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Patients Undergoing Primary Total Joint Arthroplasty with Primary Hypercoagulable States
Xin Pan1,2, Zhe Shi3, Zhan-Jun Shi1
1Department of Orthopaedics, Southern Medical University, Guangzhou, China.
Orthopaedic Surgery
|January 20, 2021
Summary
Patients with primary hypercoagulable state (PHS) undergoing total joint arthroplasty (TJA) face higher risks of deep vein thrombosis (DVT) and other complications. Improved perioperative management is essential for these patients.
Area of Science:
- Orthopedic Surgery
- Hematology
- Public Health
Background:
- Primary hypercoagulable state (PHS) is a condition that increases the risk of blood clots.
- Total joint arthroplasty (TJA) is a common surgical procedure to replace damaged joints.
- The perioperative risks for TJA patients with PHS are not fully understood.
Purpose of the Study:
- To analyze perioperative complications, resource consumption, and inpatient mortality in TJA patients with PHS.
- To compare complication rates, resource use, and mortality between TJA patients with and without PHS.
- To assess the adequacy of anticoagulant management in PHS patients undergoing TJA.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database from 2003-2014.
- Identified TJA patients with PHS using ICD-9-CM code 289.81.
- Employed chi-squared tests, Pearson tests, and multivariate regression analysis to compare outcomes.
Main Results:
- PHS patients had a significantly higher risk of deep vein thrombosis (DVT) after TJA (THA: OR=8.343, TKA: OR=4.712).
- No increased risk of pulmonary embolism (PE) was observed for PHS patients undergoing TJA.
- PHS patients experienced higher inpatient mortality (THA), periprosthetic joint infection (THA), extended length of stay, and increased costs.
Conclusions:
- PHS patients undergoing TJA exhibit elevated risks for DVT and other perioperative complications, alongside increased resource utilization.
- PHS was not associated with an increased risk of PE in TJA patients during the study period.
- Enhanced perioperative management strategies are crucial for improving outcomes in TJA patients with PHS.
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