title: Venous thromboembolism after surgical treatment of non-spinal skeletal metastases - An underdiagnosed complication.
abstract: OBJECTIVE
  Venous thromboembolism (VTE) is a severe complication associated both with major orthopaedic surgery and cancer. However, survival and postoperative complications of skeletal metastases despite their thrombogenic potential, have received little attention in both the clinical management and research setting. This single-centre observational cohort study aimed to evaluate the incidence and impact of VTE in association with cancer surgery targeted to the management of fractures secondary to skeletal metastases.
  
  
  METHODS
  Data were collected retrospectively from the medical database. We included consecutive 306 patients operated for 343 non-spinal skeletal metastases during a 15-year period (1999-2014). The incidence of VTE and its risk factors were assessed using binary logistic regression analysis. Kaplan-Meier and Cox regression analyses were used to evaluate variables affecting survival.
  
  
  RESULTS
  The rate of symptomatic VTE was 10% (30/306) during the 3-month postoperative period, while 79% received thromboprophylaxis. Fatal pulmonary embolism (PE) rate was high, 3.3% (10/306) after surgery. Intraoperative oxygen saturation drop, pulmonary metastases and intramedullary nailing were independent risk factors for VTE. Indicators of decreased survival were lung cancer, intramedullary nailing, multiple skeletal and pulmonary metastases, anaemia, leukocytosis, and PE.
  
  
  CONCLUSIONS
  Relationship between fractures secondary to skeletal metastases and VTE needs further clinical attention. Whether the survival of patients with fractures secondary to skeletal metastases can be improved by targeted thromboprophylactic means should be studied further.
authors.affiliation: Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, 33521 Tampere, Finland; Department of Hand Surgery, Helsinki University Central Hospital, 00260 Helsinki, Finland.
authors.forename: Maire
authors.initials: M
authors.lastname: Ratasvuori
authors.affiliation: Department of Hematology, Coagulation Disorders Unit, Cancer Center HUSLAB and Clinical Chemistry, Helsinki University Hospital and University of Helsinki, 00290 Helsinki, Finland.
authors.forename: Riitta
authors.initials: R
authors.lastname: Lassila
authors.affiliation: Department of Orthopaedics, Unit of Musculoskeletal Surgery, Tampere University Hospital, 33521 Tampere, Finland; Coxa Hospital for Joint Replacement, 33520 Tampere, Finland. Electronic address: minna.laitinen@pshp.fi.
authors.forename: Minna
authors.initials: M
authors.lastname: Laitinen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000556:secondary* / Q000601:surgery*; D001842:Bone and Bones / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D011655:Pulmonary Embolism / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000209:etiology*; D055815:Young Adult
keywords: Metastasis; Orthopaedic surgery; Pulmonary embolism; Survival; Venous thromboembolism