Original Article
Perioperative Thromboprophylaxis Is Associated With Lower Risk of Venous Thromboembolism After Knee Arthroscopy

https://doi.org/10.1016/j.arthro.2022.06.034Get rights and content

Purpose

To determine the rate of symptomatic venous thromboembolism (VTE) among patients undergoing arthroscopic knee procedures, risk factors associated with postoperative VTE, and current perioperative thromboprophylaxis prescription patterns associated with this population in the United States.

Methods

Medical records for patients ≥18 years of age were queried from the Mariner database using Current Procedural Terminology codes for knee arthroscopy performed in the United States from 2010 to 2020 in this cross-sectional study. Patients who received thromboprophylaxis and those diagnosed with VTE, including deep-vein thrombosis or pulmonary embolism, within 90 days of surgery were identified using International Classification of Diseases and National Drug Codes. Two multivariable logistic regression models were used to identify VTE risk factors and likelihood of perioperative thromboprophylaxis. Covariates included procedure type, age, oral contraceptive pill (OCP) use, and medical comorbidities.

Results

A total of 718,289 patients met inclusion criteria and 7,618 patients (1.06%) experienced VTE, including deep-vein thrombosis (n = 6,394, 0.9%) and/or pulmonary embolism (n = 2,211, 0.3%). A total of 10,769 patients (1.5%) filled perioperative thromboprophylaxis, including aspirin (n = 5,353, 0.7%), low-molecular-weight heparin (n = 4,563, 0.6%), and oral factor Xa inhibitors (n = 947, 0.1%). Perioperative thromboprophylaxis was associated with decreased odds of experiencing VTE (adjusted odds ratio [aOR] 0.65, 95% confidence interval [CI] 0.51-0.80). Procedure types categorized as moderate-to-greater risk were associated with increased odds of VTE (aOR 1.42, 95% CI 1.34-1.50). OCP use (aOR 1.63, 95% CI 1.38-1.91), obesity (aOR 1.17, 95% CI 1.11-1.24), renal disease (aOR 1.33, 95% CI 1.18-1.50) and congestive heart failure (aOR 1.30, 95% CI 1.13-1.50) were associated with increased odds of VTE.

Conclusions

While the overall rate of symptomatic VTE following knee arthroscopy remains low, procedure types that are more complex and generally require restrictive rehabilitation protocols, OCP use, obesity, renal disease, and congestive heart failure are associated with increased odds of postoperative VTE. Conversely, the use of perioperative thromboprophylaxis is associated with significantly lower VTE risk.

Level of Evidence

III, retrospective comparative prognostic trial.

Section snippets

Database

This retrospective cross-sectional study used the Mariner Patient Records Database (www.pearldiver.com, Colorado Springs, CO), a subscription-based health records dataset. The Mariner dataset is publicly available and contains more than 100 million records from 2010 through 2020 for orthopaedic patients insured through private agencies, Medicare, Medicaid, and self-pay populations. Patient records can be queried using Current Procedural Terminology (CPT) codes and International Classification

Results

A total of 718,289 patients met inclusion criteria. Approximately 28,311 patients were excluded for a previous diagnosis of VTE, hypercoagulable disorder, or surgical procedure for infection or concurrent fracture. Patient demographics are shown in Table 2. A total of 10,769 (1.5%) patients were prescribed and filled prescriptions for perioperative thromboprophylaxis, including aspirin (n = 5,353, 0.7%), LMWH (n = 4,563, 0.6%) or factor Xa inhibitors (apixaban only) (n = 947, 0.1%). A total of

Discussion

In this large, population-based study, we observed an overall rate of symptomatic VTE of 1.06% within 90 days after arthroscopic knee surgery. Procedure type and complexity was significantly associated with the rate of postoperative symptomatic VTE. The risk of experiencing postoperative VTE was also significantly impacted by OCP use and medical comorbidities, including obesity, renal disease and CHF. Furthermore, we found that patients who receive and fill perioperative thromboprophylaxis

Conclusions

While the overall rate of symptomatic VTE following knee arthroscopy remains low, procedure types that are more complex and generally require restrictive rehabilitation protocols, OCP use, obesity, renal disease, and CHF are associated with increased odds of postoperative VTE. Conversely, the use of perioperative thromboprophylaxis is associated with significantly lower VTE risk.

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  • Cited by (5)

    See commentary on page 3192

    The authors report the following potential conflicts of interest or sources of funding: A.L.Z. reported consultant for Stryker and DePuy Mitek, outside the submitted work. C.B.M. reported consultant for Stryker, Conmed, and Tornier; grants from Aesculap, Samumed, Zimmer, and Conmed; and royalties from Conmed, outside the submitted work. B.T.F. reported grants/grants pending from National Institutes of Health and Orthopaedic Research and Education Foundation; suture anchor patent pending; and stock/stock options from Bioniks and Kaliber AI, outside the submitted work. D.A.L. reports consultant for Vericel and AlloSource; grants from AANA, American Orthopaedic Society for Sports Medicine (AOSSM), Arthritis Foundation, AANA – Arthroscopy Research Grant; AOSSM – Young Investigator Award, Arthritis Foundation – research funding outside the submitted work; and patent pending for suture anchor device, outside the submitted work. ICMJE author disclosure forms are available for this article online, as supplementary material.

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