Risk Factors for Preoperative DVT in Elderly Patients with Hip Fractures

Abstract

Background: Deep vein thrombosis (DVT) is a common and potentially serious complication in elderly patients with hip fractures, as it may progress to pulmonary embolism. Despite advances in perioperative care, preoperative DVT remains an important clinical concern; therefore, in this study, we aimed to identify risk factors associated with preoperative DVT in elderly patients with hip fractures. Methods: A retrospective case–control study was conducted in patients aged > 60 years with hip fractures who had undergone preoperative Doppler ultrasonography between January 2015 and August 2024, while patients with prior or chronic DVT or incomplete medical records were excluded. Demographic, clinical, and laboratory data were collected, and uni- and multivariate logistic regression analyses were performed to identify independent predictors of preoperative DVT. Results: Of 669 eligible patients, 454 were included, and 23 (5.1%) were diagnosed with preoperative DVT. The mean age of the whole cohort was 79.5 years, and 70.7% were female. Univariate analysis revealed that thirteen predictors with p < 0.1 were associated with preoperative DVT, while through multivariate analysis, we identified four independent predictors: female sex (p = 0.02), active smoking (p = 0.01), Wells’ score ≥ 2 (p = 0.01), and elevated platelet-to-lymphocyte ratio (PLR) (p = 0.05). The model demonstrated good discriminative performance, with an AUC of 0.81. Conclusions: Preoperative DVT remains clinically significant in elderly patients with hip fractures. Female sex, active smoking, higher Wells’ score, and elevated PLR are independent predictors of this condition, so incorporating these factors into preoperative assessment may improve risk stratification and optimize Doppler ultrasonography use.