Khan Shehzaad A, Logan Peter, Asokan Ajay, Handford Charles, Rajgor Harshadkumar Dhirajlal, Khadabadi Nikhil Aravind, Moores Thomas, Targett John
Trauma and Orthopaedics, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.
Trauma and Orthopaedics, Nuffield Health Brentwood Hospital, Brentwood, UK.
Bone Jt Open. 2020 Dec 14;1(12):751-756. doi: 10.1302/2633-1462.112.BJO-2020-0144.R1.
As the first wave of the COVID-19 pandemic began to dip, restarting elective orthopaedics became a challenge. Protocols including surgery at 'green' sites, self-isolation for 14 days, and COVID-19 testing were developed to minimize the risk of transmission. In this study, we look at risk effects of 14-day self-isolation on the incidence of venous thromboembolism (VTE) in our green site hospital among patients undergoing total joint replacement (TJR).
This retrospective cohort study included 50 patients who underwent TJR. Basic demographic data was collected including, age, sex, American Society of Anesthesiologists (ASA) grade, body mass index (BMI), type of surgery, and complications at two and four weeks. Univariate and multivariate analysis were used to identify risk factors associated with an increased risk of VTE.
A total of 50 patients were included in our study, with 24 males and 26 females. The mean age was 67.86 (SD 11.803). Overall, 8% of patients suffered a VTE complication; symptomatic non-fatal pulmoary embolism was confirmed in 6% of patients (n = 3) as an inpatient, and symptomatic deep vein thrombosis was diagnosed in 2% of patients (n = 1) within two weeks of their operation. All patients were found to be female (p < 0.001), had a BMI > 30 (p = 0.317), and were immobile prior to their operation using walking aids (p = 0.016).
The incidence we report is much higher than the reported incidence in the literature, which we believe is related to the 14-day self-isolation period and immobility prior to their operation. We recommend that all patients undergoing TJR that require a period of self-isolation, are pre-assessed prior to self-isolation for their risk of VTE, potentially using mechanical and chemical prophylaxis to reduce the likelihood of developing VTE.Cite this article: 2020;1-12:751-756.
随着新冠疫情第一波高峰开始回落，重新启动择期骨科手术成为一项挑战。为此制定了包括在“绿色”区域进行手术、自我隔离14天以及新冠病毒检测等方案，以尽量降低传播风险。在本研究中，我们观察了在我们绿色区域医院接受全关节置换术（TJR）的患者中，14天自我隔离对静脉血栓栓塞症（VTE）发生率的风险影响。
这项回顾性队列研究纳入了50例行TJR的患者。收集了基本人口统计学数据，包括年龄、性别、美国麻醉医师协会（ASA）分级、体重指数（BMI）、手术类型以及术后两周和四周的并发症情况。采用单因素和多因素分析来确定与VTE风险增加相关的危险因素。
我们的研究共纳入50例患者，其中男性24例，女性26例。平均年龄为67.86岁（标准差11.803）。总体而言，8%的患者出现了VTE并发症；6%的患者（n = 3）在住院期间被确诊为有症状的非致命性肺栓塞，2%的患者（n = 1）在术后两周内被诊断为有症状的深静脉血栓形成。所有出现VTE并发症的患者均为女性（p < 0.001），BMI > 30（p = 0.317），且术前使用助行器行动不便（p = 0.016）。
我们报告的发生率远高于文献报道的发生率，我们认为这与14天的自我隔离期以及术前行动不便有关。我们建议，所有需要进行一段时间自我隔离的TJR患者，在自我隔离前对其VTE风险进行预先评估，可能需要采用机械和药物预防措施以降低发生VTE的可能性。引用本文：2020;1 - 12:751 - 756。
