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.
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Article info
Publication history
Published online: July 12, 2022
Accepted:
June 25,
2022
Received:
December 20,
2021
Footnotes
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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© 2022 by the Arthroscopy Association of North America
