Incidence and factors influencing the occurrence of postoperative thrombosis in patients with lower limb fractures across different age groups: a retrospective study

Abstract

Abstract Background Postoperative venous thrombosis (PVT) is a common complication following lower limb fracture surgery, yet age-specific risk factors remain unclear. This study aimed to identify distinct predictors and develop tailored prediction models for young/middle-aged and elderly patients. Patients and methods This multicentre retrospective cohort study analysed factors influencing of PVT in 483 patients undergoing lower limb fracture surgery at two tertiary hospitals between 1 January 2020 and 31 December 2022. Participants were divided into young/middle-aged (18–59 years, n = 269) and elderly (≥60 years, n = 214) groups for stratified analysis. Comprehensive perioperative variables were analysed. PVT was diagnosed via ultrasound within seven days postoperatively. Age-specific predictors were identified using multivariable logistic regression, and nomogram models were subsequently developed. Model performance was evaluated through the area under the curve (AUC). Results The overall PVT incidence was 15.24% and 23.36% (p < 0.05) in young/middle-aged and elderly patients, respectively. Predictive of postoperative thrombosis among the young/middle aged population were intraoperative colloid infusion rate (OR = 0.784, 95% CI: 0.667–0.921), preoperative prothrombin time activity (OR = 0.947, 95% CI: 0.913–0.982) and postoperative anticoagulant use (OR = 7.117, 95% CI: 2.062–24.560) and among the elderly group were total intraoperative crystalloids (OR = 1.001, 95% CI: 1.000–1.001) and colloid infusion rate (OR = 1.101, 95% CI: 1.104–1.208), postoperative total protein (OR = 0.937, 95% CI: 0.886–0.990) and serum sodium (OR = 0.918, 95% CI: 0.848–0.994). The AUC and total score points for young/middle-aged group model was 0.760 and 204 points, and 0.750 and 116 points among the elderly. Conclusions Fracture patients of different age groups require distinct risk management and perioperative treatments. This study developed age-specific PVT prediction models, highlighting the different risk profiles between young/middle-aged and elderly patients. For young/middle-aged patients, preoperative coagulation status should be optimized, postoperative anticoagulant overuse limited and fluid volume recovery enhanced. For elderly patients, intraoperative fluid input should be strictly restricted, and postoperative protein and electrolyte levels monitored.