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Thromb Haemost 2005; 93(05): 860-866
DOI: 10.1160/TH04-11-0769
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Fatal vascular outcomes following major orthopedic surgery

Ola E. Dahl
1   Thrombosis Research Institute, London, United Kingdom
,
Joseph A. Caprini
2   Department of Surgery, Evanston Northwestern Healthcare, Evanston, USA
,
Clifford W. Colwell Jr.
3   Department of Orthopedic Surgery, Scripps Clinic, La Jolla, USA
,
Simon P. Frostick
4   Department of Musculoskeletal Science, Royal Liverpool University Hospital, Liverpool, United Kingdom
,
Sylvia Haas
5   Technische Universität München, München, Germany
,
Russell D. Hull
6   Thrombosis Research Unit, University of Calgary, Calgary, Canada
,
Sylvie Laporte
7   Thrombosis Research Group, Clinical Pharmacology Department, University Hospital Bellevue, Saint-Etienne, France
,
Paul D. Stein
8   St. Joseph Mercy Oakland Hospital, Pontiac, Michigan, USA
› Author Affiliations
Further Information

Publication History

Received 29 November 2004

Accepted after resubmission 23 February 2005

Publication Date:
11 December 2017 (online)

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Summary

Major orthopedic surgery is known to be associated with potentially serious arterial and venous vascular complications, although uncertainty exists about current event rates. Using electronic databases and investigator contact, we identified randomized and cohort studies reporting overall mortality and fatal vascular events. Where possible, studies reporting high autopsy rates (>60%) were examined. Pooled incidences were calculated from eligible studies. For Autopsy studies: Pooled overall mortality and fatal pulmonary embolism for patients undergoing elective hip and knee replacement without prophylaxis could not be calculated, while with prophylaxis they were 0.44% (95% confidence interval 0.02 to 0.87%) and 0.43% (0.01 to 0.85%). For patients undergoing hip fracture surgery, the corresponding rates without prophylaxis were 15.9% (14.5 to 17.3%) and 1.9% (1.4 to 2.4%). With prophylaxis, mortality and fatal pulmonary embolism rates were 8.5% (7.3 to 9.7%) and 1.0% (0.6 to 1.5%). Among Cohort studies: Pooled overall mortality and fatal pulmonary embolism for patients undergoing elective hip and knee replacement without prophylaxis were 0.93% (0.57 to 1.29%) and 0.36% (0.14 to 0.59%). For patients receiving prophylaxis (7 to 14 days), mortality and fatal pulmonary embolism were 0.57% (0.51 to 0.62%) and 0.18% (0.14 to 0.21%). Patients undergoing hip fracture surgery receiving prophylaxis had mortality and fatal pulmonary embolism rates of 3.2% (2.8 to 3.6%) and 0.30% (0 to 0.61%). Vascular events contributed towards approximately 50% of all deaths with similar proportions due to ischemic heart disease, cardiac failure and pulmonary embolism. In conclusion, although prophylaxis results in a reduction in overall mortality and fatal pulmonary embolism, vascular events continue to be a common cause of mortality.

Keywords

Orthopedic surgery - prophylaxis - fatal vascular outcomes
 

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