Venous Thromboembolism in Geriatric Trauma Patients-Risk Factors and Associated Outcomes
BACKGROUND: Venous thromboembolism (VTE) places elderly trauma patients at a high risk of morbidity. The purpose of this study was to determine the outcomes related to VTE in geriatric trauma patients, as well as to identify risk factors for the development of VTE in this population. We also assessed the impact of the type and timing of VTE prophylaxis, and the type of injuries, on development of VTE in geriatric trauma population.
METHODS: We performed a 2-year retrospective review from American College of Surgeons-Trauma Quality Improvement Project (ACS-TQIP) databank from 2014 to 2016. A total of 354,272 patients aged 65 y or older who developed VTE after trauma were included in the study.
RESULTS: Overall, 354,272 elderly trauma patients with complete records were identified from the year 2014 to 2016, and of this, 4290 (1.1%) patients developed in-hospital VTE. Male gender was more predominant in the VTE group (P < 0.001). Both the ICU length of stay and hospital length of stay (P < 0.001) were higher in the VTE group. Spine injury (P = 0.002), lower extremity injury (P < 0.001), age category 75-84 y (P < 0.001), age ≥85 y (P < 0.001), frailty (P < 0.001), severe traumatic brain injury (TBI) (GCS3-8) (P < 0.001), ventilator days (P < 0.001), and transfusion of plasma products in first 24 h of admission (P < 0.001) were independent predictors of developing VTE after trauma in the elderly. Higher injury severity score, TBI, and transfusion of packed red blood cells within 24 h were associated with longer time to initiate VTE prophylaxis. Time to initiate chemical deep vein thrombosis prophylaxis was significantly longer in those patients that developed VTE (3.73 ± 4.82 d), when compared with those patients without VTE ((1.81 ± 2.53 d) (P < 0.001).
CONCLUSIONS: Our study demonstrates that ICU and hospital length of stay were higher in VTE group. Frailty, severe TBI, spine injury, lower extremity injury, longer duration of mechanical ventilation, and transfusion of plasma products in the first 24 h of hospital admission were independent predictors of developing VTE after trauma in elderly. Type and timing of VTE prophylaxis were not significant independent predictors of developing VTE after trauma, while higher injury severity score, TBI, and transfusion of packed red blood cells within 24 h were associated with longer time to initiate VTE prophylaxis. Future multi-institutional prospective studies are warranted to gather more evidence on this topic.
Prabhakaran, K., Gogna, S., Lombardo, G., & Latifi, R. (2020). Venous Thromboembolism in Geriatric Trauma Patients-Risk Factors and Associated Outcomes. The Journal of Surgical Research, 254, 327-333. https://doi.org/10.1016/j.jss.2020.05.008