PURPOSE: Venous thromboembolism is a clinical syndrome affected by certain risk factors, one of which is orthopedic surgery. It is the objective of this study to determine the incidence of pharmacologic and non-pharmacologic use of VTE prophylaxis in all patients undergoing orthopedic surgery in a tertiary hospital from 2007-2008.
METHODS: A review of records of all patients seen for orthopedic surgery in University of Santo Tomas Hospital from January 1, 2007 up to December 31, 2008, were included in the study. The patient characteristics, type of orthopedic surgery, pharmacologic and non-pharmacologic use of antithrombotic prophylaxis were noted. The primary outcome of in-hospital mortality as well as secondary outcomes of length of hospital stay and morbidities were recorded. Association of giving pharmacologic prophylaxis and survival was done using Spearman correlation.
RESULTS: A total of 79 patients were included in the study. Majority underwent partial hip replacement (n= 36/79). The use of chemical prophylaxis in the form of subcutaneous heparin was utilized in 17/38 patients in 2007, while only 9/41 were given prophylaxis in 2008. Consultation to a rehab med specialist was made while in the hospital in 32/38 patients in 2007 while 28/41 in 2008. Mechanical prophylaxis, in the form of anti-embolic stockings was used in 4/38 patients in 2007 (10.5%); of whom, 4/38 had contraindication for LMWH. In 2008, out of the 3/41 who were given mechanical prophylaxis, 6 actually had contraindication. Mean length of hospital stay was 14.8 days in 2007 while 11 days in 2008. All-cause in hospital mortality was 2/38 in year 2007; 0/41 in 2008. A significant association of giving LMWH with those who were discharged alive was seen (approximation significant= 0.041).
CONCLUSION: There is underutilization of pharmacologic antithrombotic prophylaxis in patients for orthopedic surgery in our institution. Utilization of LMWH was associated with survival.
CLINICAL IMPLICATIONS: A change in paradigm of bleeding risk versus VTE risk and mortality risk should be considered in these orthopedic patients for surgery.
DISCLOSURE: Julie Christie Visperas, No Financial Disclosure Information; No Product/Research Disclosure Information