Analysis Of Perioperative Risk Factors For Deep Vein Thrombosis In Patients With Femoral And Pelvic Fractures

PART Ⅰ: ANALYSIS OF RISK FACTORS FOR DEEP VEIN THROMBOSIS IN FEMORAL AND PELVIC PATIENTSBackground: Bone trauma patients are recognized as a high-risk group for DVT.At present,more active DVT prevention and treatment has not significantly reduced its incidence.We are still exploring the optimized risk factors for DVT,so as to provide reference for early identification of high-risk groups and effective prevention and treatment of DVT.Objective: The clinical characteristics,anticoagulant regimen and risk factors of the whole perioperative period of DVT patients with femoral and pelvic fractures were analyzed,so as to provide reference for early identification and optimization of risk factors and the development of individualized anticoagulant regimen to reduce the incidence of DVT.Methods: This was a retrospective study.A total of 569 patients undergoing surgery of femoral and pelvic fractures from May 2018 to December 2019 were included.The clinical data including general conditions,trauma,surgery,anticoagulant protocols,and laboratory indexes were collected.According to the results of deep vein Doppler ultrasonography of the lower extremities,the patients were divided into non-DVT group and DVT group.Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors of preoperative and postoperative DVT.Results:1.The incidence of DVT was 40.25% and preoperative DVT was 26.71%,which was higher than the incidence of postoperative DVT of17.22%.Most of them were thrombus on the affected side(60.26%)and distal thrombus(81.66%).The average time of DVT formation was 6.55±0.47 days after trauma and 6.67±0.48 days after surgery.2.COPD,anemia,hypoproteinemia,non-anticoagulation before surgery,delayed anticoagulation after trauma and admission,high-energy trauma,multiple injuries,drinking history,andadvanced age were independent risk factors for perioperative DVT.3.The increased level of fibrinogen degradation products was an independent risk factor for preoperative DVT.4.These risk factors were identified to be independently associated with postoperative DVT,including intraoperative blood transfusion,postoperative blood transfusion,pulmonary infection,preoperative non-anticoagulation,postoperative delayed anticoagulation,preoperative waiting time > 7 days,operative time > 2 h,c-reactive protein,fibrinogen level,platelet count 1 day after surgery,c-reactive protein,fibrinogen,and hemoglobin levels 3 days after surgery,comminuted fracture.Conclusions: 1.Current DVT prevention and treatment programs such as anticoagulation have reduced the incidence of DVT in femoral and pelvic fractures.However,it does not change the current situation that the incidence of DVT is still high.3.By analyzing the risk factors of the entire perioperative DVT,we optimized perioperative blood transfusion,preoperative pulmonary disease,hypoproteinemia,anemia,inflammation and other aspects.Early surgery after trauma may further reduce the incidence of DVT.PART Ⅱ PERIOPERATIVE RED BLOOD CELL INFUSION AND DEEP VEIN THROMBOSIS IN PATIENTS WITH FEMORAL AND PELVIC FRACTURES: A PROPENSITY SCORE MATCHING ANALYSISBackground: Currently,the relationship between perioperative red blood cell infusion and DVT has not been determined.Our previous studies have shown that red blood cell infusion is a risk factor for perioperative DVT in patients with femoral and pelvic fractures.Objective: To analyze the time-event relationship between perioperative red blood cell infusion and DVT in patients with fracture of femur and pelvis after adjusting for confounding factors,and to determine the relationship between perioperative red blood cell infusion and DVT.Methods: Clinical data of 569 patients with femoral and pelvic fractures who received surgical treatment in our hospital from May 2018 to December 2019 were retrospectively analyzed.PSM was applied to 20 covariates of DVT,including gender,BMI,smoking history,alcohol consumption history,diabetes mellitus,hypertension,coronary heart disease,hyperlipidemia,liver disease,kidney disease,lung disease,malignant tumor,anticoagulant therapy,ASA grade,etc.,and 0.01 was used as caliper value to match the transfusion group and non-transfusion group in a ratio of 1:1.The matching effect of PSM was evaluated by standardized difference method,and the matched subjects were divided into non-thrombosis group and thrombosis group.With the formation or progression of DVT after red blood cell infusion as the end point,the time-event relationship between perioperative red blood cell infusion and DVT in patients with femoral and pelvic fractures was analyzed by binary Logistic regression.Results:1.Preoperative,intraoperative and postoperative transfusion rates were 8.44%,29.70% and 13.88%,respectively.2.After 1:1 PSM,there were 126 cases in the two groups.There were no statistically significant differences between the two groups in covariates such as gender,BMI,smoking history,drinking history,diabetes mellitus,hypertension,coronary heart disease,hyperlipidemia,liver disease,kidney disease,lung disease,malignant tumor and anticoagulant therapy(P >0.05),and the standardized difference values of each covariate were all <0.1.3.Before PSM(P=0.023,OR=1.496),perioperative RBC infusion was associated with the formation of DVT for femoral and pelvic fractures.After PSM(P=0.038,OR=1.728),they were still correlated.4.The risk of DVT in patients with RBC infusion of 2-4U and >4U was 1.833 and 2.667 times of ≤2U,respectively.5.After excluding 21 patients who received preoperative RBC infusion and 5 patients whose DVT formation or progression preceded the transfusion,there was still a difference in perioperative RBC infusion between the thrombus group and the non-thrombus group(P=0.037,OR=2.231).Conclusion: Perioperative RBC infusion is the cause of DVT in patients with femoral and pelvic fractures,and its risk is positively correlated with the amount of perioperative RBC infusion.