title: Early thromboembolic events ≤1week after fast-track total hip and knee arthroplasty.
abstract: BACKGROUND
  Thromboembolic events (TEE) are serious complications after total hip (THA) and knee arthroplasty (TKA), with reported in-hospital incidences of about 0.5-1% for venous thromboembolic events (VTE) and 0.2% for myocardial infarctions (MI) and stroke. However, little data exist on in-hospital TEE when using a standardized fast-track protocol with early mobilization.
  
  
  METHODS
  A large detailed cohort study in primary unilateral THA and TKAs on "early" (in-hospital or after discharge but within 1week of surgery) and 30-days TEEs, including prospective recording of patient characteristics, complete follow-up through the Danish National Patient Register, and detailed evaluation on disposing factors and consequences of "early" TEEs through review of medical records.
  
  
  RESULTS
  In 13,775 procedures with a median LOS of 2days, 43 (0.32%; 95% CI: 0.23-0.42) "early" and 90 (0.65%; 95% CI: 0.53-0.80) 30-day TEEs were recorded. "Early" TEEs consisted of 9 (0.07%; 95% CI: 0.04-0.13) MI, 10 (0.08% 95% CI: 0.04-0.13) strokes, 13 (0.09%; 95% CI: 0.05-0.16) pulmonary embolisms and 11 (0.08%; 95% CI: 0.04-0.15) deep venous thromboses. Most TEEs were in patients with irreversible dispositions (e.g. previous TEE, high age and cardiac disease), but 5 of 9 MIs were associated with postoperative anemia. All in-hospital VTE (n: 16) occurred while patients received recommended thromboprophylaxis.
  
  
  CONCLUSIONS
  Incidence of "early" TEEs after fast-track THA and THA is low, but MIs may be further reduced by improving perioperative treatment of anemia. Further research is needed regarding interventions for prevention of "early" TEE in disposed patients.
authors.affiliation: Section for Surgical Pathophysiology, 4074, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Denmark. Electronic address: christoffer.calov.joergensen@regionh.dk.
authors.forename: Christoffer C
authors.initials: CC
authors.lastname: Jørgensen
authors.affiliation: Section for Surgical Pathophysiology, 4074, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
authors.affiliation: Section for Surgical Pathophysiology, 4074, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Denmark.
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D004434:Early Ambulation / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000209:etiology* / Q000517:prevention & control; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D020246:Venous Thrombosis / Q000209:etiology* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants
keywords: Arthroplasty; Fast-track; Myocardial infarction; Stroke; Surgical outcomes; Thromboembolism