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Thromboprophylaxis After Hospitalization for Joint Replacement Surgery

Giuliano, Karen K.; Pozzar, Rachel; Hatch, Courtney

The Journal for Healthcare Quality (JHQ): May 08, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/JHQ.0000000000000204
Original Article: PDF Only
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PAP

ABSTRACT Venous thromboembolism (VTE) is a leading cause of mortality during the perioperative period, with individuals who have undergone hip and knee arthroplasty at the highest risk for VTE. The American College of Chest Physicians recommends 35 days of postoperative thromboprophylaxis and the use of intermittent pneumatic compression (IPC) therapy for mechanical compression after major orthopedic surgery. However, little research has described adherence to these recommendations during recovery at home. The purpose of this cross-sectional descriptive study was to describe thromboprophylaxis prescription, use, and education among patients discharged home after major orthopedic surgery. We surveyed patients within 2 years of major orthopedic surgery. A total of 388 subjects completed the survey. More than three-quarters of respondents reported a thromboprophylaxis duration <35 days. Most (93.8%) respondents were prescribed a pharmacologic agent, while 55.9% were prescribed mechanical compression therapy. Of the respondents who were prescribed mechanical compression therapy, 13.4% were prescribed IPC. Adherence to mechanical compression therapy was moderate, with 63% of respondents wearing mechanical compression therapy ≥75% of the time. The results of this study suggest a need for increased duration of thromboprophylaxis and increased use of IPC in the outpatient setting. Additional research describing prescribers' perceptions of thromboprophylaxis is also needed.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

For more information on this article, contact Rachel Pozzar at pozzar.r@husky.neu.edu.

One author (K. K. Giuliano) received partial research funding from Recovery Force, LLC. Recovery Force, LLC, was not involved in data collection, data analysis, data interpretation, or creation of the final report.

The authors declare no conflicts of interest.

K. K. Giuliano received partial research funding from and works as a paid consultant for Recovery Force, LLC. The remaining authors declare no conflicts of interest.

© 2019 National Association for Healthcare Quality