Title : Risk factors for deep venous thrombosis within three months after joint replacement surgery
Abstract:
Objective: To explore the relevant risk factors for deep venous thrombosis (DVT) of lower limb occurring 3 months after joint replacement surgery.
Methods: A retrospective analysis was conducted on the clinical data of 1,782 patients who underwent joint replacement surgery at Chongqing Orthopedic Hospital of Traditional Chinese Medicine, from February 2008 to December 2023. Of these, 1,298 were male and 484 were female, with an average age of 65.4±12.3 years (range, 18-95 years). Fourteen factors associated with DVT occurrence at 3 months were investigated, including age, gender, body mass index (BMI), season of surgery, preoperative coagulation function, type of surgery, selection of minimally invasive approach, occurrence of lower limb venous thrombosis 1 day after surgery, history of previous thrombotic diseases, smoking, tumors, diabetes, hypertension, and heart disease. Independent sample t-tests and chi-square tests were used to analyze the risk factors for DVT occurrence. Indicators with statistically significant differences were included in a binary logistic regression analysis to determine the risk factors for DVT 3 months after surgery. The risk prediction model was established according to the results of logistic regression analysis, and the receiver operating characteristic curve was drawn. The area under the curve of the prediction model was calculated.
Results: A total of 1,782 patients were included. The overall incidence of DVT occurring 3 months after joint replacement surgery was 10.5% (187/1,782). The thrombosis group included 5 symptomatic cases and 182 asymptomatic cases, with 13 proximal and 174 distal cases. DVT was found in the iliac vein (1 case), femoral vein (10 cases), popliteal vein (8 cases), peroneal vein (14 cases), and intramuscular vein (168 cases). Single-factor analysis showed that female gender, increasing age, previous thrombotic disease, hypertension, surgery in autumn, and the occurrence of DVT on the first day after surgery were correlated with DVT occurring 3 months after joint replacement surgery (P<0.05). After excluding the missing data, a total of 1,744 patients were included in the final analysis. DVT occurrence on the first day after surgery [ OR=7.498, 95% CI (5.312, 10.584), P<0.001], surgery in autumn [ OR=1.834, 95% CI (1.215, 2.769), P=0.004], age [ OR=1.024, 95% CI (1.007, 1.042), P=0.009], female gender [ OR=1.863, 95% CI(1.184, 2.931), P=0.007], and history of previous thrombotic diseases [ OR=0.012, 95% CI (1.136, 2.830), P=0.012] were found to be associated with DVT occurrence at 3 months after surgery. The area under the curve (AUC) for predicting DVT three months after hip or knee arthroplasty was 0.803 [95% CI (0.761, 0.844)].
Conclusion: Advanced age, female gender, history of previous thrombotic diseases, occurrence of DVT on the first day after surgery, and surgery in autumn are risk factors for DVT occurring 3 months after joint replacement surgery.
