非关节置换膝关节手术的术后静脉血栓栓塞预防：一项闭环临床审计
Post-operative Venous Thromboembolism Prophylaxis for Non-arthroplasty Knee Surgery: A Closed Loop Clinical Audit.
作者信息
Imtiaz Hassan, Anaga Emmanuel, Kouklidis Georgios, Horgan Majella
机构信息
Trauma and Orthopaedics, University Hospitals Dorset, Poole, GBR.
Orthopaedics, Royal National Orthopaedic Hospital, London, GBR.
出版信息
Cureus. 2025 Aug 6;17(8):e89461. doi: 10.7759/cureus.89461. eCollection 2025 Aug.
BACKGROUND
Venous thromboembolism (VTE) is a preventable complication following orthopaedic surgery. While most guidelines focus on arthroplasty, a significant number of knee surgeries fall under non-arthroplasty procedures, where post-operative VTE prophylaxis recommendations vary depending on anaesthetic time and weight-bearing status. National guidelines and available literature suggest the use of VTE prophylaxis for these cases, yet adherence in clinical practice remains inconsistent. To evaluate and improve compliance with NICE (National Institute for Health and Care Excellence) guidelines on VTE prophylaxis following non-arthroplasty knee surgery at a tertiary orthopaedic centre.
METHODS
A closed-loop audit was conducted. Patient data from two six-month cycles (January-June 2023 and July-December 2023) were retrospectively reviewed. Inclusion criteria were patients aged ≥18 years undergoing non-arthroplasty knee procedures under the joint replacement unit. Compliance with NICE standards was assessed, and outcomes were compared pre- and post-intervention, which included a teaching session for the surgical team.
RESULTS
In the first cycle (n=46), compliance with VTE prophylaxis was 50% for arthroscopic cases with anaesthetic time >90 minutes, and 36% for other non-arthroplasty surgeries. Post-intervention (n=66), compliance improved to 55% and 68% respectively. The 5% improvement in arthroscopic procedures was not statistically significant (p=1.0), whereas the 32% improvement in other non-arthroplasty procedures was statistically significant (p=0.02).
CONCLUSION
The audit identified significant gaps in adherence to VTE prophylaxis guidelines for non-arthroplasty knee procedures. Targeted education led to a notable improvement in compliance, particularly in non-arthroscopic cases. Sustained efforts, including documentation standardisation and ongoing training, are essential to maintain and further improve prophylactic practices.
背景
静脉血栓栓塞症（VTE）是骨科手术后可预防的并发症。虽然大多数指南侧重于关节置换术，但大量膝关节手术属于非关节置换手术，此类手术后VTE预防建议因麻醉时间和负重状态而异。国家指南和现有文献建议对此类病例进行VTE预防，但临床实践中的依从性仍不一致。为评估并提高在一家三级骨科中心进行非关节置换膝关节手术后VTE预防的英国国家卫生与临床优化研究所（NICE）指南的依从性。
方法
开展了一项闭环审核。回顾性分析了来自两个六个月周期（2023年1月至6月和2023年7月至12月）的患者数据。纳入标准为年龄≥18岁、在关节置换科接受非关节置换膝关节手术的患者。评估了对NICE标准的依从性，并比较了干预前后的结果，干预措施包括为手术团队举办一次培训课程。
结果
在第一个周期（n = 46），麻醉时间>90分钟的关节镜手术的VTE预防依从率为50%，其他非关节置换手术的依从率为36%。干预后（n = 66），依从率分别提高到55%和68%。关节镜手术5%的改善无统计学意义（p = 1.0），而其他非关节置换手术32%的改善具有统计学意义（p = 0.02）。
结论
审核发现非关节置换膝关节手术在遵循VTE预防指南方面存在重大差距。针对性教育使依从性有了显著提高，尤其是在非关节镜手术病例中。持续努力，包括文件标准化和持续培训，对于维持并进一步改善预防措施至关重要。
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