Using a Bundle Prophylactic Approach in Post-Operative Total Knee and Hip Arthroplasty

2.50
Hdl Handle:
http://hdl.handle.net/10755/621634
Category:
Full-text
Format:
Text-based Document
Type:
Poster
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Using a Bundle Prophylactic Approach in Post-Operative Total Knee and Hip Arthroplasty
Author(s):
Wang, Haofei; Ryan, Patrick G.
Lead Author STTI Affiliation:
Omicron Delta
Author Details:
Haofei Wang, DNP, RN, NEA-BC, Professional Experience: 2016-present -- Director, Nursing Practice & Quality, NewYork-Presbyterian/Regional Hospital Network, New York, NY 2011-2016 -- Program Director, Patient Education and Nursing Practice, NewYork-Presbyterian Hospital/Office of Professional Nursing practice, New York, NY 2007-2011 -- Performance Improvement and Quality Management Specialist, NewYork-Presbyterian Hospital/Division of Quality and Patient Safety, New York, NY. Responsible for integration of NYP/Regional Hospitals nursing practice and quality (2016-present). Responsible for development, implementation, and maintenance of nursing clinical standards based on evidence-based practice in accordance with all applicable federal, state, local professional and regulatory requirements (2011-2016). Lead Hospital wide Patient and Family Education program including planning, development, implementation and evaluation on policies, guidelines, programs and processes (2011-2016). Author Summary: Demonstrate in-depth understanding of complex patient population and ability to forge, lead, and motivate outstanding health care teams that provide top-quality patient care. Promote the organizational philosophy, goals and objectives, and ensure development, implementation, and monitoring of nursing department goals and objectives. Promote nursing research and evidence-based practice, and provide an environment that is conductive to the conduct of ongoing research and evidence-based practice.
Abstract:

Background: Evidence is limited on which prophylactic intervention(s) to prevent post-operative VTE is/are optimal or suboptimal in TKA and THA population.

Objectives: To examine the different types of prophylactic interventions (pharmacological and mechanical), patient age and BMI, bleeding tendency and renal function, and type of surgeries (TKA and THA) in relation to VTE incidence.

Purpose: Deep vein thrombosis (DVT) is a blood clot that occurs in a deep vein of the body; pulmonary embolism (PE) occurs when a clot breaks free and enters the arteries of the lungs (CDC, 2015). Both DVT and PE comprise venous thromboembolism (VTE), which is a serious condition associated with prolonged duration of hospitalization and mortality. Each year in the United State, an estimated 350,000-900,000 people develop incident VTE, of whom approximately 100,000 die (CDC, 2014). Patients who undergo major orthopedic surgeries such as total hip arthroplasty or total knee arthroplasty are at the highest risk for postoperative VTE due to coagulation activation from tissue and bone injury, venous injury, reduced venous emptying intra-or post-surgery, and prolong immobilization (Florescu et al., 2013). The incidence of DVT varies from 42% to 57% after hip arthroplasty and from 41% to 85% after knee arthroplasty; the incidence of PE varies from 0.9% to 28% after hip arthroplasty and from 1.5% to 10% after arthroplasty (Januel et al., 2012). Methods of VTE prophylaxis include mechanical interventions such as compression stockings, compression device, or ambulation, and pharmacological intervention such as oral or subcutaneous anticoagulation agents. The purpose of this study is to look at the rates of VTE between those that received mechanical intervention only, pharmacological intervention only and those that received both mechanical and pharmacological interventions in the post-operative total hip and total knee arthroplasty patients.

Methods: A retrospective chart review study on a total of 135 adult patients underwent TKA (n = 66, 49%) and THA (n = 69, 51%) between October 2015 and December 2015 was conducted at a large tertiary Academic Medical Center. A convenient sample of the charts of all patients who underwent total hip or total knee arthroplasty and discharged from the hospital from October 2015 to December 2015 was pulled from the electronic medical record using the International Classification of Disease (ICD-10) code. Information was extracted including: age, gender, race, ethnicity, body mass index (BMI), surgery type, VTE risk factors, bleeding risks, mechanical measure used, pharmacological prophylaxis used, and duration of the mechanical measures used. The inclusion criteria included all adult patients greater than 18 years of age who underwent hip and/or knee arthroplasty procedures from October 1, 2015 to December 31, 2015. Exclusion criteria included patients with a documented VTE at the time of the surgery, past medical history of VTE and a past medical history of malignancy.

Results:  None of the patients developed post-operative VTE complications during the hospitalization. Compliance rate of using both pharmacological and mechanical prophylaxis was 99%. Majority of the patients were on either Rivaroxaban (= 54, 40%) or aspirin (n =63, 46.7%) and mechanical intervention(s). Sixty-three percent of patients received early mobilization therapy within 24 hours of the surgery.

Conclusion: Use of a bundle prophylactic interventions, both pharmacological and mechanical, improved venous circulation and prevented the likelihood of VTE development in postoperative TKA and THA patients. Aspirin used along with mechanical intervention(s) might be as effective as an anti-coagulant agent. Strategies to improve practice compliance are crucial in efforts to prevent post-operative VTE. Future clinical trials of multiple VTE prophylactic interventions involving different types of pharmacological and mechanical approach for TKA and THA population and evaluation of the relative risks and benefits of these interventions are needed.

