Background
Stratification of patients into different risk categories for pulmonary embolism (PE) after total joint arthroplasty (TJA) may allow clinicians to individualize venous thromboembolism prophylaxis based on an appropriate risk-benefit scale.
Methods
- Patients undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) as part of the American College of Surgeons National Surgical Quality Improvement Program were identified.
- Independent risk factors for PE within 30 days of surgery were identified and used to develop a point-scoring system to estimate the relative risk for PE.
- For validation, the system was tested on patients undergoing TJA at a single institution.
Results
- A total of 118,473 patients were identified, including 72,673 (61.3%) undergoing TKA and 45,800 (38.7%) undergoing THA.
- The incidence of PE within 30 days of the index arthroplasty was 0.50%.
- The risk factors associated with PE were age 70, female gender, higher body mass index (25-30 kg/m(2) and 30 kg/m(2)), and TKA (vs THA); anemia was protective.
- The point scores derived for each of these factors were as follows: anemia: -2; female: +1; body mass index 25-30 kg/m(2): +2; body mass index 30 kg/m(2): +3; age 70 years: +3; TKA: +5.
- The point-scoring system was then applied to 17,384 patients from a single institution.
- Single-institution patients categorized as low risk using the point-scoring system had a 0.44% 90-day risk for PE (95% CI = 0.29%-0.58%); medium risk, 1.51% (95% CI = 1.18%-1.84%); and high risk, 2.60% (95% CI = 2.09%-3.10%).
Conclusions
This point-scoring system predicts risk for PE after TJA and may help surgeons to optimize selection of chemical prophylaxis.
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