Dietz Matthew J, Ray Justin J, Witten Brent G, Frye Benjamin M, Klein Adam E, Lindsey Brock A
Department of Orthopaedics, West Virginia University, Morgantown, WV, USA.
Aurora Orthopedics, Aurora Sinai Medical Center of Aurora Health Care Metro, Milwaukee, WI, USA.
Arthroplast Today. 2020 Mar 6;6(1):118-122. doi: 10.1016/j.artd.2019.12.004. eCollection 2020 Mar.
Aspirin and mechanical compression devices are approved means of venous thromboembolism (VTE) prophylaxis after total joint arthroplasty. Prior studies of mechanical compression pumps after joint arthroplasty have been limited to the inpatient setting. The purpose of this study was to evaluate outpatient compliance and utilization factors in a rural population after elective hip or knee arthroplasty.
Utilization for portable pneumatic compression pumps after joint arthroplasty was prospectively recorded (hours). Compliance was defined as the recommended 20 hours per day. A questionnaire 2 weeks postoperatively assessed factors that may contribute to noncompliance. Patients were followed up for 90 days postoperatively to record VTE events.
Data were collected for 115 joint arthroplasty patients (50 hips, 65 knees). Postdischarge day one had the highest average usage at 13.2 hours/day (66.0%, range 0%-100%), but this number fell to 4.8 hours/day (24.0, range 0%-100%) by day 14. Patient compliance (>20 hours use/day) was highest on postdischarge day one at 40 patients (34.7%). By postdischarge day 14, patient compliance fell to 17 patients (14.8%). Difficulty using the pumps ( = .027) and pump-associated heat ( = .009) were significantly associated with patient compliance. A deep vein thrombosis and nonfatal pulmonary embolism were recorded in 2 separate patients.
This study demonstrated poor outpatient compliance with portable pneumatic compression devices. Poor compliance was related to pump heat and difficulty with pump use. Even with poor compliance, a low incidence of VTE events was observed.
阿司匹林和机械压迫装置是全关节置换术后预防静脉血栓栓塞（VTE）的常用方法。此前关于关节置换术后机械压迫泵的研究仅限于住院患者。本研究旨在评估农村地区择期髋关节或膝关节置换术后患者的门诊依从性及使用因素。
前瞻性记录关节置换术后便携式气动压迫泵的使用情况（小时数）。依从性定义为每天推荐使用20小时。术后2周进行问卷调查，评估可能导致不依从的因素。对患者进行术后90天的随访，记录VTE事件。
收集了115例关节置换患者的数据（50例髋关节，65例膝关节）。出院后第1天的平均使用时间最长，为13.2小时/天（66.0%，范围0%-100%），但到第14天时降至4.8小时/天（24.0，范围0%-100%）。患者依从性（>20小时/天）在出院后第1天最高，有40例患者（34.7%）。到出院后第14天，患者依从性降至17例患者（14.8%）。使用泵的困难程度（P = 0.027）和泵相关的发热（P = 0.009）与患者依从性显著相关。2例患者分别发生了深静脉血栓形成和非致命性肺栓塞。
本研究表明门诊患者对便携式气动压迫装置依从性较差。依从性差与泵发热及使用困难有关。即使依从性较差，VTE事件的发生率仍较低。
