Dataset Information

A prediction nomogram for deep venous thrombosis risk in patients undergoing primary total hip and knee arthroplasty: a retrospective study.

ABSTRACT:

Introduction

Deep venous thrombosis (DVT) prediction after total hip and knee arthroplasty remains challenging. Early diagnosis and treatment of DVT are crucial. This research aimed to develop a nomogram for early DVT prediction.

Methods

A total of 317 patients undergoing primary total hip and knee arthroplasty in Sun Yat-sen Memorial Hospital were enrolled between May 2020 and September 2022. Data from May 2020 to February 2022 were used as the development datasets to build the nomogram model (n = 238). Using multivariate logistic regression, independent variables and a nomogram for predicting the occurrence of DVT were identified. Datasets used to validate the model for internal validation ranged from March 2022 to September 2022 (n = 79). The nomogram's capacity for prediction was also compared with the Caprini score.

Results

For both the development and validation datasets, DVT was found in a total of 38 (15.97%) and 9 patients (11.39%) on post-operative day 7 (pod7), respectively. 59.6% patients were symptomatic DVT (leg swelling). The multivariate analysis revealed that surgical site (Knee vs. Hip), leg swelling and thrombin-antithrombin complex (TAT) were associated with DVT. The previously indicated variables were used to build the nomogram, and for the development and validation datasets, respectively. In development and validation datasets, the area under the receiver operating characteristic curve was 0.836 and 0.957, respectively. In both datasets, the predictive value of the Nomogram is greater than the Caprini score.

Conclusions

A proposed nomogram incorporating surgical site (Knee vs. Hip), leg swelling, and thrombin antithrombin complex (TAT) may facilitate the identification of patients who are more prone to develop DVT on pod7.

SUBMITTER: Lin Z

PROVIDER: S-EPMC10568791 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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Publications

A prediction nomogram for deep venous thrombosis risk in patients undergoing primary total hip and knee arthroplasty: a retrospective study.

Lin Zhencan Z Sun Hao H Li Deng D Cai Zhiqing Z Huang Zhencheng Z Liu Fangzhou F Chen Meiyi M Wang Yimin Y Xu Jie J Ma Ruofan R

Thrombosis journal 20231012 1

<h4>Introduction</h4>Deep venous thrombosis (DVT) prediction after total hip and knee arthroplasty remains challenging. Early diagnosis and treatment of DVT are crucial. This research aimed to develop a nomogram for early DVT prediction.<h4>Methods</h4>A total of 317 patients undergoing primary total hip and knee arthroplasty in Sun Yat-sen Memorial Hospital were enrolled between May 2020 and September 2022. Data from May 2020 to February 2022 were used as the development datasets to build the n ...[more]

