抄録
Objective: The purpose of this study was to clarify the incidence and the risk factors of preoperative deep venous thrombosis (DVT) in patients with hip fracture (HF) and to evaluate the efficacy in reducing DVT with the mechanical thromboprophylaxis alone, including compression stockings and/or intermittent pneumatic compression devices (IPC).
Methods: A retrospective chart review was conducted on 162 patients (33 men and 129 women, mean age 82.5 years old) admitted to our institution with HF in 2011. All patients wore a compression stocking during the hospital stay, and underwent duplex ultrasonography (US) to rule out DVT before surgery. Patients without preoperative DVT (non-DVT group) were treated with IPC for two days postoperatively. Patients with preoperative proximal DVT (DVT group) were treated with inferior vena cava filter insertion before surgery. The differences between the groups were tested for statistical significance using the Chi square test, the unpaired t-test, and logistic regression analysis. Statistical significance was defined as p < 0.05. All statistical analyses were performed using an SPSS ver.19 (SPSS Inc., Chicago, IL).
Results: Preoperative DVT was diagnosed in 28 patients (17.3%). Patients with femoral neck fracture were at a higher risk of developing DVT compared to patients with femoral trochanteric fractures (p = 0.039). The DVT group (7.29±3.48 days) showed a significant difference compared to the non-DVT group (6.01±3.11 days) in delayed length from the time of injury until the time of surgery (p = 0.050). The DVT group required more blood transfusion postoperatively than the non-DVT group (p = 0.026). Hemoglobin values at one week postoperatively were significantly lower in the DVT group (9.37±1.38 g/dl) than the non-DVT group (9.95±1.35 g/dl) (p = 0.035). Although one patient (0.6%) developed symptomatic DVT after surgery, there was no patient (0%) who suffered from pulmonary embolism.
Conclusion: HF patients are susceptible to dehydration, and therefore they are at a higher risk of developing preoperative DVT. We recommend the routine use of mechanical thromboprophylaxis immediately after admission to prevent development of DVT, and for patients to undergo compression ultrasonography to rule out DVT in all the patients before delayed surgery exceeding more than 3 days.
