Abstract
Introduction
Venous Thromboembolism is a well documented complication of Total hip and total knee replacement, and NICE guidelines recommend use of pharmacological prophylaxis routinely after these procedures. Current practice in our department is use of mechanical prophylaxis routinely, and chemical prophylaxis in high risk cases only. Previous departmental audit has shown VTE rates to be lower than the national average, however medical and haematology audit has contradicted this, and suggested that practices should be revised to include chemical prophylaxis routinely. This study seeks to determine whether we are seeing the full extent of the problem and whether our practices should be revised accordingly.
Methods
Retrospective study of all patients presenting to our hospital with suspected DVT/PE from February 2009 – August 2009. Patients were identified through radiology records; every patient undergoing venous Doppler studies or CT pulmonary angiography were included. The casenotes of patients with positive scans were reviewed; and relevant information extracted from the notes.
Results
475 patients presenting with suspected DVT/PE between February 2009 and August 2009. 39 confirmed DVT; 37 confirmed PE. 87% admitted under acute medical intake. 2 confirmed DVT's in post operative THR/TKR patients, accounting for 5.1% of DVT's in this timeframe. No PE's following THR/TKR in this timeframe. Overall postoperative THR/TKR accounts for 2.6% of confirmed VTE in this hospital. Rates of DVT 1.19% of total hip replacements; 0.93% of total knee replacements.
Discussion
Actual rates of VTE low amongst our post operative patients, suggesting current methods of thromboprohylaxis are effective. Changes in thromboprophylaxis practices probably not cost-effective; however it is difficult to justify not changing practices due to recent publication of NICE guidance. Rates comparable to previous audit, suggesting that patients are not being ‘missed by orthopaedic audit’.
