Systematic review and meta-analysis on the rate of postoperative venous thromboembolism in orthopaedic surgery in Asian patients without thromboprophylaxis

Background: Postoperative venous thromboembolism (VTE) is a common life-threatening complication after surgery. This review analysed the rate and mortality of VTE after orthopaedic surgery in Asia. Methods: Inclusion criteria were: prospective study; deep vein thrombosis (DVT) diagnosed by venography or ultrasonography; hip fracture surgery (HFS), total hip arthroplasty (THA) or total knee arthroplasty (TKA); and no thromboprophylaxis. The pooled proportion was back-calculated by Freeman-Tukey variant transformation, using a random-effects model. Results: Twenty-two studies (total population 2454) published from 1979 to 2009 were included. Using venography, the pooled rates of all-site, proximal, distal and isolated distal DVT were 31.7, 8.9, 22.5 and 18.8 per cent respectively. With duplex ultrasonography, the respective rates were 9.4, 5.9, 5.9 and 5.8 per cent. After THA or HFS, using venography, the pooled rates of all-site and proximal DVT were 25.8 and 9.6 per cent; with ultrasonography, the respective rates were 10.8 and 7.2 per cent. In TKA groups, using venography, the pooled rates of all-site and proximal DVT were 42.5 and 8.7 per cent; with ultrasonography, the respective rates were 9.5 and 5.2 per cent. The overall pooled rates of symptomatic DVT and symptomatic pulmonary embolism (PE) were 4.5 and 0.6 per cent. No patient died from PE (pooled rate 0.2 per cent). Conclusion: None of these Asian patients undergoing orthopaedic surgery died from VTE. Pooled rates of proximal and symptomatic DVT were lower than in Western reports.