Analysis of Perioperative Risk Factors for Deep Vein Thrombosis in Patients With Femoral and Pelvic Fractures

DOI: https://doi.org/10.21203/rs.3.rs-74152/v1

Abstract

Objective: Clinical characteristics, anticoagulant protocols and risk factors of deep Vein thrombosis (DVT) in patients with femoral and pelvic fractures were analyzed throughout the perioperative period to provide references for early identification and optimization of risk factors.

Methods: This was a retrospective study. A total of 569 patients undergoing surgery of femoral and pelvic fractures from May 2018 to December 2019 were included.

The Clinical data including general conditions,trauma, surgery,anticoagulant protocols and laboratory indexes were collected.According to the results of deep vein Doppler ultrasonography of the lower extremities, the patients were divided into non-DVT group and DVT group.Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors of preoperative and postoperative DVT.

Results: The incidence of DVT was 40.25%, PE was 1.93%, and preoperative DVT was 26.71%,which was higher than the incidence of postoperative DVT of 17.22%. Most of them were thrombus on the affected side (60.26%) and distal thrombus (81.66%).The average time of DVT formation was 6.55±0.47 days after trauma and 6.67±0.48 days after surgery. Chronic obstructive pulmonary disease(COPD), anemia, hypoproteinemia, non-anticoagulation before surgery, delayed anticoagulation after trauma and admission, high energy trauma, multiple injuries, drinking history, and advanced age were independent risk factors for perioperative DVT.The increased level of fibrinogen degradation products was an independent risk factor for preoperative DVT. These risk factors were identified to be independently associated with postoperative DVT, including intraoperative blood transfusion, postoperative blood transfusion, pulmonary infection, preoperative non-anticoagulation, postoperative delayed anticoagulation, preoperative waiting time > 7d, operative time > 2h, c-reactive protein, fibrinogen level, platelet count 1 day after surgery, c-reactive protein, fibrinogen, and hemoglobin levels 3 days after surgery, comminuted fracture.

Conclusions: At present, anticoagulation and other DVT prevention and treatment programs have not changed the current situation that the incidence of DVT is still high. Through the analysis of the risk factors of DVT throughout the perioperative period, optimizing the perioperative blood transfusion, preoperative lung disease, hypoproteinemia, anemia, inflammation, etc., and surgery as soon as possible after trauma may further reduce its incidence.

Introduction

Most of the patients with femoral and pelvic fractures are at high risk of Venous thromboembolism(VTE) due to hypercoagulable state[1], trauma and surgical injury, prolonged immobilization and edema of surrounding tissues,for example, the incidence of preoperative DVT and the postoperative DVT in femoral neck fracture was 32% and 56% respectively[2].Previous studies focused more on the analysis and prevention of DVT risk factors after fracture surgery, and less on the analysis of risk factors during the whole perioperative period, including pre-operation,intro-operation and post-operation.For example, the influence of preoperative risk factors including chronic obstructive pulmonary disease, pulmonary infection, hypoproteinemia and perioperative blood transfusion on the occurrence and development of DVT. Secondly, anticoagulation therapy, early activities, and lower extremity pneumatic therapy are the main measures for the prevention and treatment of DVT. Although the incidence of DVT during the perioperative period of femoral and pelvic fractures has been reduced to a certain extent, it has not changed the current status of the high incidence of DVT. Therefore, routine anticoagulant regimens may not be appropriate for preventing fractures in patients with different thrombotic risks.

Therefore, we further analyzed the clinical characteristics and risk factors of DVT in patients with femoral and pelvic fractures, so as to provide reference for early identification and optimization of risk factors and the development of individual anticoagulation protocols, so as to reduce the incidence of perioperative DVT.

Materials And Methods

This study has been approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (2019-277) and registered in the World Health Organization International Clinical Trial (ChiCTR2000035103).

Inclusion and exclusion criteria

Inclusion criteria were patients aged 18 years or older, traumatic fracture,definite diagnosis of femoral and pelvic fractures, surgical treatment, and complete data available in medical records. Exclusion criteria were patients combined with diseases of the blood system or coagulation disorders,long-term use of anticoagulant drugs,vascular surgery,the pregnancy.

