scholarly journals Equivalent VTE rates after total joint arthroplasty using thromboprophylaxis with aspirin versus potent anticoagulants: retrospective analysis of 4562 cases across a diverse healthcare system

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Chelsea Matzko ◽  
Zachary P. Berliner ◽  
Gregg Husk ◽  
Bushra Mina ◽  
Barton Nisonson ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
High Volume ◽  
Antiplatelet Agents ◽  
Joint Arthroplasty ◽  
Bivariate Analysis ◽  
Supporting Evidence ◽  
Case Volume ◽  
Vte Prophylaxis ◽  
Lower Volume ◽  
Hip And Knee Arthroplasty

Abstract Background Guidelines support aspirin thromboprophylaxis for primary total hip and knee arthroplasty (THA and TKA) but supporting evidence has come from high volume centers and the practice remains controversial. Methods We studied 4562 Medicare patients who underwent elective primary THA (1736, 38.1%) or TKA (2826, 61.9%) at 9 diverse hospitals. Thirty-day claims data were combined with data from the health system’s electronic medical records to compare rates of venous thromboembolism (VTE) between patients who received prophylaxis with: (1) aspirin alone (47.3%), (2) a single, potent anticoagulant (29%), (3) antiplatelet agents other than aspirin or multiple anticoagulants (21.5%), or (4) low-dose subcutaneous unfractionated heparin or no anticoagulation (2.2%). Sub-analyses separately evaluating THA, TKA and cases from lower volume hospitals (n = 975) were performed. Results The 30-day VTE incidence was 0.6% (29/4562). VTE rates were equal in patients receiving aspirin and those receiving a single potent anticoagulant (0.5% in both groups). Patients with VTE were significantly older than patients without VTE (mean 76.5 vs. 73.1 years, P = 0.04). VTE rate did not associate with sex or hospital case volume. On bivariate analysis considering age, aspirin did not associate with greater VTE risk compared to a single potent anticoagulant (OR = 2.1, CI = 0.7–6.3) with the numbers available. Odds of VTE were increased with use of subcutaneous heparin or no anticoagulant (OR = 6.4, CI = 1.2–35.6) and with multiple anticoagulants (OR = 3.6, CI = 1.1–11.2). THA and TKA demonstrated similar rates of VTE (0.5% vs. 0.7%, respectively, P = 0.43). Of 975 cases done at lower volume hospitals, 387 received aspirin, none of whom developed VTE. Conclusions This study provides further support for aspirin as an effective form of pharmacological VTE prophylaxis after total joint arthroplasty in the setting of a multi-modal regimen using 30-day outcomes. VTE occurred in 0.7% of primary joint arthroplasties. Aspirin prophylaxis did not associate with greater VTE risk compared to potent anticoagulants in the total population or at lower volume hospitals.

scholarly journals Integration of Patient-reported Outcomes in a Total Joint Arthroplasty Program at a High-volume Academic Medical Center

2020 ◽  
Vol 4 (5) ◽  
pp. e20.00034 ◽  
Author(s):  
Surabhi Bhatt ◽  
Kristina Davis ◽  
David W. Manning ◽  
Cynthia Barnard ◽  
Terrance D. Peabody ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Patient Reported Outcomes ◽  
Medical Center ◽  
Academic Medical Center ◽  
High Volume ◽  
Joint Arthroplasty ◽  
Academic Medical ◽  
Patient Reported

scholarly journals An Update on Venous Thromboembolism Rates and Prophylaxis in Hip and Knee Arthroplasty in 2020

Medicina ◽  
2020 ◽  
Vol 56 (9) ◽  
pp. 416 ◽  
Author(s):  
Daniel C. Santana ◽  
Ahmed K. Emara ◽  
Melissa N. Orr ◽  
Alison K. Klika ◽  
Carlos A. Higuera ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
High Volume ◽  
Optimal Choice ◽  
Slight Reduction ◽  
Vte Prophylaxis ◽  
Prophylactic Agent ◽  
Total Hip ◽  
Number Of Patients ◽  
Hip And Knee Arthroplasty

