Estimating Venous Thromboembolism Risk in Foot and Ankle Surgical Patients: A Base-Population Case-Control Study

Category: Complications Introduction/Purpose: Venous thromboembolism (VTE) is the leading cause of preventable hospital death. There are several risk factors for VTE of which orthopedic surgery is an important one. VTE risk is highest following major orthopedic surgery and therefore some form of prophylactic therapy is usually recommended here. In contrast, the risk for VTE following foot and ankle surgery is less clear and so are guidelines on VTE prophylaxis in these patients. The purpose is to estimate the risk of VTE and the duration of the increased risk period after foot and ankle surgery. Methods: Data from a large population-based case–control study (the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis [MEGA] study) on the etiology of venous thrombosis were used (5129 cases; 5882 controls). Odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for age, sex and body mass index (ORadj) were calculated for patients undergoing any foot or ankle intervention before the index date (VTE date or control date). Results: 286 cases and 96 controls underwent any orthopedic intervention in the year before the index date for an ORadj of 3.7 (95%CI 2.9-4.8) The ORadj in the first 90-days was 11.4 (95%CI 7.3-17.7). 57 cases and 20 controls had a foot or ankle intervention in the year before the index date, resulting in a three-fold increased risk for VTE (OR 3.3, 95% CI 1,9-5.5). VTE risk was highest in the first 30 (ORadj 10.2,95%CI 3.0-33.9) and 90-days following surgery (ORadj 12.4, 95% CI 4.4-34.8). In 34 patients the surgery was trauma related while 43 patients underwent elective surgery. Traumatic surgery was associated with a higher risk compared with elective surgery for an OR of 13.9 (95%CI 1.8-108.4) and 8.3 (95%CI 1.9-36.9), respectively at 30-days. Conclusion: Foot and ankle procedures were associated with an increased VTE risk which was highest in the first 90-days following surgery. Trauma related surgery was associated with a higher VTE risk than elective surgery. These results are important to decide on thromboprophylactic measures following foot and ankle surgery.

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TL 18040 - Venous thromboembolism risk in foot and ankle surgical patients

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.1004 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. 62S

Author(s):

Roberto Zambelli de Almeida Pinto ◽

Banne Nemeth ◽

Carolina Touw ◽

Suely Rezende ◽

Suzanne Cannegieter

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Orthopedic Surgery ◽

Index Date ◽

Elective Surgery ◽

Foot And Ankle ◽

Increased Risk ◽

Ankle Surgery ◽

First 90 Days

Introduction: Venous thromboembolism (VTE) is the leading cause of preventable hospital death. There are several risk factors for VTE, of which orthopedic surgery is an important one. VTE risk is highest following major orthopedic surgery, and therefore, some form of prophylactic therapy is usually recommended. In contrast, the risk for VTE following foot and ankle surgery is less clear, as are guidelines on VTE prophylaxis in these patients. Objective: To estimate the risk of VTE and the duration of the increased risk period after foot and ankle surgery. Methods: Data from a large population-based case–control study (the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis [MEGA] study) on the etiology of venous thrombosis were used (4721 cases; 5638 controls). Odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for age, sex and body mass index (ORadj), were calculated for patients undergoing any foot or ankle intervention before the index date (VTE date or control date). Results: The 263 cases and 94 controls underwent any orthopedic intervention in the year before the index date for an ORadj of 3,74 (95% CI 2,91-4,80) The ORadj in the first 90 days was 11,35 (95% CI 7,28-17,70). Fifty-five cases and 20 controls had a foot or ankle intervention in the year before the index date, resulting in a three-fold increased risk for VTE (OR 3,29, 95% CI 1,98-5,49). VTE risk was highest in the first 30 (ORadj 10,15 (95% CI 3,04-33,85)) and 90 days following surgery (ORadj 12,42, 95% CI 4,43-34,84). In 34 patients, the surgery was trauma-related, while 43 patients underwent elective surgery. Traumatic surgery was associated with a higher risk than elective surgery with an OR of 13,85 (95% CI 1,77-108,36) and 8,32 (95% CI 1,87-36,94), respectively, at 30 days. Conclusion: Foot and ankle procedures were associated with an increased VTE risk, which was highest in the first 90 days following surgery. Trauma-related surgery was associated with a higher VTE risk than elective surgery. These results are important for decisions regarding thromboprophylactic measures following foot and ankle surgery.

