Venous Thromboembolism Prophylaxis after Major Orthopedic Surgeries

From the 2021 HVPAA National Conference

Purna Sharma (Crozer Chester Medical Center), Kumar Ashish, Brandon Boyer, Devashish Desai, Rahul Patel

Background

Major orthopedic surgeries (hip fracture repair, hip and knee arthroplasty) are the most critical risk factors for Deep vein thrombosis (DVT) and Pulmonary Embolism (PE) development. Without prophylaxis, 40-80% of patients will develop DVT, and up to 10% will develop PE. With appropriate prophylaxis, the risk can be reduced significantly. Among the various guidelines, the American College of Chest Physicians (ACCP) guideline is the most followed guideline. The preferred recommendation is to use Low molecular weight heparin (LMWH) for a minimum of 10-14 days and extend up to 35 days after major orthopedic surgeries.

Objectives

The study’s primary objective was to assess the type and duration of medication used for VTE prophylaxis after major orthopedic surgeries in two community hospitals.

Methodology

This retrospective, the double-centered study included patients admitted at two community hospitals (Crozer-Chester Medical Center and Taylor Hospital) over two years who underwent major orthopedic surgeries. A total of 450 charts were reviewed. The final sample size was 284 after excluding the patients on chronic anticoagulant therapy, had contraindications to use anticoagulants, and duration of hospital stay was greater than 35 days. In hospital and on discharge, venous thromboembolism (VTE) prophylaxis medications were reviewed. We also reviewed the total duration of VTE prophylaxis. We compared these data between the two hospitals noted above.

Results

Of the 284 patients, 36%(102/284) were from Crozer hospital, and 64%(182/284) were from Taylor hospital. 40%(114/284) had hip fracture repair surgery, and 60%(170/284) had hip/knee arthroplasty.

Among the arthroplasty group, 82%(139/170) of patients were given aspirin, 7%(12/170) were given Lovenox, and the remaining 11%(19/170) were given other anticoagulants like Unfractionated heparin, Eliquis or Xarelto in hospital. 76%(130/170) of patients got the extended duration of prophylaxis for up to 35 days.

Among the hip fracture repair surgery group, 4%(5/114) of patients were given aspirin, 57%(65/114) were given Lovenox, 36%(41/114) were given unfractionated heparin and 3%(3/114) were given Eliquis or Xarelto in hospital. Only 15%(17/114) of patients got the extended duration of prophylaxis for up to 35 days.

35%(36/102) of patients were discharged without VTE prophylaxis from Crozer hospital as compared to 6.5%(12/182) at Taylor hospital (P<0.0001).

31%(32/102) of the patients got VTE prophylaxis for <10 days at Crozer hospital as compared to 5.5%(10/182) at Taylor hospital(P<0.0001).

After major orthopedic surgeries, the incidence of DVT/PE was higher at Crozer hospital 3.92%(4/102) compared to Taylor hospital 0.54%(1/182).

Conclusion

The study concludes that there is a need for better awareness about the importance of the extended duration of VTE prophylaxis after the major orthopedic surgeries to reduce DVT and PE incidence postoperatively.