Post-discharge symptomatic thromboembolic events in hip fracture patients.

INTRODUCTION: The aim of this study was to audit referral rates for post-discharge symptomatic thromboembolic events following hip fracture surgery to assess the extent of the clinical problem and to initiate discussion on prolonged chemoprophylaxis. PATIENTS AND METHODS: All patients who underwent surgery for proximal hip fractures in one year (2001-2002) were followed up. Patient case-notes were used to identify all morbidity episodes within 3 months following discharge. Patients with suspected symptomatic thromboembolic episodes were investigated to confirm the diagnoses objectively. Reasons for hospital readmission and causes of death were identified.
RESULTS: A total of 267 patients who underwent surgery for proximal hip fractures were included in the study. Forty-three patients died during initial admission episode. Of the 224 patients discharged, 46 (20.54%) patients were referred back to hospital within 3 months, for unplanned emergency management. Of these, 8 patients (3.57%) were referred back for suspected thromboembolic events. Of these, 6 (2.67%) were referred with a clinical diagnoses of deep vein thrombosis (DVT) but only 1 patient (0.45%) was confirmed to have DVT. Two patients (0.89%) were referred with features of pulmonary embolism (PE). Both were confirmed on ventilation-perfusion scans and both patients died. One patient died following PE in the community.Thus, overall, 3 deaths (1.34%) following discharge were recorded to be due to pulmonary embolism.
CONCLUSIONS: Suspected thromboembolic events constitute a major proportion of unplanned referrals back to the hospital. Three deaths due to delayed pulmonary embolism may justify prolonged universal chemoprophylaxis following hip fracture surgery.