Advertisement

Incidence and Risk Factor Analysis of Symptomatic Venous Thromboembolism After Knee Arthroscopy

      Purpose

      To (1) determine the incidence of symptomatic venous thromboembolic events (VTEs) after knee arthroscopy and arthroscopy-assisted procedures at a single institution and (2) determine associated risk factors for VTEs in these patients.

      Methods

      The records of patients who underwent knee arthroscopy at a single institution between 1988 and 2008 were reviewed. Chemoprophylaxis was not routinely used. Confirmed VTEs occurring within 4 weeks after the index arthroscopy procedure were included. A 2:1 matched control group was generated to include patients in whom knee arthroscopy was performed by the same surgeon either on the same day or immediately before each case resulting in a VTE. Preoperative and perioperative data were collected with respect to demographic data, medical history, medications, and surgical and anesthesia data. Univariate and multivariate analyses were performed.

      Results

      During the study period, 12,595 patients underwent knee arthroscopy. Among these patients, 43 cases of VTEs (35 deep venous thromboses [DVTs], 5 pulmonary embolisms [PEs], and 3 DVTs that progressed to PEs) occurred, resulting in an incidence of 0.30% (95% confidence interval [CI], 0.22% to 0.41%) for DVT, 0.06% (95% CI, 0.03% to 0.12%) for PE, and 0.34% (95% CI, 0.25% to 0.46%) for VTEs overall. Factors associated with an elevated risk of symptomatic postoperative VTEs included a history of malignancy (P = .01; odds ratio [OR], 6.3), a history of VTEs (P = .02; OR, 5.2), or the presence of more than 2 classic risk factors for VTEs (P = .01; OR, 13.6).

      Conclusions

      In this study, symptomatic VTEs were rare and occurred infrequently, with an incidence of 0.34% (95% CI, 0.25% to 0.46%), after knee arthroscopy and arthroscopy-assisted cases in the absence of routine chemoprophylaxis. Patients with a history of VTEs, a history of malignancy, or 2 or more classic risk factors are at increased risk of VTEs after knee arthroscopy, and chemoprophylaxis should be considered in these select patients.

      Level of Evidence

      Level III, case-control study.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sun Y.
        • Chen D.
        • Xu Z.
        • et al.
        Deep venous thrombosis after knee arthroscopy: A systematic review and meta-analysis.
        Arthroscopy. 2014; 30: 406-412
        • Cullison T.R.
        • Muldoon M.P.
        • Gorman J.D.
        • Goff W.B.
        The incidence of deep venous thrombosis in anterior cruciate ligament reconstruction.
        Arthroscopy. 1996; 12: 657-659
        • Demers C.
        • Marcoux S.
        • Ginsberg J.S.
        • Laroche F.
        • Cloutier R.
        • Poulin J.
        Incidence of venographically proved deep vein thrombosis after knee arthroscopy.
        Arch Intern Med. 1998; 158: 47-50
        • Jaureguito J.W.
        • Greenwald A.E.
        • Wilcox J.F.
        • Paulos L.E.
        • Rosenberg T.D.
        The incidence of deep venous thrombosis after arthroscopic knee surgery.
        Am J Sports Med. 1999; 27: 707-710
        • Marlovits S.
        • Striessnig G.
        • Schuster R.
        • et al.
        Extended-duration thromboprophylaxis with enoxaparin after arthroscopic surgery of the anterior cruciate ligament: A prospective, randomized, placebo-controlled study.
        Arthroscopy. 2007; 23: 696-702
        • Williams Jr., J.S.
        • Hulstyn M.J.
        • Fadale P.D.
        • et al.
        Incidence of deep vein thrombosis after arthroscopic knee surgery: A prospective study.
        Arthroscopy. 1995; 11: 701-705
        • Delis K.T.
        • Hunt N.
        • Strachan R.K.
        • Nicolaides A.N.
        Incidence, natural history and risk factors of deep vein thrombosis in elective knee arthroscopy.
        Thromb Haemost. 2001; 86: 817-821
        • Navarro-Sanz A.
        • Fernandez-Ortega J.F.
        Fatal pulmonary embolism after knee arthroscopy.
        Am J Sports Med. 2004; 32: 525-528
        • Sherman O.H.
        • Fox J.M.
        • Snyder S.J.
        • et al.
        Arthroscopy—“No-problem surgery.” An analysis of complications in two thousand six hundred and forty cases.
        J Bone Joint Surg Am. 1986; 68: 256-265
      1. Centers for Disease Control and Prevention. International Classification of Diseases, Ninth Revision (ICD-9). Available at http://www.cdc.gov/nchs/icd/icd9.htm. Accessed May 24, 2014.

