Symptomatic In-Hospital Deep Vein Thrombosis and Pulmonary Embolism Following Hip and Knee Arthroplasty Among Patients Receiving Recommended Prophylaxis

Januel, Jean-Marie; Chen, Guanmin; Ruffieux, Christiane; Quan, Hude; Douketis, James D.; Crowther, Mark; Colin, Cyrille; Ghali, William A.; Burnand, Bernard

doi:10.1001/jama.2011.2029

Cited by 240 publications

(104 citation statements)

References 76 publications

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“…The diagnosis of VTE was based on clinical suspicion and confirmed with imaging studies, such as Doppler sonography and chest computer tomography. While a recent systematic review reported a much lower incidence of VTE (0.5% knee to 1% hip TJA) among patients receiving recommended prophylaxis, data capture in previous studies was limited to the inpatient period only, highlighting the importance of ongoing active surveillance after discharge (18). Furthermore, the rate of VTE was higher in patients undergoing knee TJA compared to hip TJA.…”

Section: Discussionmentioning

confidence: 97%

Direct Hospital Cost Determinants Following Hip and Knee Arthroplasty

Peel

Cheng

Liew

et al. 2015

Arthritis Care & Research

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Objective. Total joint arthroplasty (TJA) places a significant economic burden on health care resources. This cohort study examines the costs associated with arthroplasty in 827 patients undergoing hip and knee TJA from January 2011 to June 2012 at a single center in Melbourne, Australia. Methods. Data included total inpatient, outpatient, and readmissions costs in the 30 days following TJA. Factors associated with cost were modeled using negative binomial regression and extrapolated to the Australian population. Results. The base cost (i.e., the cost for a patient with no modifying factors) over the first 30 days following TJA was $13,060 Australian (AU) (interquartile range $12,126-14,067 AU). The median length of stay was 4 days (range 2-33 days) and 35 patients (4%) were readmitted in the first 30 days following index TJA, the majority of whom had a surgical site infection (SSI) (74%). The following factors were independently associated with increased costs: SSI, preoperative warfarin therapy, American Society of Anesthesiologists score of 3 or 4, hip TJA, increasing operation time, increasing postoperative blood transfusion requirements, other nosocomial infections, postoperative venous thromboembolism (VTE), pressure ulcers, postoperative confusion, and acute urinary retention. Based on data from the present study, the cost of TJA in Australia is estimated to exceed $1 billion AU per year. Preventable postoperative complications were major cost drivers: SSI and VTE added a further $97 million AU and $66 million AU, respectively, to arthroplasty costs in the first 30 days following surgery. Conclusion. This unique study has identified important factors influencing TJA costs and providing guidance for future research and resource allocation.

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Section: Discussionmentioning

confidence: 97%

Direct Hospital Cost Determinants Following Hip and Knee Arthroplasty

Peel

Cheng

Liew

et al. 2015

Arthritis Care & Research

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“…Although venous thromboembolic (VTE) disease has been researched extensively and discussed in hip and knee arthroplasties [6,8,10], the phenomenon has not been as well described after shoulder surgery. Deep vein thrombosis (DVT) and pulmonary embolism (PE) are potential complications of shoulder procedures such as arthroscopy and closed reductions of the shoulder [2,11,14].…”

Section: Introductionmentioning

confidence: 99%

Risk of Thromboembolism in Shoulder Arthroplasty: Effect of Implant Type and Traumatic Indication

Navarro

Inacio

Burke

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Prior research about symptomatic venous thromboembolism (VTE) after shoulder arthroplasty has not determined whether procedure type (hemiarthroplasty, total shoulder arthroplasty, or reverse shoulder arthroplasty) or surgical indication (traumatic or elective) represent risk factors for VTE after shoulder replacement.Questions/purposes We therefore asked whether the risk of symptomatic VTE events and mortality within 90 days of shoulder arthroplasty was influenced by (1) procedure type, and (2) surgical indication (traumatic or elective). Methods We performed a retrospective database review of symptomatic VTE events and mortality within 90 days of shoulder arthroplasty in a large (30-hospital) integrated healthcare system over a 5-year period, from January 2005 to December 2009. We compared the likelihood of VTE and death in patients undergoing reverse shoulder arthroplasties (RSAs), total shoulder arthroplasties (TSAs), and hemiarthroplasties (HAs), and we compared the likelihood of VTE and death in patients who underwent elective shoulder arthroplasties with those who underwent shoulder arthroplasty in the setting of acute trauma. Results In the 2574 eligible shoulder arthroplasties identified during the study period, VTE developed in 1.01% of patients (deep vein thrombosis 0.51% and pulmonary embolism 0.54%). With the numbers available, no differences were observed in rates of VTE or mortality by procedure type. A trend toward increased VTE occurred more frequently in patients having surgery for traumatic indications than after elective surgery (1.71% versus 0.80%; p = 0.055). A higher likelihood of 90-day mortality was observed in trauma patients compared with elective (odds ratio = 7.4; 95% CI, 2.4-25.2).

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“…Median Age (yrs) 71 72 *f/u=follow up major guidelines, (study sample sizes ranging from 4177 to 5738) [16][17][18]. Our findings of both symptomatic and asymptomatic DVT and PE (fatal and non-fatal) amongst post operative TKR patients receiving short course anti-coagulation therapy lie well within these indices.…”

Section: -91 54-91mentioning

confidence: 58%

Combined Short Course Low Molecular Weight Heparin and Calf Compression Therapy in Prevention of Deep Vein Thrombosis after Total Knee Replacement: A Randomized Prospective Study

Ramakrishna¹,

Gupta²,

Sarathy³

et al. 2013

J Hematol Thromb Dis

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Background and aims: Anti-coagulation is an important component of post-operative Venous-Thombo-Embolic (VTE) prophylaxis but can be associated with significant complications including hemorrhage. Current guidelines favour anti-coagulation for ≥ 14 days with little evidence evaluating the efficacy of anticoagulation <14 days. Our study hypothesizes that short course Low-Molecular-Weight-Heparin (LMWH for 5-7 days) in combination with Calf Compression Device (CCD) is equally effective as standard therapy LMWH (14 days) in preventing VTE and related events amongst patients undergoing Total-Knee-Replacement (TKR).

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Symptomatic In-Hospital Deep Vein Thrombosis and Pulmonary Embolism Following Hip and Knee Arthroplasty Among Patients Receiving Recommended Prophylaxis

Abstract: Using current VTE prophylaxis, approximately 1 in 100 patients undergoing TPKA and approximately 1 in 200 patients undergoing TPHA develops symptomatic VTE prior to hospital discharge.

Cited by 240 publications

References 76 publications

Direct Hospital Cost Determinants Following Hip and Knee Arthroplasty

Direct Hospital Cost Determinants Following Hip and Knee Arthroplasty

Risk of Thromboembolism in Shoulder Arthroplasty: Effect of Implant Type and Traumatic Indication

Combined Short Course Low Molecular Weight Heparin and Calf Compression Therapy in Prevention of Deep Vein Thrombosis after Total Knee Replacement: A Randomized Prospective Study

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