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Antidepressant use during pregnancy and the risk of gestational diabetes mellitus: a nested case–control study

BMJ Open ◽

10.1136/bmjopen-2018-025908 ◽

2019 ◽

Vol 9 (9) ◽

pp. e025908 ◽

Cited By ~ 7

Author(s):

Maëlle Dandjinou ◽

Odile Sheehy ◽

Anick Bérard

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Index Date ◽

Case Control Study ◽

Case Control ◽

Increased Risk ◽

Antidepressant Use ◽

Nested Case Control ◽

Control Study

ObjectivesThe aim of this study was to determine the association between antidepressant (AD) classes, types and duration of use during pregnancy and the risk of gestational diabetes mellitus (GDM).Design and settingA nested case–control study was conducted within the Quebec Pregnancy Cohort (QPC), a Canadian provincial database which includes data on all pregnancies and children in Quebec from January 1998 to December 2015.Primary outcome measuresGestational diabetes mellitus.ParticipantsCases of GDM were identified after week 20 of pregnancy and randomly matched 1:10 to controls on gestational age at index date (ie, calendar date of GDM) and year of pregnancy. AD exposure was assessed by filled prescriptions between the beginning of pregnancy (first day of last menstrual period) and index date. Conditional logistic regression models were used to estimate crude and adjusted odds ratios (aOR).ResultsAmong 20 905 cases and 209 050 matched controls, 9741 (4.2%) women were exposed to ADs. When adjusting for potential confounders, AD use was associated with an increased risk of GDM (aOR 1.19, 95% CI 1.08 to 1.30); venlafaxine (aOR 1.27, 95% CI 1.09 to 1.49) and amitriptyline (aOR 1.52, 95% CI 1.25 to 1.84) were also associated with an increased risk of GDM. Moreover, the risk of GDM was increased with longer duration of AD use, specifically for serotonin norepinephrine reuptake inhibitors, tricyclic ADs and combined use of two AD classes. No statistically significant association was observed for selective serotonin reuptake inhibitors.ConclusionThe findings suggest that ADs—and specifically venlafaxine and amitriptyline—were associated with an increased risk of GDM.

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Malnutrition and Increased Risk of Adverse Outcomes in Elderly Patients Undergoing Elective Colorectal Cancer Surgery: A Case-Control Study Nested in a Cohort

Nutrients ◽

10.3390/nu14010207 ◽

2022 ◽

Vol 14 (1) ◽

pp. 207

Author(s):

Cristina Martínez-Escribano ◽

Francisco Arteaga Moreno ◽

Marcos Pérez-López ◽

Cristina Cunha-Pérez ◽

Ángel Belenguer-Varea ◽

...

Keyword(s):

