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Open Access Research article

Risk of venous thromboembolism after total hip and knee replacement in older adults with comorbidity and co-occurring comorbidities in the Nationwide Inpatient Sample (2003-2006)

Alok Kapoor1*, Alan J Labonte2, Michael R Winter2, Jodi B Segal3, Rebecca A Silliman45, Jeffrey N Katz67, Elena Losina789 and Dan Berlowitz1011

Author Affiliations

1 Hospital Medicine Unit, Boston University School of Medicine, 715 Albany Street, Boston, 02118, MA, USA

2 Data Coordinating Center, Boston University School of Public Health, 715 Albany Street, Talbot Building, Boston, 02118, MA, USA

3 Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, 21205, MD, USA

4 Section of Geriatrics, Boston University School of Medicine, 715 Albany Street, Boston, 02118 MA, USA

5 Section of Epidemiology, Boston University School of Public Health, 715 Albany Street, Talbot Building, Boston, 02118, MA, USA

6 Department of Orthopaedic Surgery and Division of Rheumatology, Immunology, and Allergy, Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis Street, Boston, 02115, MA, USA

7 Harvard Medical School, 25 Shattuck Street, Boston, 02115, MA, USA

8 Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, 02115, MA, USA

9 Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Talbot Building, Boston, 02118, MA, USA

10 Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial VA Hospital, 200 Springs Road, Bedford, 01730, MA, USA

11 Boston University School of Public Health 715 Albany Street, Talbot Building, Boston, 02118, MA, USA

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BMC Geriatrics 2010, 10:63  doi:10.1186/1471-2318-10-63

Published: 17 September 2010

Abstract

Background

Venous thromboembolism is a common, fatal, and costly injury which complicates major surgery in older adults. The American College of Chest Physicians recommends high potency prophylaxis regimens for individuals undergoing total hip or knee replacement (THR or TKR), but surgeons are reluctant to prescribe them due to fear of excess bleeding. Identifying a high risk cohort such as older adults with comorbidities and co-occurring comorbidities who might benefit most from high potency prophylaxis would improve how we currently perform preoperative assessment.

Methods

Using the Nationwide Inpatient Sample, we identified older adults who underwent THR or TKR in the U.S. between 2003 and 2006. Our outcome was VTE, including any pulmonary embolus or deep venous thrombosis. We performed multivariate logistic regression analyses to assess the effects of comorbidities on VTE occurrence. Comorbidities under consideration included coronary artery disease, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, and cerebrovascular disease. We also examined the impact of co-occurring comorbidities on VTE rates.

Results

CHF increased odds of VTE in both the THR cohort (OR = 3.08 95% CI 2.05-4.65) and TKR cohort (OR = 2.47 95% CI 1.95-3.14). COPD led to a 50% increase in odds in the TKR cohort (OR = 1.49 95% CI 1.31-1.70). The data did not support synergistic effect of co-occurring comorbidities with respect to VTE occurrence.

Conclusions

Older adults with CHF undergoing THR or TKR and with COPD undergoing TKR are at increased risk of VTE. If confirmed in other datasets, these older adults may benefit from higher potency prophylaxis.