Risk of venous thromboembolism after total hip and knee replacement in older adults with comorbidity and co-occurring comorbidities in the Nationwide Inpatient Sample (2003-2006)

BMC Geriatrics

Research Article

Dan Berlowitz¹  Michael R Winter²  Alan J Labonte²  Jodi B Segal³  Jeffrey N Katz⁴  Elena Losina⁵  Alok Kapoor⁶  Rebecca A Silliman⁷ 

[1] Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial VA Hospital, 200 Springs Road, 01730, Bedford, MA, USA;Boston University School of Public Health, 715 Albany Street, Talbot Building, 02118, Boston, MA, USA;Data Coordinating Center, Boston University School of Public Health, 715 Albany Street, Talbot Building, 02118, Boston, MA, USA;Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, 21205, Baltimore, MD, USA;Department of Orthopaedic Surgery and Division of Rheumatology, Immunology, and Allergy, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis Street, 02115, Boston, MA, USA;Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA;Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA;Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, 02115, Boston, MA, USA;Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Talbot Building, 02118, Boston, MA, USA;Hospital Medicine Unit, Boston University School of Medicine, 715 Albany Street, 02118, Boston, MA, USA;Section of Geriatrics, Boston University School of Medicine, 715 Albany Street, 02118, Boston, MA, USA;Section of Epidemiology, Boston University School of Public Health, 715 Albany Street, Talbot Building, 02118, Boston, MA, USA;

关键词: Chronic Obstructive Pulmonary Disease;    Congestive Heart Failure;    Fondaparinux;    Nationwide Inpatient Sample;    Nationwide Inpatient Sample Data;   

DOI  :  10.1186/1471-2318-10-63

 received in 2010-04-10, accepted in 2010-09-17,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundVenous thromboembolism is a common, fatal, and costly injury which complicates major surgery in older adults. The American College of Chest Physicians recommends high potency prophylaxis regimens for individuals undergoing total hip or knee replacement (THR or TKR), but surgeons are reluctant to prescribe them due to fear of excess bleeding. Identifying a high risk cohort such as older adults with comorbidities and co-occurring comorbidities who might benefit most from high potency prophylaxis would improve how we currently perform preoperative assessment.MethodsUsing the Nationwide Inpatient Sample, we identified older adults who underwent THR or TKR in the U.S. between 2003 and 2006. Our outcome was VTE, including any pulmonary embolus or deep venous thrombosis. We performed multivariate logistic regression analyses to assess the effects of comorbidities on VTE occurrence. Comorbidities under consideration included coronary artery disease, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, and cerebrovascular disease. We also examined the impact of co-occurring comorbidities on VTE rates.ResultsCHF increased odds of VTE in both the THR cohort (OR = 3.08 95% CI 2.05-4.65) and TKR cohort (OR = 2.47 95% CI 1.95-3.14). COPD led to a 50% increase in odds in the TKR cohort (OR = 1.49 95% CI 1.31-1.70). The data did not support synergistic effect of co-occurring comorbidities with respect to VTE occurrence.ConclusionsOlder adults with CHF undergoing THR or TKR and with COPD undergoing TKR are at increased risk of VTE. If confirmed in other datasets, these older adults may benefit from higher potency prophylaxis.

【 授权许可】

CC BY   
© Kapoor et al; licensee BioMed Central Ltd. 2010