Venous thromboembolism after hospital discharge in pelvic and acetabular fracture patients treated operatively

Abstract

Purpose: The purposes of this study were to determine the rate of venous thromboembolism (VTE) after discharge from the hospital in patients treated operatively with a pelvic ring or acetabular fracture and to define the main time frame in which VTE occurs within the 90-day period after hospital discharge. Methods: California and Florida State Inpatient Databases from 2005 to 2009 were used to identify patients with clinically significant VTEs within 90 days of hospital discharge. ICD-9 diagnosis codes identified patients with a pelvic ring or acetabular fracture and a VTE. Procedure codes distinguished patients having surgical fracture treatment. Deep vein thrombosis (DVT) and pulmonary embolus (PE) were included. Results: Overall, 13,589 patients had a pelvic ring or acetabular fracture and operative treatment. One hundred thirteen patients (0.83%) had a VTE within 90 days after hospital discharge: 0.51% had a DVT, 0.21% had a PE, and 0.12% had both. Twenty eight percent of DVTs and 23% of PEs occurred >35 days after discharge, being evenly distributed out to 90 days. Therefore, overall, <0.2% of patients developed a DVT and <0.1% were diagnosed with a PE (<0.01% fatal) >35 days after the index hospitalization. Conclusions: A substantial proportion of VTE events occur over 35 days after discharge; however, the overall risk is low with fatal PE being extremely low (<0.01%). Given the diminished VTE risk after 35 days, the decision to further extend antithrombotic drug therapy may be guided by patient-specific factors, such as prolonged immobility.