Keywords:
Mechanical Interventions; Post-operative Hip or Knee Arthroplasty; VTE Prophylaxis
Repository Posting Date:
3-Jul-2017
Date of Publication:
3-Jul-2017
Other Identifiers:
INRC17PST185
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePosteren
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleUsing a Bundle Prophylactic Approach in Post-Operative Total Knee and Hip Arthroplastyen_US
dc.contributor.authorWang, Haofeien
dc.contributor.authorRyan, Patrick G.en
dc.contributor.departmentOmicron Deltaen
dc.author.detailsHaofei Wang, DNP, RN, NEA-BC, Professional Experience: 2016-present -- Director, Nursing Practice & Quality, NewYork-Presbyterian/Regional Hospital Network, New York, NY 2011-2016 -- Program Director, Patient Education and Nursing Practice, NewYork-Presbyterian Hospital/Office of Professional Nursing practice, New York, NY 2007-2011 -- Performance Improvement and Quality Management Specialist, NewYork-Presbyterian Hospital/Division of Quality and Patient Safety, New York, NY. Responsible for integration of NYP/Regional Hospitals nursing practice and quality (2016-present). Responsible for development, implementation, and maintenance of nursing clinical standards based on evidence-based practice in accordance with all applicable federal, state, local professional and regulatory requirements (2011-2016). Lead Hospital wide Patient and Family Education program including planning, development, implementation and evaluation on policies, guidelines, programs and processes (2011-2016). Author Summary: Demonstrate in-depth understanding of complex patient population and ability to forge, lead, and motivate outstanding health care teams that provide top-quality patient care. Promote the organizational philosophy, goals and objectives, and ensure development, implementation, and monitoring of nursing department goals and objectives. Promote nursing research and evidence-based practice, and provide an environment that is conductive to the conduct of ongoing research and evidence-based practice.en
dc.identifier.urihttp://hdl.handle.net/10755/621634-
dc.description.abstract<p><strong><strong>Background: </strong></strong><span>Evidence is limited on which prophylactic intervention(s) to prevent post-operative VTE is/are optimal or suboptimal in TKA and THA population.</span><strong><strong><br /></strong></strong></p> <p><strong><strong>Objectives:</strong> </strong>To examine the different types of prophylactic interventions (pharmacological and mechanical), patient age and BMI, bleeding tendency and renal function, and type of surgeries (TKA and THA) in relation to VTE incidence.</p> <p><strong>Purpose: </strong>Deep vein thrombosis (DVT) is a blood clot that occurs in a deep vein of the body; pulmonary embolism (PE) occurs when a clot breaks free and enters the arteries of the lungs (CDC, 2015). Both DVT and PE comprise venous thromboembolism (VTE), which is a serious condition associated with prolonged duration of hospitalization and mortality. Each year in the United State, an estimated 350,000-900,000 people develop incident VTE, of whom approximately 100,000 die (CDC, 2014). Patients who undergo major orthopedic surgeries such as total hip arthroplasty or total knee arthroplasty are at the highest risk for postoperative VTE due to coagulation activation from tissue and bone injury, venous injury, reduced venous emptying intra-or post-surgery, and prolong immobilization (Florescu et al., 2013). The incidence of DVT varies from 42% to 57% after hip arthroplasty and from 41% to 85% after knee arthroplasty; the incidence of PE varies from 0.9% to 28% after hip arthroplasty and from 1.5% to 10% after arthroplasty (Januel et al., 2012). <strong>Methods </strong>of VTE prophylaxis include mechanical interventions such as compression stockings, compression device, or ambulation, and pharmacological intervention such as oral or subcutaneous anticoagulation agents. The purpose of this study is to look at the rates of VTE between those that received mechanical intervention only, pharmacological intervention only and those that received both mechanical and pharmacological interventions in the post-operative total hip and total knee arthroplasty patients.</p> <p><strong>Methods: </strong>A retrospective chart review study on a total of 135 adult patients underwent TKA (<em>n</em> = 66, 49%) and THA (<em>n</em> = 69, 51%) between October 2015 and December 2015 was conducted at a large tertiary Academic Medical Center. A convenient sample of the charts of all patients who underwent total hip or total knee arthroplasty and discharged from the hospital from October 2015 to December 2015 was pulled from the electronic medical record using the International Classification of Disease (ICD-10) code. Information was extracted including: age, gender, race, ethnicity, body mass index (BMI), surgery type, VTE risk factors, bleeding risks, mechanical measure used, pharmacological prophylaxis used, and duration of the mechanical measures used. The inclusion criteria included all adult patients greater than 18 years of age who underwent hip and/or knee arthroplasty procedures from October 1, 2015 to December 31, 2015. Exclusion criteria included patients with a documented VTE at the time of the surgery, past medical history of VTE and a past medical history of malignancy.</p> <p><strong><strong>Results: </strong> </strong>None of the patients developed post-operative VTE complications during the hospitalization. Compliance rate of using both pharmacological and mechanical prophylaxis was 99%. Majority of the patients were on either Rivaroxaban (<em>n </em>= 54, 40%) or aspirin (<em>n</em> =63, 46.7%) and mechanical intervention(s). Sixty-three percent of patients received early mobilization therapy within 24 hours of the surgery.</p> <p><strong>Conclusion: </strong>Use of a bundle prophylactic interventions, both pharmacological and mechanical, improved venous circulation and prevented the likelihood of VTE development in postoperative TKA and THA patients. Aspirin used along with mechanical intervention(s) might be as effective as an anti-coagulant agent. Strategies to improve practice compliance are crucial in efforts to prevent post-operative VTE. Future clinical trials of multiple VTE prophylactic interventions involving different types of pharmacological and mechanical approach for TKA and THA population and evaluation of the relative risks and benefits of these interventions are needed.</p>en
dc.subjectMechanical Interventionsen
dc.subjectPost-operative Hip or Knee Arthroplastyen
dc.subjectVTE Prophylaxisen
dc.date.available2017-07-03T17:04:20Z-
dc.date.issued2017-07-03-
dc.date.accessioned2017-07-03T17:04:20Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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