Patients undergoing total hip and knee arthroplasty are at high risk for venous thromboembolism (VTE) with an incidence of approximately 0.6–1.5%. Given the high volume of these operations, with approximately one million performed annually in the U.S., the rate of VTE represents a large absolute number of patients. The rate of VTE after total hip arthroplasty has been stable over the past decade, although there has been a slight reduction in the rate of deep venous thrombosis (DVT), but not pulmonary embolism (PE), after total knee arthroplasty. Over this time, there has been significant research into the optimal choice of pharmacologic VTE prophylaxis for individual patients, with the objective to reduce the rate of VTE while minimizing adverse side effects such as bleeding. Recently, aspirin has emerged as a promising prophylactic agent for patients undergoing arthroplasty due to its similar efficacy and good safety profile compared to other pharmacologic agents. However, there is no evidence to date that clearly demonstrates the superiority of any given prophylactic agent. Therefore, this review discusses (1) the current prevalence and trends in VTE after total hip and knee arthroplasty and (2) provides an update on pharmacologic VTE prophylaxis in regard to aspirin usage.

scholarly journals Surgeon–anaesthesiologist team case volume and perioperative outcomes in total joint arthroplasty

2020 ◽  
Vol 125 (5) ◽  
pp. e395-e396
Author(s):  
Stavros G. Memtsoudis ◽  
Lauren A. Wilson ◽  
Jiabin Liu ◽  
Jashvant Poeran
Keyword(s):  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Perioperative Outcomes ◽  
Case Volume

scholarly journals Factors Determining Home versus Rehabilitation Discharge Following Primary Total Joint Arthroplasty for Patients Who Live Alone

Geriatrics ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 7 ◽  
Author(s):  
Christopher Fang ◽  
Sara J. Lim ◽  
David J. Tybor ◽  
Joseph Martin ◽  
Mary E. Pevear ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Tertiary Care ◽  
Joint Arthroplasty ◽  
Future Research ◽  
Discharge Destination ◽  
Nursing Facilities ◽  
Academic Hospital ◽  
Skilled Nursing ◽  
Hip And Knee Arthroplasty ◽  
Discharge Location

Patients who are discharged home following primary hip and knee arthroplasty have lower associated costs and better outcomes than patients who are discharged to skilled nursing facilities (SNFs). However, patients who live alone are more likely to be discharged to an SNF. We studied the factors that determine the discharge destination for patients who live alone after total joint arthroplasty (TJA) at an urban tertiary care academic hospital between April 2016 and April 2017. We identified 127 patients who lived alone: 79 (62.2%) were sent home, and 48 (37.8%) were sent to an SNF after surgery. Patients who went home versus to an SNF differed in age, employment status, exercise/active status, patient expectation of discharge to an SNF, ASA score, and the length of stay. After controlling for expectations of discharge to an SNF (OR: 28.98), patients who were younger (OR: 0.03) and employed (OR: 6.91) were more likely to be discharged home. In conclusion, the expectation of discharge location was the strongest predictor of discharge to an SNF even after controlling for age and employment. Future research should include a multi-hospital approach to strengthen the validity of our findings and investigate additional factors that impact discharge destination.

Establishing a patient centered, outpatient total joint home recovery program within an integrated healthcare system

2020 ◽  
Vol 10 (1) ◽  
pp. 23-41
Author(s):  
Paul David Weyker ◽  
Christopher Allen-John Webb
Keyword(s):  
Total Joint Arthroplasty ◽  
Physical Therapists ◽  
High Volume ◽  
Joint Arthroplasty ◽  
Multidisciplinary Teams ◽  
Patient Centered ◽  
Eligibility Criteria ◽  
Hospital Administrators ◽  
Home Health Services ◽  
Recovery Program

Outpatient total joint home recovery (HR) is a rapidly growing initiative being developed and employed at high volume orthopedic centers. Minimally invasive surgery, improved pain control and home health services have made HR possible. Multidisciplinary teams with members ranging from surgeons and anesthesiologists to hospital administrators, physical therapists, nurses and research analysts are necessary for success. Eligibility criteria for outpatient total joint arthroplasty will vary between medical centers. Surgeon preference in addition to medical comorbidities, social support, preoperative patient mobility and safety of the HR location are all factors to consider when selecting patients for outpatient total joint HR. As additional knowledge is gained, the next steps will be to establish ‘best practices’ and speciality society-endorsed guidelines for patients undergoing outpatient total joint arthroplasty.

