Yu-Chih Lin1, Shen-Hsun Lee2, I-Jung Chen2, Chih-Hsiang Chang3, Chee-Jen Chang4, Yi-Chun Wang5, Yuhan Chang2, Pang-Hsin Hsieh6. 1. Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 5 Fu-Hsing Street, Kweishan, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5 Fu-Hsing Street, Kweishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kweishan, Taoyuan, Taiwan. Electronic address: b101092127@tmu.edu.tw. 2. Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 5 Fu-Hsing Street, Kweishan, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5 Fu-Hsing Street, Kweishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kweishan, Taoyuan, Taiwan. 3. Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 5 Fu-Hsing Street, Kweishan, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5 Fu-Hsing Street, Kweishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kweishan, Taoyuan, Taiwan. Electronic address: 8802032@cgmh.org.tw. 4. Graduate Institute of Clinical Medicine, Chang Gung University, Tao-Yuan, Taiwan; Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan; Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Tao-Yuan, Taiwan; Department of Cardiovascular Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; Resource Center for Clinical Research, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan. Electronic address: cjchang@mail.cgu.edu.tw. 5. Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan. 6. Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, No. 5 Fu-Hsing Street, Kweishan, Taoyuan, Taiwan; Bone and Joint Research Center, Chang Gung Memorial Hospital, No. 5 Fu-Hsing Street, Kweishan, Taoyuan, Taiwan; College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kweishan, Taoyuan, Taiwan. Electronic address: hsiehph@adm.cgmh.org.tw.
Abstract
INTRODUCTION: This study evaluated the incidence of symptomatic pulmonary embolism (PE), subsequent mortality, risk factors, and the effects of pharmacological thromboprophylactic intervention following hip fracture surgery in Taiwan. MATERIALS AND METHODS: A nationwide study was conducted from February 2004 to September 2013. Hip fracture patients were placed into two groups: without symptomatic PE (control group) and with symptomatic PE (PE group). We analyzed the incidence of and risk factors for symptomatic PE, post-operative mortality rate, and effects of pharmacological thromboprophylactic intervention. RESULTS: We identified 165,748 hip fracture patients. The 3-month cumulative incidence of post-operative symptomatic PE was 0.24% (n = 392). The cumulative 1-, 3-, and 6-month mortality rates were significantly higher in the PE group (16.1%, 23.0%, and 28.6%, respectively) than in the controls (3.3%, 6.7%, and 10.2%, respectively). Increased risk of post-operative symptomatic PE was associated with prior history of PE (adjusted odds ratio [OR], 40.00; 95% CI, 24.75-64.67; P < 0.001), female sex (adjusted OR, 1.33; 95% CI, 1.07-1.65; P = 0.009), older age (>75 years) (adjusted OR, 1.51; 95% CI, 1.20-1.91; P < 0.001), and hemiarthroplasty (adjusted OR, 1.23; 95% CI, 1.01-1.51; P < 0.043). Pharmacological thromboprophylaxis significantly reduced the incidence of post-operative PE (adjusted hazard ratio, 4.54; 95% CI, 2.08-9.88; P < 0.001). CONCLUSIONS: The incidence of symptomatic PE after hip fracture surgery was not low in Asian patients, and PE significantly decreased patient survival rates. Some groups were at higher risk for PE; in these instances, thromboprophylaxis, prompt diagnosis, and subsequent intervention are advised.
INTRODUCTION: This study evaluated the incidence of symptomatic pulmonary embolism (PE), subsequent mortality, risk factors, and the effects of pharmacological thromboprophylactic intervention following hip fracture surgery in Taiwan. MATERIALS AND METHODS: A nationwide study was conducted from February 2004 to September 2013. Hip fracturepatients were placed into two groups: without symptomatic PE (control group) and with symptomatic PE (PE group). We analyzed the incidence of and risk factors for symptomatic PE, post-operative mortality rate, and effects of pharmacological thromboprophylactic intervention. RESULTS: We identified 165,748 hip fracturepatients. The 3-month cumulative incidence of post-operative symptomatic PE was 0.24% (n = 392). The cumulative 1-, 3-, and 6-month mortality rates were significantly higher in the PE group (16.1%, 23.0%, and 28.6%, respectively) than in the controls (3.3%, 6.7%, and 10.2%, respectively). Increased risk of post-operative symptomatic PE was associated with prior history of PE (adjusted odds ratio [OR], 40.00; 95% CI, 24.75-64.67; P < 0.001), female sex (adjusted OR, 1.33; 95% CI, 1.07-1.65; P = 0.009), older age (>75 years) (adjusted OR, 1.51; 95% CI, 1.20-1.91; P < 0.001), and hemiarthroplasty (adjusted OR, 1.23; 95% CI, 1.01-1.51; P < 0.043). Pharmacological thromboprophylaxis significantly reduced the incidence of post-operative PE (adjusted hazard ratio, 4.54; 95% CI, 2.08-9.88; P < 0.001). CONCLUSIONS: The incidence of symptomatic PE after hip fracture surgery was not low in Asian patients, and PE significantly decreased patient survival rates. Some groups were at higher risk for PE; in these instances, thromboprophylaxis, prompt diagnosis, and subsequent intervention are advised.