Abstract
Elderly patients undergoing surgery for a hip fracture are at risk of thromboembolic events (TEV). The risk of TEV is now rare due to thromboprophylaxis. However, hip fracture treatment has evolved over the last decade. The risk of TEV may have been modified. The objective of this study was to determine the risk of symptomatic TEV following surgery for a hip fracture, in an elderly population.
Retrospective cohort study of all patients > 65 years old undergoing surgery for a femoral neck or intertrochanteric hip fracture in two academic centers, between January 1st 2008 and January 1st 2019. The follow-up was fixed at 3 months. The cumulated risk of thromboembolic events was calculated using the Kaplan-Meier estimator and a predictive logistic regression model was used to determine risk factors.
3265 patients were eligible for analysis. The mean age was 83.3 ±8.1 years old and 75.6% of patients were female. The mortality was 7.55% (N=112) at 3 months. 98.53% of this cohort received thromboprophylaxis. The cumulated risk for a thromboembolic event was 3.55% at 1 month and 6.41% at 3 months (N=99). There were 9 fatal pulmonary embolisms. 89.19% thromboembolic events occurred within 20 days following surgery. Chronic obstructive pulmonary disease (odds ratio 1.909 [1.179–3.089]), renal failure (odds ratio 1.896 [1.172–3.066]) and the use of a bridge between different types of anticoagulant (odds ratio 2.793 [1.057–7.384]) were associated with TEV. The risk of bleeding was 5.67% at 1 month and 9.38% at 3 months (N=142). 77% of bleeding events were hematomas.
The risk of thromboembolic events is higher than expected in a population treated for this condition. Most thromboembolic events occur shortly following surgery. The risk of bleeding is high and most of them are hematomas. Future research could focus on the management of thromboprophylaxis in elderly patients undergoing surgery for a hip fracture.