Screening of MRSA colonization in patients undergoing total joint arthroplasty

2021 ◽  
pp. 175717742110134
Author(s):  
AM Valverde Villar ◽  
J Gutiérrez del Álamo Oms ◽  
I Neira Borrajo ◽  
S de Miguel Fernández ◽  
P Flox Benítez ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Periprosthetic Infection ◽  
Joint Arthroplasty ◽  
Level Of Evidence ◽  
Management Protocol ◽  
Screening Protocol ◽  
Hip And Knee Arthroplasty ◽  
Prior Surgery ◽  
Anatomic Locations ◽  
Mrsa Colonization

Background: Periprosthetic infection is commonly caused by Staphylococcus aureus and, if resistant to methicillin (MRSA), is associated with increase in severity and costs to patient and healthcare systems. MRSA colonizes 1–5% of the population, therefore using a screening and decolonisation protocol the risk of periprosthetic infection could be reduced. The objective of our study is to report the results of a preoperative MRSA screening and management protocol utilised at our hospital. Methods: All patients undergoing a total joint arthroplasty at our hospital were preoperatively screened for MRSA colonization with swab samples of five different locations. Exposure to risk factors were investigated in colonised patients and they were treated for 5 days prior surgery with nasal mupirocin, chlorhexidine sponges and oral tablets. Results: During the 48 months of the study, MRSA colonisation was identified in 22 (1.01%) of 2188 patients operated. The culture was positive only in the nasal swab in 55 patients. In five patients the nasal culture was negative, but they had another positive swab culture (three in the groin and two perianal). None of the patients reported a history of recent antibiotic treatment or hospitalization. Conclusion: At our institution, the prevalence of MRSA colonisation is 1.01% in patients undergoing hip and knee arthroplasty. Interestingly, our screening protocol included samples from five different anatomic locations, and it is important to highlight that we found patients with negative nares culture and positive cultures in other locations. Therefore, the number of carriers may be underdiagnosed if only nasal samples are obtained. Level of evidence: IV

scholarly journals The impact of enhanced recovery after surgery on total joint arthroplasty: A protocol for systematic review and meta-analysis (Preprint)

2020 ◽  
Author(s):  
Siddharth Rele ◽  
Cade Shadbolt ◽  
Chris Schilling ◽  
Nicholas F Taylor ◽  
Michelle M Dowsey ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Service ◽  
Knee Arthroplasty ◽  
Total Joint Arthroplasty ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Meta Analysis ◽  
Joint Arthroplasty ◽  
Total Hip ◽  
Hip And Knee Arthroplasty

BACKGROUND The number of total joint arthroplasty being performed is increasing worldwide. To match this increasing demand, there has been focus on hastening patients’ recovery of function. This effort has culminated in formulation of enhanced recovery for surgery (ERAS) strategies. However, with evolving ERAS programs and new recommendations, a review of current evidence is required to provide clinicians with up-to-date information about its effect on outcomes for total joint arthroplasty. OBJECTIVE This study outlines the protocol for a systematic review and meta-analysis that aims to assess the utility of enhanced recovery after surgery programs on patient, health services and economic outcomes for primary, elective total hip and knee arthroplasty. METHODS A systematic search will be conducted in Medline (OVID), EMCARE (OVID), Web of Science, CINAHL, National Health Service Economic Evaluations Database and the Cochrane Library. Analytical, observational and experimental designs will be included in this systematic review. Only studies including patients undergoing primary, total knee and hip arthroplasty comparing ERAS programs with conventional surgery and postoperative care will be included. Data related to patient outcomes, health service outcomes, safety and economic evaluation will be extracted. RESULTS The search terms have been finalized, and the final primary database search will be completed in November 2020. The results of this systematic review will be disseminated in a peer-reviewed journal. CONCLUSIONS This protocol will guide a systematic review assessing outcomes associated with ERAS surgery in primary, total hip and knee arthroplasty CLINICALTRIAL Open Science Framework. Doi: 10.17605/OSF.IO/Y4BHS

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