1
|
Tong K, Liu H, Qin J, Pan Z, Shangguan Y, Xiao H, Wang H, Chen L, Tan Y. Current status survey of the extramural hospital management of venous thromboembolism after total hip and knee arthroplasty in China. BMC Musculoskelet Disord 2021; 22:787. [PMID: 34517870 PMCID: PMC8438984 DOI: 10.1186/s12891-021-04663-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a potentially fatal complication after arthroplasty. Numerous prophylactic strategies and studies to reduce VTEs have focused on the duration of the hospital stay and on few extramural hospitals. This study aimed to investigate extramural hospital management of VTE after total hip/knee arthroplasty (THA/TKA) in China with a novel survey tool. METHODS A total of 180 patients undergoing arthroplasty, including 68 THA patients and 112 TKA patients, were enrolled in this study. All patients received anticoagulant treatment management. A survey querying VTE management and adherence, such as therapy information, understanding of anticoagulation, satisfaction with the ability of medical staff, and satisfaction with health care costs, was administered by a questionnaire (TKA/THA Patients' Experience with Anticoagulation in the Post-discharge Period) for quality improvement. RESULTS The average age of the patients was 65.27 ± 13.62 years. All patients knew their follow-up times. 85 % of them were suggested that re-examine at the next 14 days, and the others at the next 28 days. All patients continued to visit the orthopaedic clinic after discharge without choosing other types of outpatient services, such as an anticoagulant clinic or home visit with a nurse/pharmacist or remote evaluation by telephone. A total of 96.6 % of all patients used new oral anticoagulants, and the most common treatment duration was 2-4 weeks (93.3 %). 48 % informed their physicians that they were taking anticoagulation medications when they visited ophthalmology, dentistry, dermatology, and other departments. The overall rate of satisfaction with anticoagulation management was 81.67 %, and 6.67 % of patients were not unsatisfied with their medical expenses. Patient compliance decreased with increasing follow-up time. Continuous follow-ups after discharge significantly improved patient compliance. CONCLUSIONS These results elucidate how we can improve the quality of anticoagulation. Continuous follow-up appointments for 30 days after discharge, especially for individuals over 65 years old, significantly improved patient satisfaction and reduced the incidence of VTE and medical costs.
Collapse
Affiliation(s)
- Kai Tong
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan City, Hubei Province, 430071, PR China
| | - Hankun Liu
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan City, Hubei Province, 430071, PR China
| | - Jun Qin
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan City, Hubei Province, 430071, PR China
| | - Zhengqi Pan
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan City, Hubei Province, 430071, PR China
| | - Yangfan Shangguan
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan City, Hubei Province, 430071, PR China
| | - Hao Xiao
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan City, Hubei Province, 430071, PR China
| | - Hua Wang
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan City, Hubei Province, 430071, PR China
| | - Liaobin Chen
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan City, Hubei Province, 430071, PR China
| | - Yang Tan
- Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan City, Hubei Province, 430071, PR China.
| |
Collapse
|
2
|
Alameri MA, Syed Sulaiman SA, Ashour AM, Al-Saati MF. Venous thromboembolism prevention protocol for adapting prophylaxis recommendations to the potential risk post total knee replacement: a randomized controlled trial. Pharm Pract (Granada) 2020; 18:2025. [PMID: 33029262 PMCID: PMC7523558 DOI: 10.18549/pharmpract.2020.3.2025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/20/2020] [Indexed: 12/11/2022] Open
Abstract
Background Total knee replacement (TKR) is a major orthopedic surgery that is considered high risk for the development of venous thromboembolism (VTE). Objective The aim of this study is to evaluate the clinical outcomes that resulted from the use of a new proposed VTE risk stratification protocol for selecting a suitable extended VTE prophylaxis for post TKR surgery patients administered in conjunction with patient education programs. Method A randomized controlled trial was conducted in two medical centers in Saudi Arabia. A total of 242 patients were enrolled in the study, 121 patients in each group. The experimental group (A) was assessed by using the proposed VTE risk stratification protocol and also took part in patient education programs about TKR and its complications. The control group (B) was assessed by using the 2005 Caprini risk assessment tool and no education programs were given to this group. Both groups were followed for 35 days post operation. Results The mean age of the participants was 65.86 (SD 8.67) and the majority of them were female 137 (56.6%). The mean body mass index of the study sample was 32.46 (SD 5.51). There were no significant differences between the two groups except for surgery type; the proportion of bilateral TKR in group A was higher than in group B (69/121 (28.5%) vs. 40/121(16.5%), p<0.05). There were no confirmed pulmonary embolism cases in the study sample and diagnosis of deep-vein thrombosis was confirmed in 12/242 (5.0%) of patients: 1/121 (0.8%) in group A and 11/121 (9.1%) in group B (p<0.05). The readmission rate for all patients was 2.5% (6/242), all of whom were in group B (p<0.05). Conclusion The proposed VTE risk stratification protocol that was applied in conjunction with patient education programs reduced VTE complications and readmission events, post TKR surgery. Trial Registration: ClinicalTrials.gov: Identifier: NCT04031859.
