Dunbar Mark R, Upadhyay Piyush K, Karthikeyan Shanmugam
Academic Department of Orthopaedics, Warwick Medical School, Clinical Sciences Research Institute, University Hospital, Coventry, UK.
Ann R Coll Surg Engl. 2008 Sep;90(6):500-3. doi: 10.1308/003588408X300957. Epub 2008 Jul 2.
Most orthopaedic surgeons in the UK use some form of prophylaxis against venous thromboembolic events. Warfarin has been recommended as one of the preferred methods to use. The period of in-hospital postoperative rehabilitation has reduced significantly since lower limb arthroplasty was introduced. We sought to identify and quantify any delay in discharge associated in using warfarin as chemical prophylaxis.
During a 12-week period, all patients undergoing a lower limb arthroplasty procedure were identified and any delay in discharge related to their warfarin prophylaxis was recorded.
Of the 25 arthroplasties performed in this time period, 17 (68%) were subject to a delay. The total delay in discharge was 39 days. When the standard warfarin dosing protocol was followed, 33% of patients were still delayed. When the protocol was not followed, only 23% were delayed. The majority of deviations from the protocol led to a shorter hospital stay.
Patients using warfarin prophylaxis generate an additional cost of 417 pounds related to bed occupancy. There is considerable scope for significantly reducing this cost by moving the early postoperative anticoagulation monitoring into the community. Delayed discharge is an important consideration in the economic issues that surround the choice of thromboprophylaxis.
英国大多数骨科医生都采用某种形式预防静脉血栓栓塞事件。华法林已被推荐为首选方法之一。自引入下肢关节置换术以来，术后住院康复期已显著缩短。我们试图确定并量化使用华法林进行化学预防所导致的出院延迟情况。
在为期12周的时间里，确定了所有接受下肢关节置换手术的患者，并记录了与华法林预防相关的任何出院延迟情况。
在此期间进行的25例关节置换手术中，17例（68%）出现了延迟。出院总延迟天数为39天。遵循标准华法林给药方案时，33%的患者仍出现延迟。未遵循该方案时，只有23%的患者出现延迟。大多数与方案的偏差导致住院时间缩短。
使用华法林进行预防的患者因床位占用产生了额外417英镑的费用。通过将术后早期抗凝监测转移到社区，有很大的空间可以显著降低这笔费用。出院延迟是围绕血栓预防选择的经济问题中的一个重要考虑因素。
