Improving outcomes in patients at risk for venous thromboembolism following total knee and total hip replacement: implications for managed care.

An estimated 1 million Americans suffer from venous thromboembolism (VTE) annually and more than 600,000 experience symptomatic VTE events each year. Patients undergoing total knee replacement (TKR) and total hip replacement (THR) are at high risk for developing VTE (40%-60% risk without prophylaxis). The economic burden of post-TKR/THR VTE is very large, with the average length of stay more than double that of patients without VTE, and risk-adjusted overall costs 4 and 5 times greater among the TKR and THR populations, respectively, compared with non-VTE patients. Efforts are underway, however, in the public and private sectors to increase the rates of appropriate VTE thromboprophylaxis. Payers are experimenting with quality measurement and improvement programs to incentivize clinical behavior toward optimizing outcomes; the role of patient education in VTE prophylaxis is also evolving. There is an excellent opportunity to reshape the current patient education approach and develop appropriate, accessible materials, but, ultimately, a multipronged effort that targets as many variables related to VTE risk as possible is necessary in order to achieve success in lowering the burden of post-TKR/THR VTE.