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Higher venous thromboembolism risk at low-volume hospitals


Patients who undergo elective total hip or total knee replacements at hospitals with lower surgical volume have a higher risk of venous thromboembolism and mortality following the procedure, according to an American study.

Researchers looked at the records of around 10,000 patients who had undergone a hip replacement and about 20,000 who had a knee replacement.

The study published in Arthritis and Rheumatism, a journal of the American College of Rheumatology, found complications at low volume sites could be reduced by modifying procedures before and after surgery.

Compared to high-volume hospitals, patients who underwent elective primary THA at low-volume hospitals had a higher risk of venous thromboembolism and one-year mortality.

Patients aged more than 60 years who underwent elective primary TKA at low-volume hospitals had significantly higher risk of one-year mortality compared with high volume hospitals.

The researchers said: “Modifiable system-based factors/processes should be targeted to reduce complications.”


Readers' comments (8)

  • does this mean that birtish hospitals are still neglecting to put all these patients on prophylactic s/c heparin 5000units pre and post op as is done routinely in europe?

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  • The moral of this tale is, if you are over 60 and need elective surgery of this type, do not choose to have it done in a Britsh hospital!

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  • katrinaG

    To the two anonymous post's authors 'read the article! This paper is set in America (Pennsylvania) and describes the practice there. There is so much work being done to reduce VTE events in the UK - the first anonymous post seems to suggest that routine thromboprophylaxis does not happen in the UK (you are wrong, it does and what is more for this group of patients extended prophylaxis is the norm). The second anonymous post has likewise, completley missed the point.

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  • i haven't missed the point at all from my above two comments. i simply know from experience that some european countries are far in advance of the uk in this regard and with concern for patient safety. patients are put on sc heparin routiinely pre and post op and take this home with them to self inject. i have never seen this happen in the uk and hence the higher incidence of dvt.

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  • besides katrinaG | 13-Jun-2011 10:31 am
    the article is available on subscription only!

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  • I am a practicing RGN & have recently had my 4th revision THR in a London Orthopaedic Hospital. My pre & post op care involved SC Heparin. My care throughout was exemplary & i have made a full, uneventful recovery.

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  • i work on an orthopaedic ward and whilst we have mainly orthopaedic patients we also get medical and other surgical patients admitted. all patients are prescribed clexane and ted stocking on their drug charts. Patients who do not wish to wear the ted stockings are explained the need for these and documented if they refuse and other exemptions are patients with poor venous flow or ulcerated legs

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  • looks as though care may be improving in the UK, but only in some areas (geographical and specialisations), but sadly it still lags seriously behind the rest of west. europe.

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