Colorectal Cancer ◽

Older Adults ◽

Hospital Admission ◽

Case Control Study ◽

Elective Surgery ◽

Case Control ◽

Nutritional Risk ◽

Severe Malnutrition ◽

Increased Risk ◽

Control Study

Background: Malnutrition increases worse outcomes during hospital admission for elective colorectal cancer (CRC) surgery in older adults. Methods: This work was designed an observational, monocentric, case-control study nested in a cohort of patients undergoing elective surgery for CRC disease at the Hospital Universitario de la Ribera (HULR) (Alzira, Valencia, Spain) between 2011 and 2019. The study considered patients with a CONUT score in the range of moderate to severe malnutrition (>4 points), with control patients with normal nutritional situations or mild malnutrition. Results: Moderate-to-severe malnutrition cases presented a greater length of stay (LOS), a higher incidence of adverse events (both medical and surgical complications), a higher incidence of surgical-wound infection, a greater need for blood transfusion, and a greater amount of transfused packed red blood cells. During hospitalization, the percentage of patients without nutritional risk decreased from 46 to 9%, and an increase in mild, moderate, and severe risk was observed. Patients with severe nutritional risk at hospital admission had significantly increased mortality at 365 days after discharge (HR: 2.96 (95% CI 1.14–7.70, p = 0.002)). After adjusting for sex, age, and Charlson index score, patients with severe nutritional risk at admission maintained a higher mortality risk (HR: 3.08 (95% CI 1.10–8.63, p = 0.032)). Conclusion: Malnutrition prevalence is high in older adults undergoing CRC elective surgery. Furthermore, this prevalence increases during hospital admission. Malnutrition is linked to worse outcomes, such as LOS, surgical and clinical complications, and mortality. For this reason, nutritional interventions are very important in the perioperative period

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Incidence and Risk of Severe Ileus After Orthopedic Surgery: A Case-Control Study

HSS Journal ® ◽

10.1007/s11420-019-09712-z ◽

2019 ◽

Vol 16 (S2) ◽

pp. 272-279 ◽

Cited By ~ 1

Author(s):

Lisa A. Mandl ◽

Mayu Sasaki ◽

Jingyan Yang ◽

Sara Choi ◽

Kelianne Cummings ◽

...

Keyword(s):

Orthopedic Surgery ◽

Case Control Study ◽

Conditional Logistic Regression ◽

International Classification Of Diseases ◽

Case Control ◽

Orthopedic Procedures ◽

Retrospective Case ◽

Full Diet ◽

Increased Risk ◽

Control Study

Abstract Background Post-operative ileus (POI) is common and can be associated with significant morbidity. Questions/Purposes We aimed to identify the incidence of and risk factors associated with severe post-operative ileus (SPOI) after elective orthopedic surgery. Methods We conducted a retrospective case–control study of patients undergoing elective orthopedic procedures at a single musculoskeletal specialty hospital. SPOI cases matched 1:2 to non-POI controls. International Classification of Diseases, Ninth Revision (ICD-9), codes were used to identify patients who were coded as having an episode of POI. After chart review, a subset was classified as clinical SPOI cases, based on set criteria. Regression models were constructed to identify variables associated with SPOI. Results Of 273 POI cases, 77 (28.2%) were classified as SPOI. Overall rates of SPOI were 2.74/1000 orthopedic discharges, with SPOI most common in spine surgeries (9.07/1000 spine procedure discharges). Hypothesis-generating multivariable conditional logistic regression suggested that, for hip and knee cases, not being on a full diet by post-operative day (POD) 2 posed an increased risk of SPOI. For spine cases, not being on a full diet on POD 2 and longer surgery times were associated with risk of SPOI. Conclusions In this retrospective case–control study, patients undergoing elective orthopedic procedures who had not progressed to full diet by POD 2 and spine patients with longer operative times were most at risk for SPOI. These data can be used clinically by peri-operative physicians to stratify patients according to risk.

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Thyroid disorders and breast cancer risk in Asian population: a nationwide population-based case–control study in Taiwan

BMJ Open ◽

10.1136/bmjopen-2017-020194 ◽

2018 ◽

Vol 8 (3) ◽

pp. e020194 ◽

Cited By ~ 8

Author(s):

Chien-Hsiang Weng ◽

Yi-Huei Chen ◽

Ching-Heng Lin ◽

Xun Luo ◽

Tseng-Hsi Lin

Keyword(s):

