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From the Department of Medicine (Rahme, Dasgupta, Bernatsky, Kahn), McGill University; the Division of Clinical Epidemiology (Dasgupta, Bernatsky, Nedjar), Research Institute, McGill University Health Centre; the Department of Surgery (Burman, Berry), Division of Orthopedic Surgery, McGill University Health Centre; the Centre for Clinical Epidemiology and Community Studies (Kahn), Jewish General Hospital, Montréal, Que.; and the Institute for Health Research and Policy (Yin), the University of Illinois at Chicago, Chicago, Ill.
Correspondence to: Dr. Elham Rahme, Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Ave. W, V Building, Montréal QC H3A 1A1; fax 514 934-8293; elham.rahme{at}mcgill.ca
Background: Patients undergoing hip or knee replacement are at high risk of developing a postoperative venous thromboembolism even after discharge from hospital. We sought to identify hospital and patient characteristics associated with receiving thromboprophylaxis after discharge and to compare the risk of short-term mortality among those who did or did not receive thromboprophylaxis.
Methods: We conducted a retrospective cohort study using system-wide hospital discharge summary records, physician billing information, medication reimbursement claims and demographic records. We included patients aged 65 years and older who received a hip or knee replace ment and who were discharged home after surgery.
Results: In total we included 10 744 patients. Of these, 7058 patients who received a hip replacement and 3686 who received a knee replacement. The mean age was 75.4 (standard deviation [SD] 6.8) years and 38% of patients were men. In total, 2059 (19%) patients received thomboprophylaxis at discharge. Patients discharged from university teaching hospitals were less likely than those discharged from community hospitals to received thromboprophylaxis after discharge (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.80–1.00). Patients were less likely to receive thromboprophylaxis after discharge if they had a longer hospital stay (15–30 days v. 1–7 days, OR 0.69, 95% CI 0.59–0.81). Patients were more likely to receive thromboprophylaxis if they had hip (v. knee) replacement, osteoarthritis, heart failure, atrial fibrillation or hypertension, higher (v. lower) income or if they were treated at medium-volume hospitals (69–116 hip and knee replacements per year). In total, 223 patients (2%) died in the 3-month period after discharge. The risk of short-term mortality was lower among those who received thromboprophylaxis after discharge (hazard ratio [HR] 0.34, 95% CI 0.20–0.57).
Interpretation: Fewer than 1 in 5 elderly patients discharged home after a hip-or knee-replacement surgery received postdischarge thromboprophylaxis. Those prescribed these medications had a lower risk of short-term mortality. The benefits of and barriers to thromboprophylaxis therapy after discharge in this population requires further study.
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  W. D. Fisher MD and A. G.G. Turpie MD Outpatient thromboprophylaxis after hip or knee surgery: discrepancies and concerns Can. Med. Assoc. J., June 3, 2008; 178(12): 1571 - 1572. [Full Text] [PDF]
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