Diagnosis of DVT

After admission, C5-1 linear probes,IU22 system (Philips ATL, Bothwell, WA, USA) was used to perform pulse Doppler ultrasound examinations on the lower limbs of the patients.The diagnostic criteria of DVT are incompressibility of vein, filling defect of cavity and lack of Doppler signal.Routine scanning was performed for the femoral common vein, superficial and deep femoral vein, popliteal vein, posterior and an-terior tibial vein,peroneal vein of bilateral lower ex-tremities and intermuscular vein thrombosis.

Research methods

A total of 569 patients with femoral and pelvic fractures who received surgical treatment in our hospital from May 2018 to December 2019 were included.There were 417 males and 152 females, with an average age of 69.6±19.1 years (20-112 years).The subjects included 249 cases of femoral neck fracture, 166 cases of intertrochanteric fracture, 60 cases of femoral shaft fracture, 67 cases of pelvic fracture, and 27 cases of acetabular fracture.After admission, deep vein Doppler ultrasonography of both lower extremities was performed.According to the examination time and results, the patients were divided into preoperative and postoperative non-DVT groups and DVT groups, in order to analyze the risk factors of preoperative and postoperative DVT.The postoperative DVT group included new thrombus formed after surgery or preoperative thrombus progressed after surgery.

Data collection

We collected clinical data of patients through the electronic medical record system, anesthesia system.The formation time, location and thrombosis type of DVT were collected.The distal thrombosis is defined as a thrombus that occurs beyond the popliteal vein, proximal thrombus is a popliteal vein and thrombus near the popliteal vein, both proximal and distal thrombus are mixed thrombus.Basic information such as sex, age, and body mass index (BMI). Complications including smoking history, drinking history, cerebral infarction, diabetes, hypertension, coronary heart disease, hyperlipidemia, liver disease, kidney disease, lung infections, respiratory failure, pulmonary malignant tumor, chronic obstructive pulmonary disease (COPD), hypoproteinemia, anemia, malignant tumor.Trauma and surgery-related conditions included traumatic factors (low-energy or high-energy trauma), multiple injuries, shock, fracture site, open fracture, comminuted fracture, barotherapy, time from trauma to hospital, waiting time before surgery (time from trauma to operation), preoperative blood transfusion, operation time, method of anesthesia, American Society of Anesthesiologists (ASA) , anesthesia type,use of tranexamic acid, tourniquet, intraoperative blood loss, blood transfusion, central venous catheterization, postoperative blood transfusion, postoperative analgesia.Anticoagulation treatment included preoperative anticoagulation (the time from trauma to anticoagulation, time to start anticoagulation after admission, whether to interrupt, time to stop anticoagulation), postoperative anticoagulation (time to start anticoagulation, whether to interrupt).The delayed anticoagulation time was > 24h from trauma to the beginning of anticoagulation.The laboratory indicators collected at admission, 1 day after operation, and 3 days after operation including c-reactive protein (CRP) level, serum creatinine (Crea) level, serum urea level, prothrombin time (PT) level, prothrombin time ratio (PTR) level, international normalized ratio (INR) level , thrombin Original activity (PTA) level , activated partial thromboplastin time (APTT) level , thrombin time (TT) level, fibrinogen (Fbg) level, D dimer (DD) level, fibrinogen degradation products (FDP) level, white blood cell (WBC) count, hemoglobin (Hb) level, platelet count (PLT), neutrophil percentage (NEUT%), lymphocyte percentage (LYM%), lactic acid (lac) level.

Statistical analysis

SPSS23.0 was used to perform all the tests (IBM,Armonk, New York, USA).The enumeration data were expressed as number and percentage (%) and were evaluated by chi-square or Fisher’s exact test. Shapiro-wilk test was used to determine whether the measurement data were normally distributed.Independent sample T test was used for measurement data conforming to normal distribution, and the results were expressed as mean ± standard deviation (x±s).Measurement data of non-normal distribution were tested by Mann-Whitney U test, and the results were expressed as median (quartile) [M (Q1,Q3)].Variables with statistical significance in univariate analysis were included in multivariate logistic regression analysis to determine independent risk factors. The statistical test level was set as p < 0.05.

