Early thromboembolic events ≤1week after fast-track total hip and knee arthroplasty

Christoffer C Jørgensen; Henrik Kehlet; Lundbeck Foundation Centre for Fast-track Hip and Knee replacement collaborative group

doi:10.1016/j.thromres.2015.12.025

Early thromboembolic events ≤1week after fast-track total hip and knee arthroplasty

Christoffer C Jørgensen, Henrik Kehlet, Lundbeck Foundation Centre for Fast-track Hip and Knee replacement collaborative group

Department of Clinical Medicine

22 Citations (Scopus)

Abstract

INTRODUCTION: Thromboembolic events (TEE) are serious complications after total hip (THA) and knee arthroplasty (TKA), with reported in-hospital incidences of about 0.5-1% for venous thromboembolic events (VTE) and 0.2% for myocardial infarctions (MI) and stroke. However, little data exist on in-hospital TEE when using a standardized fast-track protocol with early mobilization.

MATERIALS AND METHODS: A large detailed cohort study in primary unilateral THA and TKAs on "early" (in-hospital or after discharge but within 1week of surgery) and 30-days TEEs, including prospective recording of patient characteristics, complete follow-up through the Danish National Patient Register, and detailed evaluation on disposing factors and consequences of "early" TEEs through review of medical records.

RESULTS: In 13,775 procedures with a median LOS of 2days, 43 (0.32%; 95% CI: 0.23-0.42) "early" and 90 (0.65%; 95% CI: 0.53-0.80) 30-day TEEs were recorded. "Early" TEEs consisted of 9 (0.07%; 95% CI: 0.04-0.13) MI, 10 (0.08% 95% CI: 0.04-0.13) strokes, 13 (0.09%; 95% CI: 0.05-0.16) pulmonary embolisms and 11 (0.08%; 95% CI: 0.04-0.15) deep venous thromboses. Most TEEs were in patients with irreversible dispositions (e.g. previous TEE, high age and cardiac disease), but 5 of 9 MIs were associated with postoperative anemia. All in-hospital VTE (n: 16) occurred while patients received recommended thromboprophylaxis.

CONCLUSIONS: Incidence of "early" TEEs after fast-track THA and THA is low, but MIs may be further reduced by improving perioperative treatment of anemia. Further research is needed regarding interventions for prevention of "early" TEE in disposed patients.

Original language	English
Journal	Thrombosis Research
Volume	138
Pages (from-to)	37-42
Number of pages	6
ISSN	0049-3848
DOIs	https://doi.org/10.1016/j.thromres.2015.12.025
Publication status	Published - Feb 2016

Keywords

Aged
Aged, 80 and over
Anticoagulants
Arthroplasty, Replacement, Hip
Arthroplasty, Replacement, Knee
Early Ambulation
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Myocardial Infarction
Postoperative Complications
Prospective Studies
Pulmonary Embolism
Risk Factors
Stroke
Venous Thrombosis
Journal Article
Research Support, Non-U.S. Gov't

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10.1016/j.thromres.2015.12.025

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title = "Early thromboembolic events ≤1week after fast-track total hip and knee arthroplasty",

abstract = "INTRODUCTION: Thromboembolic events (TEE) are serious complications after total hip (THA) and knee arthroplasty (TKA), with reported in-hospital incidences of about 0.5-1% for venous thromboembolic events (VTE) and 0.2% for myocardial infarctions (MI) and stroke. However, little data exist on in-hospital TEE when using a standardized fast-track protocol with early mobilization.MATERIALS AND METHODS: A large detailed cohort study in primary unilateral THA and TKAs on {"}early{"} (in-hospital or after discharge but within 1week of surgery) and 30-days TEEs, including prospective recording of patient characteristics, complete follow-up through the Danish National Patient Register, and detailed evaluation on disposing factors and consequences of {"}early{"} TEEs through review of medical records.RESULTS: In 13,775 procedures with a median LOS of 2days, 43 (0.32%; 95% CI: 0.23-0.42) {"}early{"} and 90 (0.65%; 95% CI: 0.53-0.80) 30-day TEEs were recorded. {"}Early{"} TEEs consisted of 9 (0.07%; 95% CI: 0.04-0.13) MI, 10 (0.08% 95% CI: 0.04-0.13) strokes, 13 (0.09%; 95% CI: 0.05-0.16) pulmonary embolisms and 11 (0.08%; 95% CI: 0.04-0.15) deep venous thromboses. Most TEEs were in patients with irreversible dispositions (e.g. previous TEE, high age and cardiac disease), but 5 of 9 MIs were associated with postoperative anemia. All in-hospital VTE (n: 16) occurred while patients received recommended thromboprophylaxis.CONCLUSIONS: Incidence of {"}early{"} TEEs after fast-track THA and THA is low, but MIs may be further reduced by improving perioperative treatment of anemia. Further research is needed regarding interventions for prevention of {"}early{"} TEE in disposed patients.",

keywords = "Aged, Aged, 80 and over, Anticoagulants, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Early Ambulation, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Myocardial Infarction, Postoperative Complications, Prospective Studies, Pulmonary Embolism, Risk Factors, Stroke, Venous Thrombosis, Journal Article, Research Support, Non-U.S. Gov't",

author = "J{\o}rgensen, {Christoffer C} and Henrik Kehlet and {Lundbeck Foundation Centre for Fast-track Hip and Knee replacement collaborative group}",

year = "2016",

month = feb,

doi = "10.1016/j.thromres.2015.12.025",

language = "English",

volume = "138",

pages = "37--42",

journal = "Thrombosis Research",

issn = "0049-3848",

publisher = "Pergamon Press",

}

TY - JOUR

T1 - Early thromboembolic events ≤1week after fast-track total hip and knee arthroplasty

