Interfacility Transfer Is a Risk Factor for Venous Thromboembolism in Lower Extremity Fracture Patients

Objective: To compare the incidence of venous thromboembolism (VTE) among patients with pelvic and/or lower extremity fractures directly admitted to our institution versus those transferred from an outside hospital for definitive management. Design: Retrospective cohort. Setting: Tertiary care orthopaedic hospital. Patients: Six hundred ninety patients who received definitive care for a lower extremity fracture at our institution between 2010 and 2017. Intervention: Interfacility transfer for definitive management of pelvic or lower extremity fracture. Main Outcome Measurements: VTE incidence and time to surgery. Results: The interfacility transfer (TR) group comprised 126 patients, and the direct admission (DA) group comprised 564 patients. TR patients had a significantly higher incidence of VTE compared with the DA group: 9.5% versus 0.7%, respectively (P < 0.001). Time to surgery was also longer in the TR group compared with the DA group: 3.05 +/- 3.00 days versus 2.16 +/- 2.42 days, respectively (P = 0.005). Demographics for TR and DA did not significantly differ with regard to age, sex, length of stay, or American Society of Anesthesiologist score. In the TR group, no complete and explicit documentation regarding thromboprophylaxis administration while at the outside facility was found. Conclusions: Patients undergoing interfacility transfer for definitive management of pelvic and lower extremity fractures are at a significantly increased risk of the development of VTE.