Results

Clinical characteristics of DVT

Incidence of DVT

Table 1 presented the incidence of perioperative DVT.The total incidence of DVT was 40.25% (229/569),152 patients had thrombosis before surgery, of which 21 patients had thrombosis progressed after surgery,77 patients had newly formed thrombus after operation.The incidence of pulmonary embolism (PE) was 1.93% (11/569),implantation of inferior vena cava filter was performed in 4.57% (26/569) of patients.The average preoperative DVT formation time was 6.55±0.47 days (1-30 days) after the trauma and 6.67±0.48 days (2-28 days) after the surgery.

Dynamic Changes of DVT Types during Perioperative period

The perioperative changes of DVT types in 229 patients were shown in Figure 1. The incidence of distal, proximal and mixed thrombus was 14.85%, 3.49% and 81.66%, respectively. Among the 11 PE patients, 54.55% (6/11) complicated with distal thrombus, 18.18% (2/11) complicated with proximal thrombus, and 27.27% (3/11) complicated with mixed thrombus. The thrombosis type changed in 11.21% (13/116) of the 116 patients with intercalf muscle vein thrombosis.

Preoperative DVT Risk in Patients With Femoral and Pelvic Fractures

The preoperative DVT incidence rate was 26.71% (152/569).The univariate analysis results of general conditions,trauma, surgery,anticoagulant protocols of patients in the non-DVT group and DVT group were shown in Figure 2a-2b. The univariate analysis results of the laboratory indexes were shown in Table 2.The results showed that there were no significant differences between the two groups in gender, smoking history, preoperative blood transfusion, open fracture, shock, liver disease, lymphocyte percentage, etc. (P > 0.05).Compared with the non-DVT group, there were statistically significant differences in preoperative non-anticoagulation (P= 0.000), multiple injuries (P= 0.000), high energy trauma (P=0.003), age > 60 years old (P= 0.047), BMI > 18kg/m2(P=0.041), and drinking history (P= 0.001).

Multivariate logistic regression analysis was performed on variables with P < 0.05 (Figure 3), and the results showed that Preoperative non-anticoagulation, time from trauma to anticoagulation, anticoagulation after admission, COPD, hypoproteinemia, anemia, high energy trauma, drinking history,advanced age, and elevated FDP level were independent risk factors for preoperative DVT.

Postoperative DVT Risk in Patients With Femoral and Pelvic Fractures

The incidence of postoperative DVT was 17.22% (98/569), 98.59% (561/569) patients underwent general anesthesia.The univariate analysis results between the two groups included comorbidities, trauma (Figure 4a-4b), blood routine, biochemical indicators (Table 3a), and coagulation indicators (Table 3b).Multivariate Logistic regression analysis results (Figure 5a-5b) showed that delayed anticoagulation, lung infection, COPD, waiting for more than 7 days before surgery, anemia, hypoproteinemia, high energy trauma, multiple injuries, comminuted fractures, history of drinking,CRP and Fbg levels on the first day after surgery,HB, CRP and Fbg levels on the 3rd day after surgery were independent risk factors for DVT in Patients With Femoral and Pelvic Fractures (P<0.05). The risk of DVT in patients with intraoperative blood transfusion and postoperative blood transfusion increased to 1.46 times and 2.07 times, respectively.The use of nerve block analgesia, tranexamic acid, and barotherapy were protective factors.

Discussion

In recent years, many literatures have reported the incidence of perioperative DVT in fracture patients, and there are differences in the incidence of DVT in different regions, races and populations.The incidence of VTE after total knee arthroplasty was 20.67% in the United States after aspirin and barotherapy with multimodal prophylaxis[3].Yukizawa,s prospective, single-center study reported that the preoperative and postoperative VTE rates of 419 total hip replacement patients in Japan were 11.4% and 10.5%, respectively[4].However,a retrospective study of 1825 lower limb fractures in China found that the preoperative and postoperative DVT rates were 30.0% and 43.4%, respectively[5].The results showed that the incidence of DVT before and after femoral and pelvic fractures was 26.71% and 17.22%, respectively.Currently, the incidence of DVT in fracture patients has not been significantly reduced by "more aggressive" anticoagulant regimens.

