | 1 | 0 | 1 | 0 | 1 | 0 |
Trauma (vs. OA) | 1 | 0 | 0 | 1 | - | - | - | - |
Osteonecrosis (vs. OA) | 1 | 0 | 0 | 1 | - | - | - | - |
Dysplasia (vs. OA) | 1 | 0 | 0 | 1 | - | - | - | - |
Comorbidity
| ||||||||
Higher Charlson index† | 2 | 0 | 0 | 2 | 2 | 1 | 0 | 1 |
Cardiovascular disease | 1 | 1 | 0 | 0 | - | - | - | - |
Stroke | 1 | 0 | 0 | 1 | 1 | 1 | 0 | 0 |
Heart disease | 1 | 0 | 0 | 1 | 2 | 0 | 0 | 2 |
CHF/MI‡ | 2 | 1 | 0 | 1 | 1 | 1 | 0 | 0 |
Coronary artery disease | 1 | 0 | 0 | 1 | 1 | 0 | 0 | 1 |
Valve disease | 1 | 0 | 0 | 1 | 1 | 0 | 0 | 1 |
Arrhythmia | 2 | 0 | 0 | 2 | 2 | 0 | 0 | 2 |
VTE history | 6 | 2 | 0 | 4 | 4 | 0 | 0 | 4 |
Venous stasis | - | - | - | - | 1 | 0 | 0 | 1 |
Varicose vein | 2 | 1 | 0 | 1 | 3 | 0 | 0 | 3 |
Pulmonary disease | 1 | 0 | 0 | 1 | 1 | 0 | 0 | 1 |
Sleep apnea | 2 | 1 | 0 | 1 | 2 | 1 | 0 | 1 |
Neurological disease | 1 | 0 | 0 | 1 | 1 | 0 | 0 | 1 |
Liver and kidney disease | 1 | 0 | 0 | 1 | - | - | - | - |
CKD3B (vs. CKD1-3A)§ | 1 | 1 | 0 | 0 | - | - | - | - |
Metabolic syndrome | 1 | 1 | 0 | 0 | 2 | 2 | 0 | 0 |
Diabetes mellitus | 4 | 0 | 0 | 4 | 5 | 0 | 0 | 5 |
Hypertension | 2 | 0 | 0 | 2 | 3 | 0 | 0 | 3 |
Dyslipidemia | 2 | 0 | 0 | 2 | 2 | 0 | 0 | 2 |
Gout | - | - | - | - | 1 | 0 | 0 | 1 |
Hematological disease | 1 | 0 | 0 | 1 | 2 | 1 | 0 | 1 |
Endocrine disease | 1 | 0 | 0 | 1 | 2 | 0 | 0 | 2 |
Malignancy | 4 | 0 | 0 | 4 | 4 | 0 | 0 | 4 |
Medication
| ||||||||
Hormone replacement | 1 | 0 | 0 | 1 | 3 | 0 | 0 | 3 |
Herbal therapy | - | - | - | - | 1 | 1 | 0 | 0 |
Risk factors(laboratory indexes) | Studies reporting on a risk factor for THA or TKA:total number,number reporting a significant (p ≤ .05)increased (+) or decreased (−) risk,and number with no significant association(p > .05) | |||||||
---|---|---|---|---|---|---|---|---|
THA | TKA | |||||||
N | p ≤ .05 | p > .05 | N | p ≤ .05 | p > .05 | |||
+ | - | + | - | |||||
Preoperative index
| ||||||||
blood glucose ≥ 200 mg/dl | 1 | 1 | 0 | 0 | 1 | 1 | 0 | 0 |
Resting PaO2 < 75 mmHg | - | - | - | - | 1 | 0 | 0 | 1 |
Resting PaCO2 ≥ 45 mmHg | - | - | - | - | 1 | 1 | 0 | 0 |
RVSP ≥ 35 mmHg* | - | - | - | - | 1 | 0 | 0 | 1 |
Postoperative index
| ||||||||
Higher platelet counts | - | - | - | - | 1 | 1 | 0 | 0 |
Hemoglobin ≥ 10.5 g/dl | - | - | - | - | 1 | 1 | 0 | 0 |
AaDO2 ≥ 34 Torr† | - | - | - | - | 1 | 1 | 0 | 0 |
Seroconvertion of IgG-class HIT Antibody‡ | - | - | - | - | 1 | 1 | 0 | 0 |
Risk factors(health care provider - related factors) | Studies reporting on a risk factor for THA or TKA:total number,number reporting a significant (p ≤ .05)increased(+) or decreased (−) risk,and number with no significant association (p > .05) | |||||||
---|---|---|---|---|---|---|---|---|
THA | TKA | |||||||
N | p ≤ .05 | p > .05 | N | p ≤ .05 | p > .05 | |||
+ | - | + | - | |||||
TKA (vs. THA) | 4 | 2 | 0 | 2 | 4 | 2 | 0 | 2 |
THA (vs. resurfacing) | 1 | 1 | 0 | 0 | - | - | - | - |
