title: The incidence of pulmonary embolism and deep vein thrombosis and their predictive risk factors after lower extremity arthroplasty: a retrospective analysis based on diagnosis using multidetector CT.
abstract: OBJECTIVE
  The true incidence of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE) events, and the predictive risk factors are not well-defined in patients who undergo major lower extremity arthroplasty such as total hip arthroplasty (THA) or total or partial knee arthroplasty (TPKA). Using multidetector computed tomography (MDCT), pulmonary angiography (CTA), and MDCT venography (CTV), we investigated the prevalence of VTE and its predictive risk factors in patients for whom the guideline recommends prophylaxis.
  
  
  METHODS
  The electronic records of patients who underwent elective THA or TPKA at our institution from April 2010 through July 2013 were surveyed. We examined a total of 1,163 patient records for 986 patients who had undergone MDCT seven days after THA or TPKA.
  
  
  RESULTS
  No PE-related deaths occurred in this study, though arterial embolization was needed for major bleeding in two cases. CTA-CTV revealed VTE in 51 (4.4 %) patients, PE in 20 (1.7 %), and DVT in 43 (3.3 %). Five of 51 patients had symptoms suggestive of DVT. In the logistic regression model, the type of surgery (TPKA > THA), patient age, and body mass index (BMI) were identified as predictive risk factors for VTE.
  
  
  CONCLUSIONS
  This observational study showed that the overall incidence of VTE after THA and TPKA is 4.4 % in patients receiving recommended antithrombotic prophylaxis. TPKA is associated with a higher incidence of VTE than of THA, and greater BMI and older patient age are also independent risk factors.
authors.affiliation: Departments of Anesthesiology and ICM, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan, fujitay@med.kawasaki-m.ac.jp.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Fujita
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakatsuka
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Namba
authors.forename: Shigeru
authors.initials: S
authors.lastname: Mitani
authors.forename: Nami
authors.initials: N
authors.lastname: Yoshitake
authors.forename: Etsuko
authors.initials: E
authors.lastname: Sugimoto
authors.forename: Keita
authors.initials: K
authors.lastname: Hazama
mesh_terms: D000367:Age Factors; D000368:Aged; D001178:Arthroplasty / Q000009:adverse effects*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D015994:Incidence; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000517:prevention & control; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000517:prevention & control
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