Drug prevention is the main measure for the prevention and treatment of DVT, but there are controversies about the indications, drug selection, starting and ending time, safety and effectiveness of anticoagulation.The results of this study showed that the risk of DVT increased to 2.31-fold in patients with femoral and pelvic fractures without anticoagulation before surgery.Contrary to Lius conclusion, preoperative anticoagulation in patients with hip fractures does not significantly reduce the risk of postoperative DVT or PE[6].Haut et al. found that approximately 50% of VTE occured in patients receiving "optimal prevention[7].Many problems of anticoagulation are still inconclusivet, but it is still advocated that anticoagulation should be actively used in patients with high risk of perioperative bone trauma who have no anticoagulation contraindications.As for the timing of preventive anticoagulation, our results were consistent with Xia[8].Delayed anticoagulation 24 h after trauma was positively correlated with the occurrence of VTE, and the correlation between the two was more significant when the delayed anticoagulation time exceeded 48 h.In this study, it was found that delayed anticoagulation over 24 h and 48 h after trauma was 1.80 times and 2.65 times of the risk of DVT before surgery and 1.61 times and 2.09 times of the risk of DVT after surgery, respectively, in patients with early anticoagulation.We further found that 12–24 h, 24–72 h, and > 72 h after admission were 1.31 times, 2.01 times, and 2.02 times of the risk of DVT before anticoagulation in the patients within 12 h after admission, respectively.The risk of postoperative DVT was 1.38 times, 2.20 times and 2.18 times.The early stage of trauma patients is hypercoagulable, and early anticoagulation after admission without contraindications can reduce the risk of DVT.Interruption of preventive anticoagulation is common in trauma and in patients undergoing major surgery, and is associated with patient rejection, surgical timing, and nursing errors.Louis et al. confirmed that anticoagulation interruption is an independent risk factor for DVT in trauma patients aged ≥ 50 years[9].However, we found no correlation between anticoagulation interruption and DVT, which may be related to the risk of bleeding associated with anticoagulation interruption in this study.For patients hospitalized for total knee and hip replacement within 5 days, Samama, Petersen and other large-sample, multi-center studies have confirmed that anticoagulation in these patients is safe only in the hospital[10, 11].However, there are few studies on the timing of anticoagulation after surgery. This study found that 12–24 h and 24 h after surgery were 1.78 times and 1.65 times of the risk of DVT in patients who started anticoagulation within 12 h after surgery, respectively.Therefore, starting anticoagulation within 12 h after surgery can reduce the risk of DVT, but the benefits of early anticoagulation after surgery should be weighed against the increased risk of bleeding.