Breast Cancer ◽

Index Date ◽

Case Control Study ◽

Asian Population ◽

Population Based ◽

Case Control ◽

Thyroid Disorders ◽

Increased Risk ◽

History Of ◽

Control Study

ObjectiveTo evaluate whether hyperthyroidism or hypothyroidism increases the risk of subsequent breast cancer in an Asian population.DesignNationwide population-based case–control study.SettingAll healthcare facilities in Taiwan.ParticipantsA total of 103 466 women (mean age 53.3 years) were enrolled.Methods51 733 adult women with newly diagnosed primary breast cancer without a previous cancer history between 2006 and 2011 were identified and included in our study. 51 733 women with no cancer diagnosis prior to the index date were age matched as controls. Diagnosis of hyperthyroidism or hypothyroidism prior to the diagnosis of breast cancer or the same index date was identified, age, histories of thyroid disease treatment, oestrogen use and radioactive iodine treatment were adjusted.Main outcome measuresTo identify risk differences in developing breast cancer among patients with a medical history of hyperthyroidism or hypothyroidism.ResultsThere was a significantly increased risk of breast cancer in women with hyperthyroidism under the age of 55 years (age <45: OR 1.16, P=0.049; age 45–55: OR 1.15, P=0.019). Patients with hypothyroidism also showed an increased risk of breast cancer (OR 1.19, P=0.029) without statistical significance after stratification by age group (age <45, 45–55, >55 years). Treatment for thyroid disorders did not alter the association in subgroup analyses (P=0.857; 0.262, respectively).ConclusionsAsian women under 55 years of age with history of hyperthyroidism have a significantly increased risk of breast cancer regardless of treatment. Women with history of hypothyroidism may also have an increased risk.

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Risk of rheumatoid arthritis diagnosis in statin users in a large nationwide US study

Arthritis Research & Therapy ◽

10.1186/s13075-021-02617-5 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Madeline N. Peterson ◽

Hayley J. Dykhoff ◽

Cynthia S. Crowson ◽

John M. Davis ◽

Lindsey R. Sangaralingham ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Index Date ◽

Case Control Study ◽

Case Control ◽

Statin User ◽

Increased Risk ◽

Statin Prescription ◽

Baseline Coverage ◽

Control Study ◽

Statin Use

Abstract Objective To evaluate the association between statin use and the risk of developing rheumatoid arthritis (RA) in a large, US case-control study. Methods Using the OptumLabs Data Warehouse, RA cases were identified as patients aged ≥18 years with ≥2 RA diagnoses between January 1, 2010 and June 30, 2019 and ≥1 prescription fills for methotrexate within 1 year of the first RA diagnosis. The first RA diagnosis was the index date. Cases were matched 1:1 to controls on age, sex, region, year of index date, and length of baseline coverage. Statin users were defined by having ≥2 statin prescription fills at least 90 days pre-index. Patients identified as statin users were further classified by statin user status (current or former), statin use duration, and intensity of statin exposure. Odds ratios for RA risk with statin use were estimated using logistic regression. Results 16,363 RA cases and 16,363 matched controls were identified. Among RA cases, 5509 (33.7%) patients were statin users compared to 5164 (31.6%) of the controls. Statin users had a slightly increased risk of RA compared to non-users (OR 1.12, 95% CI 1.06–1.18), and former statin users had an increased RA risk compared to current users (OR 1.21, 95% CI 1.13–1.28). However, risk was eliminated following adjustment for hyperlipidemia. The risk estimates for statin use duration and intensity did not reach significance. Conclusion This study demonstrates no significant increase in the risk of developing RA for statin users compared to non-users after adjustment for hyperlipidemia in addition to other relevant confounders. However, more information from prospective studies would be necessary to further understand this relationship.

