Rahme Elham, Dasgupta Kaberi, Burman Mark, Yin Hongjun, Bernatsky Sasha, Berry Greg, Nedjar Hacene, Kahn Susan R
Department of Medicine, McGill University, Montréal, Que.
CMAJ. 2008 Jun 3;178(12):1545-54. doi: 10.1503/cmaj.071388.
Patients undergoing hip or knee replacement are at high risk of developing a postoperative venous thromboembolism even after discharge from hospital. We sought to identify hospital and patient characteristics associated with receiving thromboprophylaxis after discharge and to compare the risk of short-term mortality among those who did or did not receive thromboprophylaxis.
We conducted a retrospective cohort study using system-wide hospital discharge summary records, physician billing information, medication reimbursement claims and demographic records. We included patients aged 65 years and older who received a hip or knee replacement and who were discharged home after surgery.
In total we included 10 744 patients. Of these, 7058 patients who received a hip replacement and 3686 who received a knee replacement. The mean age was 75.4 (standard deviation [SD] 6.8) years and 38% of patients were men. In total, 2059 (19%) patients received thomboprophylaxis at discharge. Patients discharged from university teaching hospitals were less likely than those discharged from community hospitals to received thromboprophylaxis after discharge (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.80-1.00). Patients were less likely to receive thromboprophylaxis after discharge if they had a longer hospital stay (15-30 days v. 1-7 days, OR 0.69, 95% CI 0.59-0.81). Patients were more likely to receive thromboprophylaxis if they had hip (v. knee) replacement, osteoarthritis, heart failure, atrial fibrillation or hypertension, higher (v. lower) income or if they were treated at medium-volume hospitals (69-116 hip and knee replacements per year). In total, 223 patients (2%) died in the 3-month period after discharge. The risk of short-term mortality was lower among those who received thromboprophylaxis after discharge (hazard ratio [HR] 0.34, 95% CI 0.20-0.57).
Fewer than 1 in 5 elderly patients discharged home after a hip-or knee-replacement surgery received postdischarge thromboprophylaxis. Those prescribed these medications had a lower risk of short-term mortality. The benefits of and barriers to thromboprophylaxis therapy after discharge in this population requires further study.
接受髋关节或膝关节置换术的患者即使在出院后仍有发生术后静脉血栓栓塞的高风险。我们试图确定与出院后接受血栓预防相关的医院和患者特征，并比较接受或未接受血栓预防的患者的短期死亡风险。
我们使用全系统的医院出院总结记录、医生计费信息、药物报销申请和人口统计记录进行了一项回顾性队列研究。我们纳入了65岁及以上接受髋关节或膝关节置换术且术后出院回家的患者。
我们总共纳入了10744名患者。其中，7,058名接受髋关节置换术，3,686名接受膝关节置换术。平均年龄为75.4岁（标准差[SD]6.8），38%的患者为男性。总共有2059名（19%）患者在出院时接受了血栓预防。从大学教学医院出院的患者比从社区医院出院的患者出院后接受血栓预防的可能性更小（优势比[OR]0.89，95%置信区间[CI]0.80-1.00）。如果患者住院时间较长（15-30天与1-7天相比，OR0.69，95%CI0.59-0.81），则出院后接受血栓预防的可能性较小。如果患者接受髋关节（与膝关节相比）置换术、骨关节炎、心力衰竭、心房颤动或高血压、收入较高（与较低相比），或者在中等手术量医院（每年进行69-116例髋关节和膝关节置换术）接受治疗，则更有可能接受血栓预防。总共有223名患者（2%）在出院后的3个月内死亡。出院后接受血栓预防的患者短期死亡风险较低（风险比[HR]0.34，95%CI0.20-0.57）。
髋关节或膝关节置换手术后出院回家的老年患者中，不到五分之一的人在出院后接受了血栓预防。服用这些药物的患者短期死亡风险较低。该人群出院后血栓预防治疗的益处和障碍需要进一步研究。
