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Venous thromboembolism after total knee replacement or total hip replacement: what can be learnt from root-cause
1University of Southampton , UK.
Annals of the Royal College of Surgeons of England
|August 12, 2016
Summary
Venous thromboembolism (VTE) occurs in over 1% of total hip replacement (THR) and total knee replacement (TKR) patients. While some VTE events are unavoidable, improving hospital implementation of prophylaxis guidelines can further reduce risks.
Area of Science:
- Orthopedic Surgery
- Thrombosis Research
- Healthcare Quality Improvement
Background:
- High risk of venous thromboembolism (VTE) following total hip replacement (THR) and total knee replacement (TKR).
- Established guidelines aim to optimize VTE prophylaxis, balancing efficacy and safety.
- VTE occurrence despite guidelines may stem from adherence failures or inherent risks.
Purpose of the Study:
- To analyze the root causes of VTE in patients undergoing THR and TKR.
- To differentiate between unavoidable VTE events and those resulting from guideline non-adherence.
- To identify areas for improving VTE prevention strategies in orthopedic surgery.
Main Methods:
- Retrospective review of patient records and root-cause analysis (RCA) reports for VTE events post-THR/TKR.
- Categorization of VTE events as 'avoidable' (non-adherence) or 'unavoidable' (guideline followed).
- Statistical comparison of VTE incidence between THR and TKR procedures.
Main Results:
- Overall VTE incidence was 1.13% (25/2,214 patients).
- Total knee replacement (TKR) patients had significantly higher VTE rates than total hip replacement (THR) patients (p<0.0001).
- A notable proportion of VTE events were deemed avoidable due to non-adherence to prophylaxis guidelines.
Conclusions:
- A baseline incidence of VTE occurs even with guideline adherence.
- Earlier administration of chemical prophylaxis may reduce baseline VTE risk, requiring careful consideration of bleeding risks.
- Enhancing hospital implementation of VTE prophylaxis protocols can further mitigate VTE risk.
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