Revision (vs. primary) | 1 | 0 | 0 | 1 | 2 | 1 | 0 | 1 |
Bilateral (vs. unilateral) | 3 | 1 | 0 | 2 | 4 | 2 | 0 | 2 |
Right side (vs. left side) | - | - | - | - | 1 | 0 | 0 | 1 |
Cement (vs. cementless) | 2 | 1 | 0 | 1 | 3 | 2 | 0 | 1 |
ROBODOC* (vs. traditional) | 1 | 0 | 1 | 0 | - | - | - | - |
Longer surgery time | 3 | 1 | 0 | 2 | 3 | 1 | 0 | 2 |
General anesthesia | 3 | 0 | 0 | 3 | 3 | 0 | 0 | 3 |
Spinal anesthesia | - | - | - | - | 1 | 0 | 0 | 1 |
Bleeding ≥ 1280 ml | - | - | - | - | 1 | 1 | 0 | 0 |
Lower hospital volume | 1 | 1 | 0 | 0 | 2 | 1 | 0 | 1 |
Insurance type† | 1 | 0 | 0 | 1 | - | - | - | - |
Risk factors (thromboprophylaxes) | Studies reporting on a risk factor for THA or TKA: total number, number reporting a significant (p ≤ .05) increased (+) or decreased (−) risk, and number with no significant association (p > .05) | |||||||
---|---|---|---|---|---|---|---|---|
THA | TKA | |||||||
N | p ≤ .05 | p > .05 | N | p ≤ .05 | p > .05 | |||
+ | - | + | - | |||||
Chemoprophylaxis (vs. no-prophylaxis) | 3 | 0 | 2 | 1 | 3 | 0 | 2 | 1 |
Enoxaparin (vs. other LMWH) | 3 | 0 | 1 | 2 | 3 | 0 | 1 | 2 |
Low-dose LMWH (vs. high-dose LMWH) | - | - | - | - | 1 | 0 | 0 | 1 |
Preoperative LMWH (vs. Postoperative) | 1 | 0 | 0 | 1 | 2 | 0 | 0 | 2 |
Oligosaccharides* (vs. LMWH) | 2 | 0 | 2 | 0 | 1 | 0 | 0 | 1 |
Direct factor-Xa inhibitor (vs. LMWH) | 5 | 0 | 4 | 1 | 5 | 1 | 2 | 2 |
Direct factor-II inhibitor (vs. LMWH) | 2 | 0 | 1 | 1 | 2 | 1 | 0 | 1 |
Partial factor-VII inhibitor (vs. LMWH) | - | - | - | - | 1 | 0 | 1 | 0 |
NSAIDS (vs. LMWH) | 2 | 0 | 0 | 2 | 1 | 0 | 0 | 1 |
VKA (vs. NSAIDS) | - | - | - | - | 1 | 1 | 0 | 0 |
ACCP-recommended prophylaxis (vs. others ) | 1 | 0 | 1 | 0 | 1 | 0 | 1 | 0 |
Extended prophylaxis (vs. short)† | 1 | 0 | 1 | 0 | 2 | 0 | 2 | 0 |
Mechanical prophylaxis (vs. chemoprophylaxis) | 1 | 0 | 0 | 1 | - | - | - | - |
Below-knee stockings (vs. up-knee) | - | - | - | - | 1 | 0 | 0 | 1 |
Earlier mobilization | 2 | 0 | 2 | 0 | 3 | 0 | 3 | 0 |
Weight bearing within 48 h | 1 | 0 | 0 | 1 | 1 | 0 | 0 | 1 |
THA | TKA | |
---|---|---|
Risk factors for VTE
| 1. Older age | 1. TKA (vs. THA) |
2. Female sex | 2. Older age | |
3. Higher BMI | 3. Female sex | |
4. Bilateral surgery | 4. Higher BMI | |
5. VTE history | 5. Bilateral surgery | |
6. Surgery time > 2 hours | 6. Cemented fixation | |
7. Surgery time > 2 hours | ||
Protective factors for VTE
| 1. Chemoprophylaxis for VTE* | 1. Chemoprophylaxis for VTE* |
2. Enoxaparin (vs. other LMWH) | 2. Enoxaparin (vs. other LMWH) | |
3. Direct F-Xa inhibitor (vs. LMWH) | 3. Direct F-Xa inhibitor (vs. LMWH) | |
4. Earlier mobilization | ||
Controversial factors for VTE
| 1. Diabetes mellitus | 1. Diabetes mellitus |
2. Malignancy | 2. Malignancy | |
3. General anesthesia | 3. General anesthesia | |
4. ASA score | 4. VTE history | |
5. Varicose vein | ||
6. Hypertension | ||
7. Hormone replacement |