Low Ejection Fraction Increases The Risk Of DVT After Joint Arthroplasty

Objective:To investigate the effect of preoperative low ejection fraction(EF)on lower extremity deep vein thrombosis(DVT)in patients undergoing Joint arthroplasty(JA).Methods:We retrospectively analysised 1163 patients(840 female patients and 323 male patients)who underwent joint arthroplasty in our hospital from September 2013 to April 2017.The average age was 68.09±9.98 years.There were 597 cases who underwent hip arthroplasty and 61 1 cases who underwent knee arthroplasty.Surgeries were performed by four experienced surgeons.A combination of pharmacological and mechanical thromboprophylaxis was used to prevent deep venous thrombosis after operation.All patients were examined by venography or ultrasonography at 3 to 5 days postoperatively.We collected patients’ demographic data,preoperative ejection fraction(EF),type of surgery,type of anticoagulants,diabetes mellitus,hypertension,heart disease history,stroke history,malignance history from medical records.In univariate analysis,Chi-square test,t-test or nonparametric Mann-Whitney U test was adopted respectively according to the type of variables.Logistic regression analysis was used for multivariate analysis.Results:In present study,1163 patients who underwent joint arthroplasty were enrolled.Among them,DVT was found in 143(12.3%)patients during hospitalization.The patients were divided into low ejection fraction group(EF<60%)and high ejection fraction group(EF<60%)according to the distribution of ejection fraction.Our results showed that the incidence of DVT in low ejection fraction group(18.6%)was significantly higher than that in high ejection fraction group(9.0%)(P<0.001).In knee arthroplasty group,595 patients(494 female and 101 male patients)were enrolled in our study,with an average age of 68.15+7.74 years.The prevalence of DVT was 15.6%(n=93).Low ejection fraction(OR=2.011,P=0.002)increased the risk of DVT postoperatively.However,the heart disease history(OR=0.76,P=0.383),coronary heart disease(OR=1.17,P=0.841)or arrhythmia(OR=2.52,P=0.115)were not risk factors of DVT.In the hip arthroplasty group,568 patients(346 female and 222 male cases)in our hospital were enrolled,with an average age of 68.02+11.88 years.The prevalence of DVT was 8.8%(n=5).Low ejection fraction(OR=2.24,P=0.014),gender(OR=0.37,P=0.007),age(OR=1.06,P=0.001)were risk factors for DVT postoperatively.The heart disease history(OR=0.69,P=0.408)including coronary heart disease(OR=1.46,P=0.64)and arrhythmia(OR=0.81,P=0.837)of the patients did not increase the risk of DVT after hip arthroplasty.Conclusion:Heart disease history is not a risk factor for lower extremities DVT after joint arthroplasty.Nevertheless,the low ejection fraction may increase the risk of DVT postoperatively.More effective measures shoud be taken for patients with lower ejection fraction to prevent low extremity deep vein thrombosis.