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Cardiovascular drug treatment, statins and biopsy-confirmed giant cell arteritis: a population-based case–control study

RMD Open ◽

10.1136/rmdopen-2020-001285 ◽

2020 ◽

Vol 6 (2) ◽

pp. e001285

Author(s):

Aleksandra Turkiewicz ◽

Pavlos Stamatis ◽

Aladdin J Mohammad

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Lower Risk ◽

Index Date ◽

Case Control Study ◽

Population Based ◽

Case Control ◽

Cardiovascular Drug ◽

Increased Risk ◽

Control Study

ObjectiveTo determine whether exposure to cardiovascular medications and statins is associated with increased risk of giant cell arteritis (GCA).DesignThe population-based case–control study comprised a cohort of patients with biopsy-confirmed GCA linked to the Swedish Prescribed Drug Register to identify all exposure to drugs prior to diagnosis of GCA. Ten controls per GCA case, matched for age, sex and residential area, were included. Using corresponding Anatomical Therapeutic Chemical codes, ACE inhibitors, angiotensin II receptor blockers, beta-blocking agents, calcium antagonists, diuretics, statins and cardiac therapy drugs were investigated from July 1, 2005 to the diagnosis/index date. A conditional logistic regression model was fitted adjusted for income, education level and marital status. We repeated the analyses including only new drug users excluding those with any prescription during the year from July 1, 2005 to July 1, 2006.Results574 cases (29% men) of diagnosed GCA and 5740 controls (29% men) were included. The mean age at diagnosis is 75 years (SD 8). Of the GCA cases, 71% had at least one dispensation of a cardiovascular drug prior to the index date, compared to 74% of controls. The ORs for the association of target drug exposure with GCA were <1 for most drugs, but close to 1 in the analysis of new users. Statins were consistently associated with lower risk of GCA, OR 0.74 (95% CI 0.61 to 0.90).ConclusionStatins may be associated with lower risk of incident biopsy-confirmed GCA. No association was evident for other studied drugs.

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Increasing cancer risk over calendar year in people with multiple sclerosis: a case–control study

Journal of Neurology ◽

10.1007/s00415-020-10170-5 ◽

2020 ◽

Author(s):

Chiara Zecca ◽

Giulio Disanto ◽

Rosaria Sacco ◽

Sharon MacLachlan ◽

Jens Kuhle ◽

...

Keyword(s):

Multiple Sclerosis ◽

Cancer Risk ◽

Index Date ◽

Case Control Study ◽

Case Control ◽

Clinical Practice Research Datalink ◽

Cancer Type ◽

Increased Risk ◽

Multiple Sclerosis Patients ◽

Control Study

Abstract Background Data on cancer prevalence and incidence in multiple sclerosis (MS) patients are controversial. This study is aimed at estimating cancer risk in MS patients. Methods Nested case–control study using data collected between 01/01/1987 and 28/02/2016 from the United Kingdom Clinical Practice Research Datalink. Cancer diagnoses after first MS code (index date) was counted in 10,204 MS patients and 39,448 controls matched by sex, age, general practitioner, and registration year. Cancer rates were compared using multivariable Cox regression models. Ethics approval was not required. Results Cancer was reported in 433 (4.41%) MS patients and 2014 (5.31%) controls after index date. Cancer risk was associated with gender (HR for female = 0.88, 95% CI = 0.81–0.96, p = 0.004), age at index date (HR = 1.06, 95% CI = 1.06–1.07, p < 0.001), and index year (HR = 1.01, 95% CI = 1.00–1.02, p = 0.016), but not with MS status (HR = 0.95, 95% CI = 0.86–1.05, p = 0.323). A significant interaction between MS status and index year was found (HR = 1.02, 95% CI = 1.00–1.04, p = 0.022). Cancer risk was positively associated with index year among MS patients (HR = 1.03, 95% CI = 1.01–1.05; p = 0.010), but not controls (HR = 1.01, 95% CI = 0.99–1.02; p = 0.144). MS patients compared to controls had no increased risk for any specific cancer type. Conclusions Overall cancer risk was similar in multiple sclerosis patients and matched controls. The frequency of cancer diagnoses has increased over time among MS patients but not in controls.

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