Predictors of Rehospitalization for Symptomatic Venous Thromboembolism after Total Hip Arthroplasty

White, Richard; Gettner, Sharmeen; Newman, Jeffrey; Trauner, Kenneth B.; Romano, Patrick S.

doi:10.1056/nejm200012143432403

Cited by 236 publications

(159 citation statements)

References 34 publications

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“…Independent predictors of reduced early survival after VTE include increasing age, male gender, lower body mass index, confinement to a hospital or nursing home at VTE onset, congestive heart failure, chronic lung disease, serious neurological disease, and malignancy. 29- 31 We did not observe the beneficial effect of an IVC filter on short-term prognosis and it might be related to a low proportion of IVC filter implantations among these patients. This study has several advantages.…”

Section: Discussionmentioning

confidence: 59%

“…Prior validation studies have shown that the codes used to define VTE in this study have a positive predictive value of approximately 90%. 30, 31 Another weakness is that DVT and PE likely remained asymptomatic in a number of patients and therefore went undetected. Thus, the true incidence of VTE in Taiwanese patients might be higher than the estimate because deaths from PE associated with other medical diseases might be under-reported.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Epidemiology and Predictors of Short-Term Mortality in Symptomatic Venous Thromboembolism - A Nationwide Population-Based Study -

Lee

Cheng

Lin

et al. 2011

Circ J

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Epidemiology and Predictors of Short-Term Mortality in Symptomatic Venous Thromboembolism - A Nationwide Population-Based Study -

Lee

Cheng

Lin

et al. 2011

Circ J

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“…The trend toward faster ambulation is also reflected by the shorter duration of hospital stay that we observed in the present study. White et al reported a 30% reduction in risk of venous thromboembolism in patients who were ambulatory in the first 2 days after THA, as compared with delayed ambulation (40).…”

Section: Discussionmentioning

confidence: 99%

Changes in Mortality Patterns Following Total Hip or Knee Arthroplasty Over the Past Two Decades: A Nationwide Cohort Study

Lalmohamed

Vestergaard

Boer

et al. 2014

Arthritis & Rheumatology

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Objective. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are effective procedures for patients with moderate-to-severe osteoarthritis. Mortality rates after THA and TKA may have changed because of new surgical techniques, improvement of peri-and postoperative care, and performance of surgery in older patients having multiple comorbidities. However, data on secular mortality trends are scarce. We undertook this study to evaluate mortality patterns between 1989 and 2007 in patients undergoing elective THA and TKA.Methods. In a Danish retrospective nationwide cohort study, 71,812 patients who underwent THA and 40,642 patients who underwent TKA were identified between January 1989 and December 2007. All-cause and disease-specific mortality was assessed, stratified by calendar periods. Using Cox proportional hazards models, relative risks (RRs) of mortality were calculated between different calendar periods, adjusted for age, sex, and comorbid diseases. Conclusion. Mortality rates following elective THA and TKA have decreased substantially since the early 1990s, despite patients having more presurgical comorbidity. These findings are reassuring for patients undergoing elective THA or TKA.Total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) are considered safe and effective surgical procedures in patients with moderate-to-severe osteoarthritis (1). Given this effectiveness, the number of these procedures has substantially increased over the past decades. Estimates indicate that 1.8 million procedures are performed worldwide each year (2,3). Nevertheless, studies have shown an excess mortality rate shortly after THA and TKA (4-7), particularly due to venous thromboembolism and acute myocardial infarction (MI) (8). The all-cause mortality rate during the first 90 days following these orthopedic surgeries has been estimated at 0.7%.Improvements in surgical technique and the introduction of new therapeutic agents may have improved survival following THA and TKA during the past

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“…This finding emphasizes the importance of early mobilization in prevention of VTE, as has been reported after total hip arthroplasty. 31 The other important finding was that bilateral simultaneous TKA was strongly associated with VTE, with over 4-fold greater odds of developing VTE compared with unilateral TKA. This effect did not disappear when we adjusted for obesity or the time to mobilization.…”

Section: Discussionmentioning

confidence: 96%

Mechanical and suboptimal pharmacologic prophylaxis and delayed mobilization but not morbid obesity are associated with venous thromboembolism after total knee arthroplasty: A case‐control study

Sadeghi¹,

Romano²,

Maynard³

et al. 2012

Journal of Hospital Medicine

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BACKGROUND:The FDA‐approved dose of low‐molecular‐weight heparin (LMWH) may not provide adequate thromboprophylaxis in morbidly obese patients after total knee arthroplasty (TKA). Suboptimal dosing, delayed initiation, and overreliance on mechanical methods may also limit the effectiveness of thromboprophylaxis.OBJECTIVE:We explored the associations between the type of thromboprophylaxis, obesity, time of mobilization, and undergoing bilateral TKA on development of symptomatic venous thromboembolism (VTE) after TKA.DESIGN/SETTING/PATIENTS:This was a case‐control study of patients undergoing TKA in 15 teaching hospitals between October 2008 and March 2010. Cases were screened using the Agency for Healthcare Research and Quality's Patient Safety Indicator 12 and had objectively documented acute VTE within 9 days of surgery; controls were randomly selected from the same hospital. Multivariable logistic regression was used to analyze risk factors for postoperative VTE, adjusted for age and gender.RESULTS:Among 130 cases with and 463 controls without acute VTE, body mass index (BMI) ranged from 17 to 61 (median = 34). Thromboprophylaxis was LMWH in 284 (48%), warfarin in 189 (32%), both in 55 (10%), and mechanical prophylaxis alone in 120 (20%). Overall, 77% ambulated on day 1 or 2 after surgery. Factors significantly associated with VTE were bilateral simultaneous TKA (odds ratio [OR] = 4.2; 95% confidence interval [CI]: 1.9–9.1), receipt of FDA‐approved pharmacological prophylaxis (OR = 0.5; 95% CI: 0.3–0.8), and ambulation by postoperative day 2 (OR = 0.3; 95% CI: 0.1–0.9). Obesity was neither a significant confounder nor a modifier of these effects.CONCLUSIONS:Severe obesity was not a significant independent predictor for VTE and did not modify the beneficial effect of FDA‐approved pharmacological thromboprophylaxis. Bilateral TKA and failure to ambulate by the second day after surgery were significant risk factors. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine

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Predictors of Rehospitalization for Symptomatic Venous Thromboembolism after Total Hip Arthroplasty

Cited by 236 publications

References 34 publications

Epidemiology and Predictors of Short-Term Mortality in Symptomatic Venous Thromboembolism - A Nationwide Population-Based Study -

Epidemiology and Predictors of Short-Term Mortality in Symptomatic Venous Thromboembolism - A Nationwide Population-Based Study -

Changes in Mortality Patterns Following Total Hip or Knee Arthroplasty Over the Past Two Decades: A Nationwide Cohort Study

Mechanical and suboptimal pharmacologic prophylaxis and delayed mobilization but not morbid obesity are associated with venous thromboembolism after total knee arthroplasty: A case‐control study

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