        • Sun Y.
        • Chen D.
        • Xu Z.
        • et al.
        Incidence of symptomatic and asymptomatic venous thromboembolism after elective knee arthroscopic surgery: A retrospective study with routinely applied venography.
        Arthroscopy. 2014; 30: 818-822
        • Michot M.
        • Conen D.
        • Holtz D.
        • et al.
        Prevention of deep-vein thrombosis in ambulatory arthroscopic knee surgery: A randomized trial of prophylaxis with low–molecular weight heparin.
        Arthroscopy. 2002; 18: 257-263
        • White R.H.
        • Romano P.S.
        • Zhou H.
        • Rodrigo J.
        • Bargar W.
        Incidence and time course of thromboembolic outcomes following total hip or knee arthroplasty.
        Arch Intern Med. 1998; 158: 1525-1531
        • Maletis G.B.
        • Inacio M.C.S.
        • Reynolds S.
        • Funahashi T.T.
        Incidence of symptomatic venous thromboembolism after elective knee arthroscopy.
        J Bone Joint Surg Am. 2012; 94: 714-720
        • Ettema H.B.
        • Hoppener M.R.
        • Veeger N.J.
        • Buller H.R.
        • van der Meer J.
        Low incidence of venographically detected deep vein thrombosis after knee arthroscopy without thromboprophylaxis: A prospective cohort study.
        J Thromb Haemost. 2006; 4: 1411-1413
        • Mantilla C.B.
        • Horlocker T.T.
        • Schroeder D.R.
        • Berry D.J.
        • Brown D.L.
        Risk factors for clinically relevant pulmonary embolism and deep venous thrombosis in patients undergoing primary hip or knee arthroplasty.
        Anesthesiology. 2003; 99 (discussion 5A): 552-560
        • Falck-Ytter Y.
        • Francis C.W.
        • Johanson N.A.
        • et al.
        Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
        Chest. 2012; 141: e278S-e325S
        • Martin C.T.
        • Pugely A.J.
        • Gao Y.
        • Wolf B.R.
        Risk factors for thirty-day morbidity and mortality following knee arthroscopy: A review of 12,271 patients from the national surgical quality improvement program database.
        J Bone Joint Surg Am. 2013; 95: e98, 1-10
        • Bushnell B.D.
        • Anz A.W.
        • Bert J.M.
        Venous thromboembolism in lower extremity arthroscopy.
        Arthroscopy. 2008; 24: 604-611
        • Ilahi O.A.
        • Reddy J.
        • Ahmad I.
        Deep venous thrombosis after knee arthroscopy: A meta-analysis.
        Arthroscopy. 2005; 21: 727-730
        • Falanga A.
        The incidence and risk of venous thromboembolism associated with cancer and nonsurgical cancer treatment.
        Cancer Invest. 2009; 27: 105-115
        • Khorana A.A.
        • Connolly G.C.
        Assessing risk of venous thromboembolism in the patient with cancer.
        J Clin Oncol. 2009; 27: 4839-4847
        • Cogo A.
        • Bernardi E.
        • Prandoni P.
        • et al.
        Acquired risk factors for deep-vein thrombosis in symptomatic outpatients.
        Arch Intern Med. 1994; 154: 164-168
        • Wirth T.
        • Schneider B.
        • Misselwitz F.
        • et al.
        Prevention of venous thromboembolism after knee arthroscopy with low-molecular weight heparin (Reviparin).
        Arthroscopy. 2001; 17: 393-399
        • Sun Y.
        • Chen D.
        • Xu Z.
        • et al.
        Incidence of symptomatic and asymptomatic venous thromboembolism after elective knee arthroscopic surgery: A retrospective study with routinely applied venography.
        Arthroscopy. 2014; 30: 818-822