AU - Jørgensen, Christoffer C

AU - Kehlet, Henrik

AU - Lundbeck Foundation Centre for Fast-track Hip and Knee replacement collaborative group

PY - 2016/2

Y1 - 2016/2

N2 - INTRODUCTION: Thromboembolic events (TEE) are serious complications after total hip (THA) and knee arthroplasty (TKA), with reported in-hospital incidences of about 0.5-1% for venous thromboembolic events (VTE) and 0.2% for myocardial infarctions (MI) and stroke. However, little data exist on in-hospital TEE when using a standardized fast-track protocol with early mobilization.MATERIALS AND METHODS: A large detailed cohort study in primary unilateral THA and TKAs on "early" (in-hospital or after discharge but within 1week of surgery) and 30-days TEEs, including prospective recording of patient characteristics, complete follow-up through the Danish National Patient Register, and detailed evaluation on disposing factors and consequences of "early" TEEs through review of medical records.RESULTS: In 13,775 procedures with a median LOS of 2days, 43 (0.32%; 95% CI: 0.23-0.42) "early" and 90 (0.65%; 95% CI: 0.53-0.80) 30-day TEEs were recorded. "Early" TEEs consisted of 9 (0.07%; 95% CI: 0.04-0.13) MI, 10 (0.08% 95% CI: 0.04-0.13) strokes, 13 (0.09%; 95% CI: 0.05-0.16) pulmonary embolisms and 11 (0.08%; 95% CI: 0.04-0.15) deep venous thromboses. Most TEEs were in patients with irreversible dispositions (e.g. previous TEE, high age and cardiac disease), but 5 of 9 MIs were associated with postoperative anemia. All in-hospital VTE (n: 16) occurred while patients received recommended thromboprophylaxis.CONCLUSIONS: Incidence of "early" TEEs after fast-track THA and THA is low, but MIs may be further reduced by improving perioperative treatment of anemia. Further research is needed regarding interventions for prevention of "early" TEE in disposed patients.

AB - INTRODUCTION: Thromboembolic events (TEE) are serious complications after total hip (THA) and knee arthroplasty (TKA), with reported in-hospital incidences of about 0.5-1% for venous thromboembolic events (VTE) and 0.2% for myocardial infarctions (MI) and stroke. However, little data exist on in-hospital TEE when using a standardized fast-track protocol with early mobilization.MATERIALS AND METHODS: A large detailed cohort study in primary unilateral THA and TKAs on "early" (in-hospital or after discharge but within 1week of surgery) and 30-days TEEs, including prospective recording of patient characteristics, complete follow-up through the Danish National Patient Register, and detailed evaluation on disposing factors and consequences of "early" TEEs through review of medical records.RESULTS: In 13,775 procedures with a median LOS of 2days, 43 (0.32%; 95% CI: 0.23-0.42) "early" and 90 (0.65%; 95% CI: 0.53-0.80) 30-day TEEs were recorded. "Early" TEEs consisted of 9 (0.07%; 95% CI: 0.04-0.13) MI, 10 (0.08% 95% CI: 0.04-0.13) strokes, 13 (0.09%; 95% CI: 0.05-0.16) pulmonary embolisms and 11 (0.08%; 95% CI: 0.04-0.15) deep venous thromboses. Most TEEs were in patients with irreversible dispositions (e.g. previous TEE, high age and cardiac disease), but 5 of 9 MIs were associated with postoperative anemia. All in-hospital VTE (n: 16) occurred while patients received recommended thromboprophylaxis.CONCLUSIONS: Incidence of "early" TEEs after fast-track THA and THA is low, but MIs may be further reduced by improving perioperative treatment of anemia. Further research is needed regarding interventions for prevention of "early" TEE in disposed patients.

KW - Aged

KW - Aged, 80 and over

KW - Anticoagulants

KW - Arthroplasty, Replacement, Hip

KW - Arthroplasty, Replacement, Knee

KW - Early Ambulation

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Incidence

KW - Male

KW - Middle Aged

KW - Myocardial Infarction

KW - Postoperative Complications

KW - Prospective Studies

KW - Pulmonary Embolism

KW - Risk Factors

KW - Stroke

KW - Venous Thrombosis

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1016/j.thromres.2015.12.025

DO - 10.1016/j.thromres.2015.12.025

M3 - Journal article

C2 - 26826506

SN - 0049-3848

VL - 138

SP - 37

EP - 42

JO - Thrombosis Research

JF - Thrombosis Research

ER -

Early thromboembolic events ≤1week after fast-track total hip and knee arthroplasty

Abstract

Keywords

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