Collapse
Affiliation(s)
- Mariam A Alameri
- Department of Clinical Pharmacy, School of Pharmaceutical Science, University of Science Malaysia. Penang (Malaysia).
| | - Syed A Syed Sulaiman
- Director. Advanced Institute of Medicine and Dentistry, University of Science Malaysia. Penang (Malaysia).
| | - Abdullah M Ashour
- Deputy Director & Director of Residency Training Programme. Division Head and Consultant of Arthroplasty and Adult Reconstructive Surgery, Orthopaedics Department, Prince Sultan Military Medical City. Riyadh (Saudi Arabia).
| | - Ma'ad F Al-Saati
- Chairmen of the Orthopedic Department. King Abdullah bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University. Riyadh (Saudi Arabia).
| |
Collapse
|
3
|
Improta G, Balato G, Ricciardi C, Russo MA, Santalucia I, Triassi M, Cesarelli M. Lean Six Sigma in healthcare. TQM JOURNAL 2019. [DOI: 10.1108/tqm-10-2018-0142] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Since healthcare spending accounts for approximately 6.6 per cent of the gross domestic product, reducing waste in health facilities is necessary to generate significant cost savings. After previous work concerning the application of Lean Six Sigma (LSS) to hip surgery, the purpose of this paper is to use LSS as the correct methodology to analyse a clinical pathway. Fast track surgery was introduced to the Complex Operative Unit of Orthopaedic and Traumatology of the University Hospital “Federico II” to improve quality and further reduce costs associated with prosthetic hip replacement surgery.
Design/methodology/approach
The DMAIC (Define, measure, analyse, improve, control) roadmap was used as the typical problem-solving approach of the LSS methodology. A rigorous process of defining, measuring, analysing, improving and controlling business problems can be used to reach fixed goals. The paper was written following the Standards for Quality Improvement Reporting Excellence (SQUIRES Guidelines).
Findings
In this work, the authors found that multiple variables could influence the length of hospital stay (LOS) for inpatient treatment, thereby increasing patient management costs due to longer periods of hospitalisation. Therefore, LSS analysis of the implemented corrective actions demonstrated the efficacy and efficiency of the novel protocol. The average LOS was reduced from 10.66 to 7.8 days (−26.8 per cent).
Originality/value
The introduction of fast track surgery was validated through a rigorous LSS analysis, which demonstrated that the new protocol benefitted both patients and the hospital.
Collapse
|
4
|
Kreutz R, Haas S, Holberg G, Lassen MR, Mantovani LG, Schmidt A, Turpie AGG. Rivaroxaban compared with standard thromboprophylaxis after major orthopaedic surgery: co-medication interactions. Br J Clin Pharmacol 2016; 81:724-34. [PMID: 26580706 PMCID: PMC4799939 DOI: 10.1111/bcp.12836] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 11/09/2015] [Accepted: 11/15/2015] [Indexed: 12/04/2022] Open
Abstract
Aim The aim of the present study was to analyse concomitant drug use and its association with outcome in patients (N = 17 701) receiving rivaroxaban or standard of care (SOC) for the prevention of venous thromboembolism after major orthopaedic surgery in the non‐interventional, phase IV XAMOS (Xarelto® in the prophylaxis of post‐surgical venous thromboembolism after elective major orthopaedic surgery of hip or knee) study. Methods Concomitant drug use was at the discretion of the treating physician. Prespecified co‐medications of interest were cytochrome P450 (CYP) 3A4/P‐glycoprotein inhibitors/inducers, platelet aggregation inhibitors (PAIs) and nonsteroidal anti‐inflammatory drugs (NSAIDs). Crude event incidences were compared between rivaroxaban and SOC groups. Results CYP3A4/P‐glycoprotein inhibitor/inducer use was infrequent, in contrast to PAI (~7%) and NSAID (~52%) use. Rivaroxaban was associated with a lower incidence of overall symptomatic thromboembolic events compared with SOC, regardless of co‐medication use. In both treatment groups, PAI users, with higher age and prevalence of cardiovascular co‐morbidities, had similar higher (>7‐fold) incidences of symptomatic arterial but not venous thromboembolic events compared with non‐users. NSAID use had no influence on thromboembolic events. However, odds ratios (ORs) for major bleeding events (European Medicines Agency definition) were higher in NSAID users compared with non‐users in rivaroxaban [OR = 1.50; 95% confidence interval (CI) 1.06, 2.13] and SOC (OR = 1.70; CI 1.16, 2.49) groups. In PAI users, ORs for major bleeding events were no different from those of non‐users in both the rivaroxaban (OR = 1.49; CI 0.84, 2.65) and SOC (OR = 1.46; CI 0.82, 2.62) groups. Conclusions Use of NSAIDs in XAMOS was frequent and associated with a higher frequency of bleeding events in patients receiving rivaroxaban or SOC, although the benefit–risk profile of rivaroxaban compared with SOC was maintained.
