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Risk factors for deep vein thrombosis following total hip arthroplasty in elderly patients with femoral neck fractures during winter
doi: 10.1515/fzm-2025-0017
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Abstract:
Objective To investigate the risk factors for deep vein thrombosis (DVT) following total hip arthroplasty in elderly patients with femoral neck fractures during the winter. Methods A total of 162 patients who underwent total hip arthroplasty were categorized based on the development of DVT within 7 days postoperatively: 28 patients formed the DVT group and 134 patients the non-DVT group. Collected data included age, gender, history of glucocorticoid use, diabetes, hypertension, body mass index (BMI), triglyceride (TG) levels, cholesterol (CHOL) levels at admission, operative time, and postoperative bed rest duration. D-dimer (D-D) and fibrinogen (Fg) levels, along with the D-D/Fg ratio, were recorded on the first postoperative day. Group comparisons were performed using t-tests. Logistic regression analysis was conducted to identify independent risk factors, and the predictive value of these factors was evaluated using receiver operating characteristic (ROC) curve analysis. Results In the DVT group, 18 patients had diabetes. Levels of TG (1.78 ± 0.44 mmol/L), CHOL (4.70 ± 1.84 mmol/L), D-D (0.40 ± 0.17 mg/L), and the D-D/Fg ratio (0.24 ± 0.07) were significantly higher than in the non-DVT group (P < 0.05). Logistic regression identified TG, CHOL, D-D, and the D-D/Fg ratio as independent risk factors for DVT, with odds ratios of 0.987, 2.395, 0.8, 4.992, and 9.004, respectively (P < 0.05). ROC curve analysis yielded areas under the curve (AUCs) of 0.715, 0.69, 0.614, and 0.726 for TG, CHOL, D-D, and the D-D/Fg ratio, respectively. Sensitivities were 0.643, 0.500, 0.429, and 0.857, and specificities were 0.694, 0.978, 0.918, and 0.537, respectively. Conclusion Elevated levels of TG, CHOL, D-D, and the D-D/Fg ratio are independent risk factors for DVT following total hip arthroplasty in elderly patients. Among these, the D-D/Fg ratio demonstrated the highest sensitivity and may serve as an effective marker for early-stage DVT screening. -
Key words:
- deep venous thrombosis /
- total hip replacement /
- senile patients /
- risk factor /
- winter
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Figure 1. ROC curve of risk factors for DVT
ROC, receiver operating characteristic; DVT, deep vein thrombosis.
Table 1. Comparison of general data between two groups of patients
Influencing factors DVT (N = 28) Without DVT (N = 134) t/χ2 P Age 69.4± 7.9 71.0± 7.4 1.00 0.316 Gender Male 16 71 0.16 0.688 Female 12 63 Operation time (h) 1.62± 0.36 1.54± 0.38 1.02 0.312 Postoperative bed rest time (h) 25.3± 5.7 24.3± 6.6 2.00 0.842 Hormone use Yes 9 22 3.70 0.054 No 19 112 Diabetes Yes 18 56 4.72 0.030 No 10 78 Hypertension Yes 6 32 0.08 0.781 No 22 102 TG (mmol/L) 1.78± 0.44 1.49± 0.34 3.35 0.002 CHOL (mmol/L) 4.70± 1.84 3.63± 0.96 2.99 0.006 BMI 25.4± 4.6 24.3± 6.6 0.81 0.421 D-D (mg/L) 0.40± 0.17 0.33± 0.10 2.15 0.039 Fg (g/L) 1.84± 1.06 2.54± 2.23 1.63 0.106 D-D/Fg 0.24± 0.07 0.18± 0.09 3.68 < 0.001 DVT, deep vein thrombosis; TG, triglyceride; CHOL, cholesterol; BMI, body fat number; D-D, D-dimer; Fg, fibrinogen. 
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Table 2. Screening of risk factors for postoperative DVT
Predictive indicators B S.E. Wald P OR 95%CI diabetes 0.987 0.547 3.258 0.071 2.683 0.919-7.834 TG 2.395 0.726 10.889 0.001 10.968 2.644-45.489 CHOL 0.800 0.213 14.103 0 2.226 1.466-3.381 D-D 4.992 2.111 5.593 0.018 147.232 2.351-9221.482 D-D/Fg 9.044 3.249 7.750 0.005 8465.607 14.534-4.93×106 TG, triglyceride; CHOL, cholesterol; D-D, D-dimer; Fg, fibrinogen.
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Table 3. Parameters of ROC curves of risk factors for DVT
Predictive indicators AUC S.E. P 95%CI Boundary value sensitivity Specificity degree TG 0.715 0.056 0 0.605-0.826 1.61 0.643 0.694 CHOL 0.690 0.071 0.002 0.550-0.829 5.32 0.500 0.978 D-D 0.614 0.071 0.058 0.474-0.754 0.47 0.429 0.918 D-D/Fg 0.726 0.048 0.000 0.633-0.820 0.185 0.857 0.537 TG, triglyceride; CHOL, cholesterol; D-D, D-dimer; Fg, fibrinogen.
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