Abstract Number: PB2279
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » VTE Diagnosis
Background: University hospitals Plymouth is a 900 bed teaching hospital and has been a national venous thromboembolism (VTE) exemplar site since 2009. VTE outcome data has been produced on all VTE events since 2011. In orthopaedic surgery, extended thromboprophylaxis (TP) with direct oral anticoagulants is used for elective hip and knee arthroplasty, with extended TP using low molecular weight heparin for emergency surgery.
Aims: All VTE events diagnosed following total hip replacement (THR), total knee replacement (TKR)and fractured neck of femur (#NOF) between 2011 and 2019, have been reviewed and compared to obtain trends over that time.
Methods: All VTE events from targeted investigations, comprising CT pulmonary angiograms, SPECT-CT scans and Doppler ultrasounds of upper and lower limbs were collected between January 1st 2010 and 31st December 2019. Positive scans reviewed to identifying whether VTE was a hospital acquired event (HAT) associated with orthopaedic surgery. HAT events following THR, TKR or # NOF were recorded and compared against annual numbers for surgery in these patients. Annual percentage rates of VTE for each operative type were calculated.
Results: The table shows all events over 9 years. VTE events in THR operations, range from 0.58% to 1.42% annual rates with overall 0.93% VTE events seen. For TKR the range was 0.21% to 1.53% with the overall rate of 0.67%. Finally for #NOF the range was 0.29% to 1.33% with an overall rate of 0.77%. Root cause analysis on all HAT events, identified 4 cases over nine years associated with inappropriate or inadequate TP.
Conclusions: VTE events were relatively stable in #NOF patients for 4 years, but have subsequently increased slightly. TKR showed initially high rates, followed by a significant reduction between 2014 and 2019 (p=0.02). Events associated with THR have remained consistent. The challenge is to facilitate further reductions in thrombosis in all, but particularly #NOF cohort.
YEAR | THR VTE Events | Total Operations | % | TKR VTE Events | Total Operations | % | #NOF VTE Events | Total Operations | % |
2011 | 3 | 433 | 0.69 | 7 | 458 | 1.53 | 3 | 541 | 0.55 |
2012 | 3 | 420 | 0.71 | 6 | 416 | 1.44 | 3 | 657 | 0.46 |
2013 | 3 | 424 | 0.71 | 3 | 402 | 0.75 | 2 | 686 | 0.29 |
2014 | 5 | 374 | 1.34 | 1 | 383 | 0.26 | 3 | 645 | 0.47 |
2016 | 4 | 421 | 0.95 | 1 | 472 | 0.21 | 6 | 636 | 0.94 |
2017 | 2 | 345 | 0.58 | 1 | 312 | 0.32 | 7 | 665 | 1.05 |
2018 | 6 | 422 | 1.42 | 3 | 392 | 0.77 | 5 | 618 | 0.81 |
2019 | 7 | 819 | 0.86 | 3 | 810 | 0.37 | 9 | 675 | 1.33 |
Totals (Inc 2015) | 37 | 3963 | 0.93 | 26 | 3896 | 0.67 | 44 | 5722 | 0.77 |
[Venous Thromboembolism events in Orthopaedic surgery 2011 – 2019]
To cite this abstract in AMA style:
Rowswell H, Nokes T. Venous Thromboembolism (VTE) Events in Elective and Emergency Orthopaedic Surgery in a Large Teaching Hospital 2011 to 2019 [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/venous-thromboembolism-vte-events-in-elective-and-emergency-orthopaedic-surgery-in-a-large-teaching-hospital-2011-to-2019/. Accessed March 21, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/venous-thromboembolism-vte-events-in-elective-and-emergency-orthopaedic-surgery-in-a-large-teaching-hospital-2011-to-2019/