Vivek Singh1, Nishanth Muthusamy1, Chibuokem P Ikwuazom1,2, Chelsea Sue Sicat1, Ran Schwarzkopf1, Joshua C Rozell3. 1. Department of Orthopaedic Surgery, Division of Adult Reconstruction, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA. 2. Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Health Science Center, New York, NY, USA. 3. Department of Orthopaedic Surgery, Division of Adult Reconstruction, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA. Joshua.Rozell@nyulangone.org.
Abstract
PURPOSE: The clinical impact of postoperative venous thromboembolism (VTE) following total joint arthroplasty (TJA) remains unclear. In this study, we evaluate the effect of VTE following TJA on postoperative outcomes including discharge disposition, readmission rates, and revision rates. METHODS: We retrospectively reviewed all patients over the age of 18 who underwent primary, elective THA or TKA between 2013 and 2020. Patients were stratified into two cohorts based on whether or not they had a VTE following their procedure. Baseline patient demographics and clinical outcomes such as readmissions and revisions were collected. Propensity score matching was performed to limit significant demographic differences, while independent sample t-tests and Pearson's chi-squared test were used to compare outcomes of interest between the groups. RESULTS: After propensity score matching, there were 109 patients in each cohort, representing a total of 218 patients for the matched comparison. Prior to matching, the VTE cohort was noted to have a significantly higher BMI than the non-VTE cohort (32.22 ± 6.27 vs 30.93 ± 32.04 kg/m2, p = 0.032). All other patient demographics were similar. Compared to the non-VTE cohort, the VTE cohort was less likely to be discharged home (66.1% vs 80.7%; p = 0.021), had a higher rate of 90-day all-cause readmissions (27.5% vs 9.2%, p = 0.001), and a higher two-year revision rate (11.0% vs 0.9%, p = 0.003). CONCLUSION: Patients with postoperative VTE were less likely to be discharged home and had higher 90-day readmission and two-year revision rates. Therefore, mitigating perioperative risk factors, initiating appropriate long-term anticoagulation, and maintaining close follow-up for patients with postoperative VTE may play significant roles in decreasing hospital costs and the economic burden to the healthcare system. LEVEL OF EVIDENCE III: Retrospective Cohort Study.
PURPOSE: The clinical impact of postoperative venous thromboembolism (VTE) following total joint arthroplasty (TJA) remains unclear. In this study, we evaluate the effect of VTE following TJA on postoperative outcomes including discharge disposition, readmission rates, and revision rates. METHODS: We retrospectively reviewed all patients over the age of 18 who underwent primary, elective THA or TKA between 2013 and 2020. Patients were stratified into two cohorts based on whether or not they had a VTE following their procedure. Baseline patient demographics and clinical outcomes such as readmissions and revisions were collected. Propensity score matching was performed to limit significant demographic differences, while independent sample t-tests and Pearson's chi-squared test were used to compare outcomes of interest between the groups. RESULTS: After propensity score matching, there were 109 patients in each cohort, representing a total of 218 patients for the matched comparison. Prior to matching, the VTE cohort was noted to have a significantly higher BMI than the non-VTE cohort (32.22 ± 6.27 vs 30.93 ± 32.04 kg/m2, p = 0.032). All other patient demographics were similar. Compared to the non-VTE cohort, the VTE cohort was less likely to be discharged home (66.1% vs 80.7%; p = 0.021), had a higher rate of 90-day all-cause readmissions (27.5% vs 9.2%, p = 0.001), and a higher two-year revision rate (11.0% vs 0.9%, p = 0.003). CONCLUSION: Patients with postoperative VTE were less likely to be discharged home and had higher 90-day readmission and two-year revision rates. Therefore, mitigating perioperative risk factors, initiating appropriate long-term anticoagulation, and maintaining close follow-up for patients with postoperative VTE may play significant roles in decreasing hospital costs and the economic burden to the healthcare system. LEVEL OF EVIDENCE III: Retrospective Cohort Study.
Authors: Yngve Falck-Ytter; Charles W Francis; Norman A Johanson; Catherine Curley; Ola E Dahl; Sam Schulman; Thomas L Ortel; Stephen G Pauker; Clifford W Colwell Journal: Chest Date: 2012-02 Impact factor: 9.410
Authors: John A Heit; W Michael O'Fallon; Tanya M Petterson; Christine M Lohse; Marc D Silverstein; David N Mohr; L Joseph Melton Journal: Arch Intern Med Date: 2002-06-10
Authors: F Vekeman; J C LaMori; F Laliberté; E Nutescu; M S Duh; B K Bookhart; J Schein; K Dea; W H Olson; P Lefebvre Journal: J Med Econ Date: 2012-03-12 Impact factor: 2.448
Authors: Bennett Levitan; Zhong Yuan; Alexander G G Turpie; Richard J Friedman; Martin Homering; Jesse A Berlin; Scott D Berkowitz; Rachel B Weinstein; Peter M DiBattiste Journal: Vasc Health Risk Manag Date: 2014-03-26