Among fracture patients, the current routine anticoagulant regimens are used for the prevention and treatment of DVT in patients with different risks, which does not change the current situation that the incidence of DVT is still relatively high.It is particularly important to further clarify independent risk factors for DVT to identify high risk groups.The occurrence of DVT was significantly correlated with the fracture site. Similar to the results of Adam and Zhang[12, 13], the incidence of hip fracture (74.90%) was relatively high. Considering that the three risk factors of Virchow were mostly present in the patients with hip fracture[14].We should pay attention to the screening of DVT in these patients with fractures at specific sites, and formulate reasonable individualized prevention and treatment strategies.Meizoso et al. used RAP score in a retrospective cohort study of 1233 trauma patients and found that transfusion of more than 4 units was an independent risk factor for DVT[15].The preoperative, intraoperative and postoperative blood transfusion rates of 569 patients in this study were 8.44% (48/569), 29.70% (169/569), and 13.88% (79/569), respectively.It was further found that intraoperative blood transfusion and postoperative blood transfusion were independent risk factors for postoperative DVT, while preoperative blood transfusion was not correlated with DVT.Perhaps we should reconsider the indications and necessity of blood transfusion in practice.Song et al. reported that most patients with postoperative DVT had complicated DVT before surgery[16],In this study, preoperative DVT occurred in 26.71% of the patients, which was considered to be related to the longer average preoperative waiting time.Most of the current recommendations are that surgery should be performed as soon as possible within 48 hours after trauma to reduce the incidence of VTE[17].But in practice, 66 percent of patients with hip fractures delayed surgery[18].The reasons for delayed surgery may be as follows. 67.66% (385/569) of the patients were transferred to our hospital from other hospitals due to serious illness or limited medical conditions.Preoperative preparation for patients with medical diseases and routine preoperative examinations such as DVT screening will also delay surgery.Recently, Luksameearunothai et al. confirmed that Caprini score ≥ 12 points should be used for preoperative ultrasound examination in elderly patients with hip fracture and patients with Wells score ≤ 1 points can be safely operated immediately[19].There is a conflict between adequate preoperative preparation and early surgery and how to achieve a comprehensive and scientific evaluation of severe patients is the key to avoid unnecessary delay in surgery.Brill and Parvizi reported that chronic pulmonary disease is associated with postoperative DVT in patients with fracture[20, 21].We further found that COPD was an independent risk factor for preoperative DVT and pulmonary infection, and COPD was an independent risk factor for postoperative DVT.Systemic inflammation, hypoxemia, oxidative stress, endothelial dysfunction, and prethrombotic status would increase the risk of VTE in patients with COPD[22].Elderly fracture patients with COPD may be chronically hypoxic for a long time.Lying in bed and immobilization after a fracture would increase the risk of pulmonary infection, as well as limited mobility and lack of muscle pumping, leading to venous stasis and hypercoagulability in the lower extremities[23].Therefore, active prevention and treatment of pulmonary diseases in patients with fractures may reduce the incidence of perioperative DVT.The European Guidelines for the prevention of perioperative VTE indicate that correcting preoperative anemia could reduce the incidence of postoperative VTE in elderly patients[24].Both we and Feng found that preoperative anemia was an independent risk factor for perioperative DVT in fracture patients, which may be associated with increased D-dimer caused by anemia[26].C-reactive protein levels on the first and third days after surgery were independent risk factors for postoperative DVT, and acute inflammation reflected by high levels of C-reactive protein was considered as the trigger factor for VTE[27].The timing and necessity of perioperative anti-infective therapy need to be further validated.Hypoproteinemia is another independent risk factor for DVT. It may be that the swelling of the lower extremities leads to weakened muscle pumping and slow blood flow, and the pain caused by swelling also reduces the active activity of the lower extremities.Many studies have confirmed that hypertension, hyperlipidemia, diabetes and other chronic diseases were risk factors for DVT. This result was not obtained in this study, which may be related to the small sample size and missed diagnosis of doctors in this single center study.Drinking history, advanced age,high-energy trauma, multiple injuries, and comminuted fracture are independent risk factors for DVT. Although these factors cannot be optimized, they are helpful for early identification of high-risk groups.D-dimer detection with high sensitivity and low specificity is mostly used to exclude patients with suspected VTE, and its increased level is related to the degree of trauma, fracture site, degree of inflammatory response, pregnancy, etc.In this study, although the increase of D-dimer was not found to be an independent risk factor for DVT, the postoperative d-dimer level of the DVT group was significantly higher than that of the non-DVT group, and the D-dimer test of almost all patients was positive.This is consistent with Wang's view that D-dimer detection has poor specificity in trauma patients and its significance is limited[28].Neither Tyagi nor we found the correlation between intraoperative tourniquet use and DVT,considering that short duration of tourniquet use could not significantly affect the blood status of lower extremities.But Tyagi still believes that patients with higher VTE risk should consider using a tourniquet during surgery[29].Whether this simple, low-cost, low-risk intraoperative method can reduce the risk of postoperative DVT remains to be further studied.The results showed that the average preoperative DVT formation was 6.55 ± 0.47 days after the trauma and 6.67 ± 0.48 days after the surgery, which may be related to the peak time of blood hypercoagulability. The d-dimer level reached its peak on the 1st and 7th days after the fracture surgery[30].This study reviewed the changes in the types of DVT during the perioperative period,54.55% (6/11) complicated with distal thrombosis, 18.18% (2/11) complicated with proximal thrombosis, and 27.27% (3/11) complicated with mixed thrombosis. The incidence of distal thrombus progression to PE is relatively high, so thrombus type should not be our sole criterion for screening high-risk populations.The therapeutic anticoagulation of intermuscular vein thrombosis of the calf is controversial,Recent studies have shown that the absence of preoperative anticoagulation does not increase the risk of progression of intermuscular vein thrombosis in the calf and may aggravate postoperative anemia[8].In this study, 11.21% of the intermuscular venous thrombosis of the calf showed progressed, and it seems that therapeutic anticoagulation is necessary for such patients.

