Post-Discharge Symptomatic Thromboembolic Events in Hip Fracture Patients

Abstract

INTRODUCTION The aim of this study was to audit referral rates for post-discharge symptomatic thromboembolic events follow-hip fracture surgery to assess the extent of the clinical problem and to initiate discussion on prolonged chemoprophylaxis. PATIENTS AND METHODS All patients who underwent surgery for proximal hip fractures in one year (2001–2002) were followed up. Patient case-notes were used to identify all morbidity episodes within 3 months following discharge. Patients with suspected symptomatic thromboembolic episodes were investigated to confirm the diagnoses objectively. Reasons for hospital readmission and causes of death were identified. RESULTS A total of 267 patients who underwent surgery for proximal hip fractures were included in the study. Forty-three patients died during initial admission episode. Of the 224 patients discharged, 46 (20.54%) patients were referred back to hospital within 3 months, for unplanned emergency management. Of these, 8 patients (3.57%) were referred back for suspected thromboembolic events. Of these, 6 (2.67%) were referred with a clinical diagnoses of deep vein thrombosis (DVT) but only 1 patient (0.45%) was confirmed to have DVT. Two patients (0.89%) were referred with features of pulmonary embolism (PE). Both were confirmed on ventilation-perfusion scans and both patients died. One patient died following PE in the community. Thus, overall, 3 deaths (1.34%) following discharge were recorded to be due to pulmonary embolism. CONCLUSIONS Suspected thromboembolic events constitute a major proportion of unplanned referrals back to the hospital. Three deaths due to delayed pulmonary embolism may justify prolonged universal chemoprophylaxis following hip fracture surgery.