PMID: 37828566

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Project description:ImportanceThe optimal pharmacologic thromboprophylaxis agent after total hip and total knee arthroplasty is uncertain and consensus is lacking. Quantifying the risk of postoperative venous thromboembolism (VTE) and bleeding and evaluating comparative effectiveness and safety of the thromboprophylaxis strategies can inform care.ObjectiveTo quantify risk factors for postoperative VTE and bleeding and compare patient outcomes among pharmacological thromboprophylaxis agents used after total hip and knee arthroplasty.Design, setting, and participantsThis retrospective cohort study used data from a large health care claims database. Participants included patients in the United States with hip or knee arthroplasty and continuous insurance enrollment 3 months prior to and following their surgical procedure. Patients were excluded if they received anticoagulation before surgery, received no postsurgical pharmacological thromboprophylaxis, or had multiple postsurgery thromboprophylactic agents. In a propensity-matched analysis, patients receiving a direct oral anticoagulant (DOAC) were matched with those receiving aspirin.ExposuresAspirin, apixaban, rivaroxaban, enoxaparin, or warfarin.Main outcomes and measuresThe primary outcome was 30-day cumulative incidence of postdischarge VTE. Other outcomes included postdischarge bleeding.ResultsAmong 29 264 patients included in the final cohort, 17 040 (58.2%) were female, 27 897 (95.2%) had inpatient admissions with median (IQR) length of stay of 2 (1-2) days, 10 948 (37.4%) underwent total hip arthroplasty, 18 316 (62.6%) underwent total knee arthroplasty; and median (IQR) age was 59 (55-63) years. At 30 days, cumulative incidence of VTE was 1.19% (95% CI, 1.06%-1.32%) and cumulative incidence of bleeding was 3.43% (95% CI, 3.22%-3.64%). In the multivariate analysis, leading risk factors associated with increased VTE risk included prior VTE history (odds ratio [OR], 5.94 [95% CI, 4.29-8.24]), a hereditary hypercoagulable state (OR, 2.64 [95% CI, 1.32-5.28]), knee arthroplasty (OR, 1.65 [95% CI, 1.29-2.10]), and male sex (OR, 1.34 [95% CI, 1.08-1.67]). In a propensity-matched cohort of 7844 DOAC-aspirin pairs, there was no significant difference in the risk of VTE in the first 30 days after the surgical procedure (OR, 1.14 [95% CI, 0.82-1.59]), but postoperative bleeding was more frequent in patients receiving DOACs (OR, 1.36 [95% CI, 1.13-1.62]).Conclusions and relevanceIn this cohort study of patients who underwent total hip or total knee arthroplasty, underlying patient risk factors, but not choice of aspirin or DOAC, were associated with postsurgical VTE. Postoperative bleeding rates were lower in patients prescribed aspirin. These results suggest that thromboprophylaxis strategies should be patient-centric and tailored to individual risk of thrombosis and bleeding.

Project description:ObjectivesTotal hip arthroplasty (THA) is classified as a high-risk surgery for venous thromboembolism (VTE) events, especially in elderly individuals and in cases of anemia. This study aims to uncover independent risk factors for predicting preoperative DVT in elderly anemic patients undergoing THA. Furthermore, it seeks to validate these factors' predictive efficacy in diagnosing DVT, with the goal of facilitating prompt identification and treatment to mitigate associated risks.MethodsClinical information and relevant laboratory test data of preoperative deep vein thrombosis (DVT) in 459 elderly patients with anemia who underwent total hip replacement surgery from January 2018 to June 2024 were retrospectively evaluated. Logistic regression analysis and backward stepwise method were used to detect independent predictors of preoperative DVT diagnosis in elderly patients with anemia who underwent total hip replacement surgery. A nomogram prediction model was established through multivariate logistic regression and subsequently utilized the testing group to validate.ResultsA multivariate logistic regression model was used to analyze the data, Hematocrit (HCT) (Odds ratio (OR) = 0.14, 95% confidence intervals (CI):[0.04,0.52]; P = 0.003), Albumin (ALB) (OR = 0.1, 95% CI:[0.03,0.37]; P = 0.001), Prothrombin Time (PT) (OR = 0.29, 95% CI:[0.1,0.83]; P = 0.02), Fibrin Degradation Products (FDP) (OR = 0.15, 95% CI:[0.05,0.49]; P = 0.002) and lymphocyte/Monocyte ratio (LMR) (OR = 0.28, 95% CI:[0.09,0.87], P = 0.028) were independent predictors for DVT before THA in elderly patients with anemia. The area under the curve (AUC) scores were 0.929 for the training group and 0.896 for the testing group, with calibration curve mean errors of 0.017 and 0.023, respectively. The decision curve analysis (DCA) graph indicates that the developed nomogram was highly practical and advantageous for clinical application.ConclusionThe independent predictors of preoperative DVT in elderly anemic patients undergoing total hip replacement primarily include HCT, ALB, PT, FDP, and LMR at admission, which are easy to obtain and can quickly yield results. Moreover, the nomogram based on HCT, ALB, PT, FDP, and LMR can help clinical doctors evaluate the possibility of DVT formation, thereby accurately and quickly assisting clinical doctors in making better clinical judgments.

Dataset Information

A prediction nomogram for deep venous thrombosis risk in patients undergoing primary total hip and knee arthroplasty: a retrospective study.

Introduction

Methods

Results

Conclusions

Publications

A prediction nomogram for deep venous thrombosis risk in patients undergoing primary total hip and knee arthroplasty: a retrospective study.

Similar Datasets

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