Impact of preoperative frailty on venous thromboembolism risk following total hip and knee arthroplasty: a meta-analysis.
Systematic Review
Frailty is commonly observed in older adults and may elevate the risk of venous thromboembolism (VTE) following total hip arthroplasty (THA) or total knee arthroplasty (TKA). This meta-analysis elucidates the association between frailty and the risk of postoperative VTE, encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), among patients undergoing THA or TKA./r/nA systematic search was conducted across PubMed, Embase, and Web of Science through August 22, 2024, to identify relevant observational studies with longitudinal follow-up. Eligible studies reported on frailty status preoperatively and subsequent postoperative VTE events. We synthesized data using random-effects models that accounted for heterogeneity and performed subgroup analyses based on the type of surgery and duration of follow-up./r/nOur meta-analysis included 14 cohort studies covering 2 218 293 patients. Analysis of univariate results from sixteen datasets showed that frailty was associated with an increased risk of VTE post-THA/TKA (odds ratio [OR]: 2.32, 95% confidence interval [CI]: 1.84-2.93, P < 0.001). This association remained consistent across primary and revision THA/TKA surgeries. Frail patients exhibited heightened risk of DVT (OR: 1.41, 95% CI: 1.12-1.78, P = 0.004) and PE (OR: 1.59, 95% CI: 1.38-1.84, P < 0.001). Subgroup analyses revealed that the link with PE was more pronounced in studies with follow-ups of 90 days (OR: 7.42) than in studies with other follow-up durations (mostly 30 days). Multivariate analysis confirmed that frailty independently predicted increased risks of DVT (OR: 1.69) and PE (OR: 1.57)./r/nPreoperative frailty significantly heightens the risk of postoperative VTE, DVT, and PE in patients undergoing THA or TKA.