Venography is the gold standard for the diagnosis of VTE, but its application is limited due to its invasiveness, unrepeatability and possible renal and venous injuries caused by contrast agents.Noninvasive and repeatable ultrasound examination has been widely used in clinical practice in recent years. Abe's study confirmed that the dilatation of plantarum vein during ultrasound examination is an independent predictor of DVT after major orthopaedic surgery[31].However, lower extremity ultrasound examination is not suitable for patients with partial fractures. For example, patients with hip fracture cannot change the body position examination, and it is difficult to form a clear image for those with severe limb swelling and thick surgical area covered by dressings.The diagnostic examination of DVT is mainly to avoid the occurrence of fatal VTE, but how to identify early and prevent the occurrence of DVT is a more important goal. It is valuable to analyze the risk factors of DVT during the whole perioperative period for femoral and pelvic fractures.

We analyzed the correlation between anticoagulation regimen, perioperative blood transfusion, pulmonary disease and other perioperative influencing factors and DVT.However, this study has the following limitations:Firstly, this is a single-center, retrospective case-control study, which is prone to confounding factors. For example, the influencing factors not included in the study may be potential risk factors for DVT, and the study subjects were not operated by the same surgeon.Secondly, only color Doppler ultrasonography was used to determine DVT, and potential DVT patients with clinical symptoms such as lower limb swelling, pain and elevated skin temperature were not included in the case group, which reduced the effectiveness of the result data.Thirdly, all patients received lower extremity venous ultrasound examination after admission. However, there may be a deviation between DVT formation time and ultrasonic examination time in some patients with delayed admission.Fourthly, this study only reviewed the clinical medical records of the patients during their hospitalization, and did not follow up the patients after discharge, which may have omitted the occurrence of DVT after discharge, thus underestimating the incidence of DVT.

Conclusion

In summary, the current anticoagulation and other DVT prevention and treatment programs have reduced the incidence of DVT of femoral and pelvic fractures, but have not changed the current situation of high incidence of DVT.By analyzing the risk factors of DVT throughout the perioperative period, optimizing the perioperative blood transfusion, preoperative lung disease, hypoproteinemia, anemia, inflammation, etc., and early surgery within 7 days after trauma may further reduce its incidence.

Abbreviations

VTE:Venous thromboembolism;DVT:deep Vein thrombosis;PE:pulmonary embolism ;COPD:Chronic obstructive pulmonary disease;BMI:body mass index ;ASA:American Society of Anesthesiologists;CRP:C-reactive protein;Crea:creatinine;PT:prothrombin time ;PTR:prothrombin time ratio;INR:international normalized ratio;PTA:thrombin Original activity;APTT:activated partial thromboplastin time;TT:thrombin time;Fbg:fibrinogen;DD:D dimer;FDP:fibrinogen degradation products;WBC:white blood cell;Hb:hemoglobin;PLT:platelet count;NEUT%:neutrophil percentage;LYM%: lymphocyte percentage;Lac:lactic acid.

Declarations

Funding

This study was supported by the national key clinical specialty construction project of the Ministry of Health NO Ministry of Finance(2011)170 and Chongqing Medical Key Discipline project NO Yu Wei Science and Education(2007)2.

Availability of data and materials

All the data will be available upon motivated request to the corresponding author of the present paper.

Ethics approval and consent to participate

This study was approved by the ethics committee of the first affiliated hospital of Chongqing medical university. Informed consent was obtained from all the

participants.

Consent for publication

Written informed consent was obtained from each patient to authorize the publication of their data.

Competing interests

The authors declare that they have no competing interests.

Author details

* Corresponding author, associate professor, Research direction: Perioperative venous thrombosis; Address: First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing; Telephone: 13983760123; E-mail: 7300703 @ qq.com.1graduate student, Address: Chongqing Medical University, Yuzhong District, Chongqing; Telephone: 18883520469; E-Mail:[email protected]

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Tables

Table 1.Perioperative incidence of deep vein thrombosis in patients with femoral and pelvic fractures [cases (%)]

Time of formation

Lower limb position

Fracture site

Preoperation

Postoperation

Affected side

Opposite side

Both sides

Femoral neck

femoral intertrochanter

pelvis

Acetabulum

Femoral shaft

152(26.71)

98(17.22)

138(60.26)

22(9.61)

69(30.13)

77(30.92)

73(43.98)

29(43.28)

13(48.14)

37(61.67)


Table 2.Univariate Analysis of Preoperative DVT Risk in Patients With Femoral and Pelvic Fractures

influencing factor

Non-DVT

DVT

z/t

P

CRP(μg/L)

