Effects of fondaparinux on pulmonary embolism following hemiarthroplasty for femoral neck fracture: a retrospective observational study using the Japanese Diagnosis Procedure Combination database

Yusuke Tsuda, Hideo Yasunaga, Hiromasa Horiguchi, Kiyohide Fushimi, Hirotaka Kawano, Sakae Tanaka
Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association 2014, 19 (6): 991-6

BACKGROUND: Pulmonary embolism (PE) is recognized as an important complication in patients undergoing hip fracture surgery. However, clinical evidence demonstrating the effectiveness of pharmacological thromboprophylaxis, including fondaparinux, is limited because the occurrence of postoperative PE after hemiarthroplasty is very low. The goal of this study was to analyze the effect of fondaparinux in reducing PE following hemiarthroplasty for femoral neck fracture using large-scale retrospective data.

METHODS: Employing data from the Japanese Diagnosis Procedure Combination database from July 1 to December 31 between 2007 and 2010, we retrospectively identified 22,776 patients who underwent hemiarthroplasty for femoral neck fracture; we included those who received mechanical prophylaxis alone (n = 17,984) and those who received both mechanical prophylaxis and pharmacological prophylaxis with fondaparinux (n = 4,792). Logistic regression analysis was performed to compare the occurrence of postoperative PE with adjustment for sex, age, comorbidities, and type and duration of anesthesia.

RESULTS: The mean age of the patients was 79.5 ± 9.4 years. Overall, postoperative PE occurred in 189 (0.83%) patients. The rate of postoperative PE in the fondaparinux group (0.61%) was lower than in the control group (0.89%), although the difference was not significant in the univariate analysis (odds ratio [OR] 0.68; p = 0.055). In the multivariate analysis, the fondaparinux group showed a significantly lower rate of postoperative PE than the group receiving mechanical prophylaxis alone (OR 0.67; p = 0.047). General anesthesia and a longer duration of anesthesia were significant risk factors for postoperative PE.

CONCLUSIONS: Fondaparinux combined with mechanical prophylaxis is more effective in preventing postoperative PE following hemiarthroplasty for femoral neck fracture than mechanical prophylaxis alone.

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