Jameson S S, Bottle A, Malviya A, Muller S D, Reed M R
Northumbria Healthcare NHS Trust, Northumberland, England.
J Bone Joint Surg Br. 2010 Jan;92(1):123-9. doi: 10.1302/0301-620X.92B1.22751.
The National Institute for Clinical Excellence (NICE) produces recommendations on appropriate treatment within the National Health Service (NHS) in England and Wales. The NICE guidelines on prophylaxis for venous thromboembolism in orthopaedic surgery recommend that all patients be offered a low molecular weight heparin (LMWH). The linked hospital episode statistics of 219 602 patients were examined to determine the rates of complications following lower limb arthroplasty for the 12-month periods prior to and following the publication of these guidelines. These were compared with data from the National Joint Registry (England and Wales) regarding the use of LMWH during the same periods. There was a significant increase in the reported use of LMWH (59.5% to 67.6%, p < 0.001) following the publication of the guidelines. However, the 90-day venous thromboembolism events actually increased slightly following total hip replacement (THR, 1.69% to 1.84%, p = 0.06) and remained unchanged following total knee replacement (TKR, 1.99% to 2.04%). Return to theatre in the first 30 days for infection did not show significant changes. There was an increase in the number of patients diagnosed with thrombocytopenia, which was significant following THR (0.11% to 0.16%, p = 0.04). The recommendations from NICE are based on predicted reductions in venous thromboembolism events, reducing morbidity, mortality and costs to the NHS. The early results in orthopaedic patients do not support these predictions, but do show an increase in complications.
英国国家卫生与临床优化研究所（NICE）针对英格兰和威尔士国民医疗服务体系（NHS）内的适当治疗制定建议。NICE关于骨科手术中静脉血栓栓塞预防的指南建议，应为所有患者提供低分子量肝素（LMWH）。对219602名患者的相关医院病历统计数据进行了检查，以确定这些指南发布之前和之后12个月期间下肢关节置换术后的并发症发生率。将这些数据与同期英国国家关节注册中心（英格兰和威尔士）关于LMWH使用情况的数据进行了比较。指南发布后，LMWH的报告使用量显著增加（从59.5%增至67.6%，p<0.001）。然而，全髋关节置换术（THR）后90天静脉血栓栓塞事件实际上略有增加（从1.69%增至1.84%，p = 0.06），全膝关节置换术（TKR）后则保持不变（从1.99%增至2.04%）。术后30天内因感染返回手术室的情况未显示出显著变化。诊断为血小板减少症的患者数量有所增加，在THR后具有统计学意义（从0.11%增至0.16%，p = 0.04）。NICE的建议基于对静脉血栓栓塞事件预测性减少的考量，旨在降低NHS的发病率、死亡率和成本。骨科患者的早期结果并不支持这些预测，但确实显示出并发症有所增加。