Collapse
Affiliation(s)
- Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité-Universitätsmedizin, Berlin, Germany
| | - Sylvia Haas
- Institute for Experimental Oncology and Therapy Research, Technical University of Munich, Munich, Germany
| | | | | | - Lorenzo G Mantovani
- CESP-Center for Public Health Research, University of Milan-Bicocca, Monza, Italy
| | | | | |
Collapse
|
5
|
Camm AJ, Amarenco P, Haas S, Hess S, Kirchhof P, van Eickels M, Turpie AGG. XANTUS: rationale and design of a noninterventional study of rivaroxaban for the prevention of stroke in patients with atrial fibrillation. Vasc Health Risk Manag 2014; 10:425-34. [PMID: 25083135 PMCID: PMC4108256 DOI: 10.2147/vhrm.s63298] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Atrial fibrillation (AF) is associated with a fivefold increase in the risk of stroke. The Phase III ROCKET AF (Rivaroxaban Once-Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) trial showed that rivaroxaban, an oral, direct Factor Xa inhibitor, was noninferior to warfarin for the reduction of stroke or systemic embolism in patients with AF. Compared with warfarin, rivaroxaban significantly reduced rates of intracranial and fatal hemorrhages, although not rates of bleeding overall. XANTUS (Xarelto(®) for Prevention of Stroke in Patients with Atrial Fibrillation) is a prospective, international, observational, postauthorization, noninterventional study designed to collect safety and efficacy data on the use of rivaroxaban for stroke prevention in AF in routine clinical practice. The key goal is to determine whether the safety profile of rivaroxaban established in ROCKET AF is also observed in routine clinical practice. XANTUS is designed as a single-arm cohort study to minimize selection bias, and will enroll approximately 6,000 patients (mostly from Europe) with nonvalvular AF prescribed rivaroxaban, irrespective of their level of stroke risk. Overall duration of follow-up will be 1 year; the first patient was enrolled in June 2012. Similar studies (XANTUS-EL [Xarelto(®) for Prevention of Stroke in Patients with Nonvalvular Atrial Fibrillation, Eastern Europe, Middle East, Africa and Latin America] and XANAP [Xarelto(®) for Prevention of Stroke in Patients with Atrial Fibrillation in Asia-Pacific]) are ongoing in Latin America and Asia-Pacific. Data from these studies will supplement those from ROCKET AF and provide practical information concerning the use of rivaroxaban for stroke prevention in AF.
Collapse
Affiliation(s)
- A John Camm
- Division of Clinical Sciences, St George's, University of London, London, UK
| | - Pierre Amarenco
- Department of Neurology and Stroke Center, Paris-Diderot-Sorbonne University, Paris, France
| | | | - Susanne Hess
- Medical Affairs, Bayer HealthCare Pharmaceuticals, Berlin, Germany
| | - Paulus Kirchhof
- Centre for Cardiovascular Sciences, University of Birmingham and Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK ; Department of Cardiovascular Medicine, University of Münster, Münster, Germany
| | | | | |
Collapse
|
6
|
Rachidi S, Aldin ES, Greenberg C, Sachs B, Streiff M, Zeidan AM. The use of novel oral anticoagulants for thromboprophylaxis after elective major orthopedic surgery. Expert Rev Hematol 2013; 6:677-95. [PMID: 24219550 PMCID: PMC4124620 DOI: 10.1586/17474086.2013.853430] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Venous thromboembolism is a common cause of morbidity and mortality among patients undergoing elective orthopedic surgery. Due to the high incidence of venous thromboembolism in this setting, perioperative anticoagulation is the recommended approach for thromboprophylaxis. Low molecular weight heparin (LMWH), fondaparinux and warfarin are the agents commonly used for thromboprophylaxis. The well-recognized limitations of warfarin and the inconvenience and discomfort associated with the subcutaneous administration of low molecular weight heparin and fondaparinux inspired intense investigation to develop novel oral anticoagulants (NOACs) with more predictable pharmacokinetics, fewer drug interactions and no need for regular laboratory monitoring. Three NOACs have been demonstrated to be effective for thromboprophylaxis after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in large randomized controlled trials. Here we review the pharmacology of rivaroxaban, dabigatran, and apixaban, summarize the major clinical trials of these agents in thromboprophylaxis after THA and TKA, and discuss the clinical factors to be considered by providers when selecting a NOAC for their patients.
Collapse
Affiliation(s)
- Saleh Rachidi
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - Ehab Saad Aldin
- Department of Internal Medicine, Good Samaritan Hospital, Baltimore, MD, USA
| | - Charles Greenberg
- Division of Hematology/Oncology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Barton Sachs
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Michael Streiff
- Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Amer M Zeidan
- Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University, The Sidney Kimmel Comprehensive Cancer Center, 1650 Orleans Street, CRB1, Room 186, Baltimore, MD, USA
| |
Collapse
|