Anesthesia in orthopedic surgery and DVT

Q; Patients undergoing General Anesthesia during orthopedic surgery have a higher risk of thromboembolism than patients undergoing spinal anesthesia?

A) True

B) False

Answer: A

Overall orthopedic procedures have a higher risk of thromboembolism. Some patients carry extra risk due to other underlying factors. Some of these factors are:

• Greater extent of surgery
• Longer duration of surgery
• General anesthesia 
• Prolonged immobilization postoperatively
• Prolonged casting postoperatively
• Bilateral total joint arthroplasty 
• Age >75 years 
• Obesity
• Cardiovascular disease
• Compression of the deep veins from the positioning of the extremity during hip surgery
• Use of a thigh tourniquet during knee surgery

#surgical-critical-care

References:

1. White RH, Zhou H, Romano PS. Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost 2003; 90:446.

2. Leizorovicz A, Turpie AG, Cohen AT, et al. Epidemiology of venous thromboembolism in Asian patients undergoing major orthopedic surgery without thromboprophylaxis. The SMART study. J Thromb Haemost 2005; 3:28.

3. Mantilla CB, Horlocker TT, Schroeder DR, et al. Risk factors for clinically relevant pulmonary embolism and deep venous thrombosis in patients undergoing primary hip or knee arthroplasty. Anesthesiology 2003; 99:552.