27.60(13.50,65.10)

27.80(12.30,58.60)

-0.578

0.563

Urea(mmol/L)

6.10(4.90,8.00)

7.05(5.03,51.00)

-4.192

0.000

Crea(μmol/L)

67(56,81)

72(52,83)

-6.143

0.000

Lac(mmol/L)

2.20(1.40,2.40)

2.20(1.43,2.48)

-1.202

0.229

WBC(10^9/L)

8.01(6.35,9.80)

8.01(6.36,10.22)

-0.346

0.729

NEUT%(%)

74.58±11.48

53.80±12.42

7.726

0.000

LYM%(%)

15.00±6.88

14.91±5.63

0.256

0.798

PLT(10^9/L)

179.74±92.02

190.13±74.87

-1.249

0.213

PT(s)

13.65±1.47

11.09±3.94

7.841

0.000

PTR

1.05±0.11

5.14±1.95

-8.452

0.000

INR

1.06±0.15

1.06±0.09

0.490

0.625

PTA(%)

95.00(87.00,102.00)

86.50(1.10,98.00)

-6.303

0.000

APTT(s)

37.48±6.11

55.63±27.14

-8.169

0.000

TT(s)

16.27±4.63

22.83±11.05

-7.101

0.000

Fbg(g/L)

4.03±1.44

7.97±2.84

-8.222

0.000

FDP(μg/L)

13.60(7.60,31.45)

10.40(4.27,26.63)

-3.480

0.001

D-D(mg/L)

5.17(2.41,12.06)

9.59(5.03,21.08)

-5.412

0.000

 

Table 3a.Univariate Analysis of Postoperative DVT Risk in Patients With Femoral and Pelvic Fractures

influencing factor

Non-DVT

DVT

Z/t

P

 

CRP0(μg/L)

26.70(13.11,62.60)

28.10(12.57,66.21)

-0.428

0.668

 

Crea0(μmol/L)

69.00(55.81,81.10)

60.01(44.01,76.49)

-5.245

0.000

 

Urea0(mmol/L)

6.10(4.90,8.00)

6.70(4.90,13.20)

-3.063

0.002

 

Lac0(mmol/L)

2.20(1.40,2.40)

2.20(1.40,2.40)

-1.495

0.135

 

CRP1(μg/L)

48.00(27.30,78.10)

56.80(35.13,86.18)

-2.682

0.007

 

Crea1(μmol/L)

66(53,80)

59(51,76)

-2.615

0.009

 

Urea1(mmol/L)

7.00(5.40,10.00)

6.70(5.25,9.05)

-1.087

0.277

 

CRP3(μg/L)

75.90(40.10,105.00)

85.50(50.65,111.75)

-2.518

0.012

 

Crea3(μmol/L)

63.50(51.00,77.80)

57.50(47.00,73.00)

-2.643

0.008

 

Urea3(mmol/L)

6.40(4.80,9.20)

5.90(4,30,8.58)

-2.013

0.044

 

WBC0(10^9/L)

8.03(6.50,9.72)

7.94(6.05,10.31)

-0.929

0.353

 

NEUT%0(%)

74.39±11.16

61.06±29.24

6.587

0.000

 

LYM%0(%)

14.40(10.80,18.60)

13.20(9.55,18.20)

-1.713

0.087

 

PLT0(10^9/L)

180.89±75.84

184.92±85.58

-0.590

0.555

 

WBC1(10^9/L)

80.79±10.05

10.02±3.32

120.219

0.000

 

NEUT%1(%)

99.88±16.29

80.62±13.31

15.438

0.000

 

Hb1(g/L)

214.84±88.58

93.95±15.64

24.569

0.000

 

LYM%1(%)

9.40(6.20,12.60)

8.85(5.83,12.48)

-1.083

0.279

 

PLT1(10^9/L)

196.10(151.60,258.20)

213.00(164.50,285.50)

-2.533

0.011

 

WBC3(10^9/L)

7.94±2.41

8.07±2.76

-0.575

0.566

 

NEUT%3(%)

72.96±11.79

74.90±10.67

-1.990

0.047

 

Hb3(g/L)

96.53±15.98

91.08±14.19

4.169

0.000

 

LYM%3(%)

14.58±5.76

13.72±6.28

1.678

0.094

 

PLT3(10^9/L)

