Division of Joint Surgery and Sports Medicine, Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan City, Hubei Province, 430071, PR China.
BMC Musculoskelet Disord. 2021 Sep 13;22(1):787. doi: 10.1186/s12891-021-04663-1.
Venous thromboembolism (VTE) is a potentially fatal complication after arthroplasty. Numerous prophylactic strategies and studies to reduce VTEs have focused on the duration of the hospital stay and on few extramural hospitals. This study aimed to investigate extramural hospital management of VTE after total hip/knee arthroplasty (THA/TKA) in China with a novel survey tool.
A total of 180 patients undergoing arthroplasty, including 68 THA patients and 112 TKA patients, were enrolled in this study. All patients received anticoagulant treatment management. A survey querying VTE management and adherence, such as therapy information, understanding of anticoagulation, satisfaction with the ability of medical staff, and satisfaction with health care costs, was administered by a questionnaire (TKA/THA Patients' Experience with Anticoagulation in the Post-discharge Period) for quality improvement.
The average age of the patients was 65.27 ± 13.62 years. All patients knew their follow-up times. 85 % of them were suggested that re-examine at the next 14 days, and the others at the next 28 days. All patients continued to visit the orthopaedic clinic after discharge without choosing other types of outpatient services, such as an anticoagulant clinic or home visit with a nurse/pharmacist or remote evaluation by telephone. A total of 96.6 % of all patients used new oral anticoagulants, and the most common treatment duration was 2-4 weeks (93.3 %). 48 % informed their physicians that they were taking anticoagulation medications when they visited ophthalmology, dentistry, dermatology, and other departments. The overall rate of satisfaction with anticoagulation management was 81.67 %, and 6.67 % of patients were not unsatisfied with their medical expenses. Patient compliance decreased with increasing follow-up time. Continuous follow-ups after discharge significantly improved patient compliance.
These results elucidate how we can improve the quality of anticoagulation. Continuous follow-up appointments for 30 days after discharge, especially for individuals over 65 years old, significantly improved patient satisfaction and reduced the incidence of VTE and medical costs.
静脉血栓栓塞症（VTE）是关节置换术后潜在的致命并发症。众多预防策略和研究都集中在住院时间和少数外院，以减少 VTE。本研究旨在使用新的调查工具，调查中国全髋关节/膝关节置换术后（THA/TKA）外院 VTE 的管理情况。
共纳入 180 例接受关节置换术的患者，包括 68 例 THA 患者和 112 例 TKA 患者。所有患者均接受抗凝治疗管理。通过问卷调查（THA/TKA 患者出院后抗凝治疗体验），了解 VTE 管理和依从性，如治疗信息、对抗凝的理解、对医务人员能力的满意度以及对医疗费用的满意度，以进行质量改进。
患者平均年龄为 65.27±13.62 岁。所有患者均知晓随访时间，85%的患者被建议在第 14 天复查，其余患者在第 28 天复查。所有患者在出院后继续到骨科门诊就诊，而没有选择其他类型的门诊服务，如抗凝门诊、护士/药剂师上门服务或电话远程评估。所有患者均使用新型口服抗凝剂，最常见的治疗持续时间为 2-4 周（93.3%）。48%的患者在就诊眼科、牙科、皮肤科和其他科室时，告知医生正在服用抗凝药物。抗凝管理总体满意度为 81.67%，6.67%的患者对医疗费用不满意。随着随访时间的增加，患者的依从性下降。出院后连续随访 30 天可显著提高患者的依从性。
这些结果阐明了如何提高抗凝质量。出院后连续 30 天的随访，尤其是对 65 岁以上的患者，显著提高了患者满意度，降低了 VTE 发生率和医疗费用。
