Venous thromboembolism and fractured neck of femur

Abstract

SummaryThe post-operative incidence of venous thromboembolism (VTE) is high for patients undergoing hip fracture surgery. Proven prophylactic measures are available although underutilized due to concern on post-operative bleeding with use of anticoagulants. This study retrospectively reviewed the clinical incidence of VTE and utilisation of thromboprophylactic protocols over an eight year period. Demographic details, mechanism of injury, VTE risk factors, prophylactic modalities (mechanical and pharmacological), operation duration, mode of anaesthesia, hospital length of stay (LOS) and post-operative complications with particular attention to suspected deep vein thrombosis (DVT) and/or pulmonary embolism (PE) were analysed. Male to female ratio was 1: 2.7 with a median age of 78 years (IQR: 70–86 years) and 83 years (IQR: 77–87 years) respectively (p<0.001). Median hospital LOS was 8 days (IQR: 5–13 days) and differed with mechanism of injury. The in-hospital incidence of VTE was 1.6% (95% CI:1.1–2.5%) with a probably underestimated three month rate of 8.2% (95% CI:5.3–12.4%). Non fatal PE was 0.5% (95% CI: 0.2–1.0%) in-hospital and 2.6% (95% CI: 1.2–5.5%) at three months. Fatal PE was 0.5% (95% CI: 0.2–1.0%) with a three month incidence of 0.4% (95% CI: 0.1–2.4%). The in-hospitalVTE incidence was kept relatively low with use of prophylactic protocols with almost all patients receiving prophylaxis by the end of the study period. Given the five-fold out of hospital increase in incidence, consideration should be given to continue prophylaxis beyond hospital discharge in this high risk group of patients.