title: Risk of venous thromboembolism after total hip and knee replacement in older adults with comorbidity and co-occurring comorbidities in the Nationwide Inpatient Sample (2003-2006).
abstract: BACKGROUND
  Venous thromboembolism is a common, fatal, and costly injury which complicates major surgery in older adults. The American College of Chest Physicians recommends high potency prophylaxis regimens for individuals undergoing total hip or knee replacement (THR or TKR), but surgeons are reluctant to prescribe them due to fear of excess bleeding. Identifying a high risk cohort such as older adults with comorbidities and co-occurring comorbidities who might benefit most from high potency prophylaxis would improve how we currently perform preoperative assessment.
  
  
  METHODS
  Using the Nationwide Inpatient Sample, we identified older adults who underwent THR or TKR in the U.S. between 2003 and 2006. Our outcome was VTE, including any pulmonary embolus or deep venous thrombosis. We performed multivariate logistic regression analyses to assess the effects of comorbidities on VTE occurrence. Comorbidities under consideration included coronary artery disease, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, and cerebrovascular disease. We also examined the impact of co-occurring comorbidities on VTE rates.
  
  
  RESULTS
  CHF increased odds of VTE in both the THR cohort (OR = 3.08 95% CI 2.05-4.65) and TKR cohort (OR = 2.47 95% CI 1.95-3.14). COPD led to a 50% increase in odds in the TKR cohort (OR = 1.49 95% CI 1.31-1.70). The data did not support synergistic effect of co-occurring comorbidities with respect to VTE occurrence.
  
  
  CONCLUSIONS
  Older adults with CHF undergoing THR or TKR and with COPD undergoing TKR are at increased risk of VTE. If confirmed in other datasets, these older adults may benefit from higher potency prophylaxis.
authors.affiliation: Hospital Medicine Unit, Boston University School of Medicine, 715 Albany Street, Boston, MA 02118, USA. alok.kapoor@bmc.org
authors.forename: Alok
authors.initials: A
authors.lastname: Kapoor
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Labonte
authors.forename: Michael R
authors.initials: MR
authors.lastname: Winter
authors.forename: Jodi B
authors.initials: JB
authors.lastname: Segal
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Silliman
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.forename: Dan
authors.initials: D
authors.lastname: Berlowitz
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D014481:United States; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology