What Are Drivers of Readmission for Readmission-Requiring Venous Thromboembolic Events After Primary Total Hip Arthroplasty? An Analysis of 544,443 Cases

BackgroundVenous thromboembolism (VTE) is a potential postoperative complication after total hip arthroplasty (THA). These events present with a range of severity, and some require readmission. The present study aimed to identify unexplored risk factors for severe VTE that lead to hospital readmission.MethodsThe Agency of Healthcare Research and Quality’s National Readmissions Database was retrospectively queried for all patients who underwent primary THA (January 2016 to December 2018). Study population included patients who were readmitted for VTE within 90 days after an elective THA. Bivariate and multivariate regression analyses were performed using patient demographics, insurance status, elective nature of the surgery, healthcare institution characteristics, and baseline comorbidities.ResultsHigher risk of readmission for VTE was evident among elderly (71-80 years vs <40 years: odds ratio [OR] 1.7, 95% confidence interval [CI] 1.3-2.2, P = .0002), male patients (OR 1.2, 95% CI 1.2-1.3). Nonelective THAs were associated with markedly higher odds of readmission for VTE (OR 20.5, 95% CI 18.9-22.2), peripheral vascular disease (OR 1.2, 95% CI 1.1-1.4), lymphoma (OR 1.5, 95% CI 1.1-2.1), metastatic cancer (OR 1.8, 95% CI 1.4-2.2), obesity (OR 1.5, 95% CI 1.4-1.6), and fluid-electrolyte imbalance (OR 1.1, 95% CI 1.0-1.2). Home health care (OR 0.8, 95% CI 0.7-0.8) and discharge to skilled nursing facility (OR 0.7, 95% CI 0.7-0.8) had lower odds of readmission for VTE vs unsupervised home discharge, while insurance type was not a significant driver(P > .05).ConclusionOne in 135 THA patients is likely to experience a VTE requiring readmission after THA. Male patients, age >70 years, and specific baseline comorbidities increase such risk. Furthermore, discharge to a supervised setting mitigated the risk of VTE requiring readmission compared to unsupervised discharge. As VTE prophylaxis protocols continue to evolve, these patients may require optimized perioperative care pathways to mitigate VTE complications.     

人工髋关节置换与下肢深静脉血栓的关系分析

目的分析人工髋关节置换术后,患者出现下肢深静脉血栓(DVT)的影响因素。方法选取我院2010年2月至2012年1月收治92例进行髋关节置换手术的患者作为观察对象,全部患者于术前7 d及术后7 d行血管彩超(双下肢),分析年龄、性别、BMI、激素应用、TG、糖尿病、高血压等15项因素与术后DVT发生的相关性。结果血管彩超结果显示,92例患者中,28例患者于术后发现DVT(30.43%),血栓均分布在患者小腿肌间。其中,13例患者(46.43%)无相关临床症状。女性、肥胖、高龄、O型血、高血压、糖尿病、总输血量大、胆固醇及三酰甘油高是DVT发生的危险因素,RR值>1。其中,患者年龄>65岁,大量输血,TG水平高(≥1.7 mmol/L)与DVT发生密切相关,P<0.05,具统计学意义。结论患者年龄>65岁,大量输血、TG水平高是诱发术后DVT的重要因素。因此,在髋关节置换术后,我们应严格控制患者输血量;若患者需要大量输血,我们可采用少量多次的方法补充血液;此外,DVT还应引起B超医师及临床医师的足够重视。     

皮下注射低分子肝素钙预防烧伤植皮后深静脉血栓形成的效果评价

目的：评估皮下注射低分子肝素钙对预防烧伤植皮后深静脉血栓(DVT)形成的效果。方法选取2013年1月~2014年12月本院收治的79例烧伤后需植皮的患者,其中皮下注射低分子肝素钙预DVT患者41例设为治疗组。植皮术后仅使用红外线治疗仪照射,硫酸镁热敷,活动肌肉组织等基础措施的38例为对照组。统计血浆D-二聚体(D-dimer)浓度、血小板计数、植皮成活率、创面愈合时间、感染病例数、组织器官出血病例数和DVT形成数等指标。结果治疗组术后第3、7、11、15 d的血浆D-dimer浓度均低于对照组(P<0.05);对照组的血栓形成率为10.5%,明显高于治疗组的0(P<0.05);两组术前1 d的D-dimer浓度、血小板计数,植皮成活率、创面愈合时间、感染及出血发生率差异无统计学意义(P>0.05)。结论皮下注射低分子肝素钙对预防烧伤植皮术后患者DVT形成有一定的临床意义。     

Venous thromboembolism after Diaphragm Pacing in amyotrophic lateral sclerosis

Introduction: Patients with amyotrophic lateral sclerosis (ALS) are prone to venous thromboembolism (VTE) and secondary complications. Because there is an increased incidence of VTE after surgical procedures, placement of a Diaphragm Pacing System (DPS) in ALS patients as treatment for respiratory muscle weakness could potentially increase the incidence of VTE, especially in patients with limited mobility. Methods: We implanted a DPS in 10 ALS patients who met the criteria for this procedure. They underwent a preoperative evaluation as recommended by the guidelines. Results: We report 2 patients with no symptoms of deep vein thrombosis (DVT) before the surgical procedure who then developed perioperative VTE. Conclusions: These patients highlight the need to consider preoperative screening for DVT and postoperative thromboprophylaxis in high‐risk ALS patients who undergo DPS placement. Muscle Nerve 50 : 863–865, 2014     

两种抗凝剂预防老年髋部周围骨折患者围手术期深静脉血栓形成的疗效对比

目的：对比分析低分子量肝素钙与阿哌沙班预防老年髋部周围骨折患者围手术期深静脉血栓形成(DVT)的疗效性及安全性。方法：收集2018年3月-2020年3月在山西省中医院骨科行手术治疗的老年髋部周围骨折患者共70例,按随机数字表法分为A组（低分子量肝素钙组）和B组（阿哌沙班组）,各35例;A组皮下注射低分子量肝素钙 0.4mL Qd,B组口服阿哌沙班 2.5mg Bid。两组术后持续抗凝35天,随访3月,比较两组凝血指标、术后引流量、围手术期DVT及出血事件发生率。结果：（1）两组患者术后与术前相比,PLT、D-二聚体下降,APTT、PT延长,且B组D-二聚体较A组明显下降,相比差异有统计学意义（P<0.05）,而两组APTT、PT、PLT相比差异无统计学意义（P>0.05）;（2）两组术后引流量（A组：170.86±126.40mL,B组：175.71±141.39mL）相比差异无统计学意义（P>0.05）;（3）两组患者围手术期DVT发生率对比差异有统计学（P<0.05）,其中A组发现DVT患者9例（25.7%）,B组发现DVT患者2例（5.7%）;（4）两组患者出血事件发生率相比差异无统计学意义（P>0.05）。结论：与低分子量肝素钙相比,老年髋部周围骨折患者围手术期使用阿哌沙班预防DVT的疗效更佳,且不增加出血风险。     

Venous thromboembolism during pregnancy and the post-partum period: incidence and risk factors in a large Victorian health service

BACKGROUND: There is a strong recommendation for post-partum thromboprophylaxis following emergency caesarean sections, particularly in overweight women, and following prolonged labour. AIMS: To analyse the incidence and epidemiological factors associated with antepartum and post-partum venous thromboembolism in a large Victorian health service. METHODS: A retrospective study of all 6987 women delivering at Ballarat Health Services between March 1999 and June 2006. Case notes of women with confirmed venous thromboembolism during this period were subjected to detailed analysis. The data were analysed for possible risk factors, the timing of thromboembolism in relation to the pregnancy and any correlation with thromboprophylaxis, if administered. Results: The rate of venous thromboembolism was 1.14 per 1000 deliveries, with risk factors of age > 30 (100%), obesity (75%), previous history of thromboembolism (62.5%) and caesarean section (37.5%). Majority of cases were diagnosed in first trimester (62.5%), and in the right lower limb (75%). None of the patients had been given thromboprophylaxis. CONCLUSION: While the incidence and risk factors were similar to those generally quoted, a much higher incidence was found in early pregnancy, and in the right lower limb. The importance of meticulous screening for risk factors in early pregnancy cannot be overemphasised.     

凝血指标监测对骨创伤及术后形成DVT的临床诊断价值

目的监测纤维蛋白原（Fib）、D-二聚体（D-Dimer）、P-选择素（P-selectin）探讨其在骨创伤深静脉血栓形成中的临床诊断价值。方法选择创伤骨折及关节置换患者223例，经彩色多普勒确诊的DVT患者45例。正常对照组为健康查体者40例。Fib测定采用PT导出法，D—Dimer测定采用散射比浊法，P-selectin测定采用酶联免疫吸附双抗体夹心法。结果Fib、D—Dimer、P—selectin在健康对照组、创伤骨折组及DVT组的结果比较，具有显著性差异（P〈0．05），且不同创伤骨折组之间Fib、D—Dimer、P-selectin阳性率的比较，均有显著性差异（P〈0．05）。D—Dimer、P-selectin在关节置换组中DVT组与非DVT组之间术前比较无显著性差异，而术后比较有显著性差异（P〈0．05）。结论检测创伤骨折患者Fib、D—Dimer、helectin对排除刨伤后DVT形成具有临床实用价值。     

One-Year Analysis of the Prospective Multicenter SENTRY Clinical Trial: Safety and Effectiveness of the Novate Sentry Bioconvertible Inferior Vena Cava Filter

Purpose

To prospectively assess the Sentry bioconvertible inferior vena cava (IVC) filter in patients requiring temporary protection against pulmonary embolism (PE).

髋及股部损伤后下肢深静脉血栓形成

目的　探讨髋及股部损伤后下肢深静脉血栓 (Deep -veinthrombosis,DVT)形成的机理和防治对策。方法　对 64例下肢DVT患者行超声多普勒检查、记录 ,并分析受伤肢体的左右侧别、库血的输入、高龄、糖尿病、心脑血管疾病、肥胖等因素与下肢DVT形成的关系。结果　在同期髋及股部损伤患者 32 5例中下肢DVT 64例 (1 8 2 % ) ;近端DVT 1 3例 (2 0 3 % ) ,远端DVT 36例 (56 3 % ) ,全静脉DVT 1 5例 (2 3 4% ) ;左下肢DVT 43例 (66 7% ) ,右下肢DVT 2 1例 (33 3 % ) ;库血的输入 59例 (92 2 % ) ;使用止血带患者 1 6例 (2 5 0 % ) ;患者平均年龄 62岁。结论　髋及股部损伤患者中 ,存在高危因素患者DVT发生率较高 ,建议对围手术期存在高危因素患者采取适当的预防性治疗 ,对发生DVT患者行规范有效的治疗