Analysis Of Risk Factors Of Postoperative Deep Venous Thrombosis In Patients With Intertrochanteric Femur Fractures

Objective This paper retrospectively studied the clinical data of patients with intertrochanteric fracture of femur,including patients’ general date,internal diseases,anesthetic methods,surgical conditions,preoperative blood routine indexes,preoperative blood coagulation indexes.To analyze the risk factors of deep vein thrombosis(DVT)after operation in patients with intertrochanteric fracture of femur.These factors are conducive to initial screening of patients at risk of DVT,and provide theoretical basis for individualized risk assessment and targeted prevention in clinical practice.Method A retrospective study was conducted to analyze the data of 216 patients with intertrochanteric fracture of femur admitted to the Department of Orthopedics,Affiliated Hospital of Hebei University from October 2016 to October 2019.There were 103 males(48%)and 113 females(52%),aged 70.3±12.8 years.According to the postoperative ultrasonography results,the patients were divided into DVT group and non-DVT group.Data were collected on patients’ age,gender,Body mass index(BMI),medical diseases,fracture classification(AO classification),American Society of Anesthesiologists(ASA)classification,anesthesia methods,the time from fracture to surgery,operation time,intraoperative blood loss,hemoglobin(HGB),white blood cell(WBC),neutrophils(NEUT),platelet(PLT),Activated partial thromboplastin time(APTT),Prothrombin time-international normalized ratio(PTINR),fibrinogen(FIB).Univariate analysis was used to screen for risk factors.Multivariate Logistic regression analysis was used to determine independent risk factors.Significant independent risk factors were determined by receiver operating characteristic(ROC)curve,and obtained the diagnostic thresholds of each influencing factors.Results The incidence of postoperative DVT of patients with femoral intertrochanteric fractures is 29.9%.The main type of DVT was distal DVT,accounted for 61.9% of DVT after surgery.No fatal pulmonary embolism occurred.The univariate analysis showed significant differences between the DVT group and non-DVT group in terms of age,the time from fracture to surgery,HGB,NEUT,PT-INR,FIB(P<0.05).There were no statistical differences between the DVT group and non-DVT group in terms of gender,BMI,combined diseases,fracture classification(AO classification),American Society of Anesthesiologists(ASA)classification,anesthesia,operation time,intraoperative blood loss,WBC,PLT,APTT.Multivariate analysis results showed age(OR=1.129,95%CI=1.052～1.212,P<0.01),HGB(OR=0.91,95%CI=0.879～0.943,P<0.01),NEUT(OR=1.575,95%CI=1.265～1.961,P<0.01),PT-INR(OR=0.030,95%CI=0.002～0.369,P<0.01)were independent risk factors for postoperative DVT of patients with femoral intertrochanteric fractures.Receiver operating characteristic(ROC)curve showed that when the diagnostic threshold of age is 72.5 years,the area under curve is the largest,which is 0.732.At this time,the sensitivity occupied 63.5% and the specificity occupied 73.2%.When the diagnostic threshold of HGB is 105.1 g/L,the area under curve is the largest,which is 0.794.At this time,the sensitivity occupied 85.0% and the specificity occupied 61.9%.When the diagnostic threshold of NEUT is 6.05×109/L,the area under curve is the largest,which is 0.793.At this time,the sensitivity occupied 76.2% and the specificity occupied 71.2%.When the diagnostic threshold of PT-INR is 1.02,the area under curve is the largest,which is 0.742.At this time,the sensitivity occupied 79.1% and the specificity occupied 61.9%.Conclusion The postoperative DVT rates of patients with intertrochanteric fracture is higher,distal DVT is the main type of thrombosis.Age ≥ 72.5 years,HGB≤105.1 g/L,NEUT≥6.05x109/L,PT-INR≤1.02 were the independent risk factors for postoperative DVT of patients with femoral intertrochanteric fractures,we should to guard against the occurrence of DVT.