238.27±97.23

244.81±105.67

-0.760

0.448

 

Note:0 represents the inspection index upon admission;1 represents the inspection index 1 day after operation;3 represents the inspection index 3 day after operation;5 represents the inspection index 5 day after operation

 
 

 

Table 3b.Univariate Analysis of Postoperative DVT Risk in Patients With Femoral and Pelvic Fractures

influencing factor

Non-DVT

DVT

Z/t

P

 

PT0(s)

13.65±1.51

11.96±3.51

6.881

0.000

 

PTR0

1.03(0.99,1.08)

1.05(1.01,1.22)

-5.110

0.000

 

INR0

1.04(0.99,1.09)

1.04(0.99,1.10)

-0.666

0.505

 

PTA0(%)

95.10(87.10,101.20)

89.10(69.25,99.10)

-5.133

0.000

 

APTT0(s)

37.72±6.27

49.19±24.07

-7.054

0.000

 

TT0(s)

16.36±4.98

20.44±9.67

-5.871

0.000

 

Fbg0(g/L)

3.95(3.19,4.74)

4.28(3.28,6.66)

-3.780

0.000

 

FDP0(μg/L)

13.65(7.90,32.75)

12.20(5.15,25.45)

-3.132

0.002

 

D-D0(mg/L)

5.31(2.51,12.37)

7.81(3.70,17.86)

-3.393

0.001

 

PT1(s)

13.80(13.20,14.30)

13.90(13.30,14.60)

-1.696

0.090

 

PTR1

1.05(1.02,1.09)

1.06(1.02,1.11)

-1.644

0.100

 

INR1

1.09±0.27

1.10±0.13

120.370

0.000

 

PTA1(%)

39.53±7.94

87.95±15.83

-42.716

0.000

 

APTT1(s)

16.09±2.66

40.14±9.07

-38.911

0.000

 

TT1(s)

4.63±1.46

15.89±2.98

-53.004

0.000

 

Fbg1(g/L)

4.51(3.83,5.22)

4.27(3.55,4.91)

-2.951

0.003

 

FDP1(μg/L)

4.60(4.40,16.10)

12.30(6.25,22.45)

-3.842

0.000

 

D-D1(mg/L)

3.31(1.42,6.65)

4.48(2.15,7.98)

-3.730

0.000

 

PT3(s)

14.01±6.45

13.62±1.21

0.895

0.371

 

PTR3

1.03(0.99,1.08)

1.04(0.99,1.08)

-0.685

0.494

 

INR3

1.05±0.12

1.06±0.11

-0.458

0.647

 

PTA3(%)

93.41±16.69

93.29±15.24

0.090

0.928

 

APTT3(s)

40.00(36.60,45.00)

42.10(37.10,47.10)

-2.629

0.009

 

TT3(s)

16.07±7.34

16.25±9.34

-0.254

0.800

 

Fbg3(g/L)

5.54±1.57

5.27±1.55

2.093

0.037

 

FDP3(μg/L)

9.70(5.90,15.00)

10.45(6.57,15.53)

-1.391

0.164

 

D-D3 (mg/L)

2.98(1.70,5.40)

3.37(2.11,5.76)

-1.805

0.071

 

PT5(s)

13.30(12.90,13.90)

13.40(12.70,13.90)

-0.659

0.510

 

PTR5

1.02(0.99,1.07)

1.02(0.98,1.07)

-0.261

0.794

 

INR5

1.03(0.99,1.10)

1.02(0.97,1.09)

-0.886

0.376

 

PTA5(%)

90.53±23.31

93.55±20.07

-0.346

0.135

 

APTT5(s)

40.10(35.03,44.00)

39.70(35.90,43.56)

-0.106

0.916

 

TT5(s)

15.50(15.00,16.50)

15.60(14.80,16.60)

-0.405

0.686

 

Fbg5(g/L)

5.23±1.90

5.26±1.87

-0.171

0.864

 

FDP5(μg/L)

11.00(7.19,16.38)

12.90(8.50,22.0)

-3.879

0.000

 

D-D5(mg/L)

4.01(2.39,7.06)

5.13(3.14,8.37)

-3.884

0.000

 

Note:0 represents the inspection index upon admission;1 represents the inspection index 1 day after operation;3 represents the inspection index 3 day after operation;5 represents the inspection index 5 day after operation