PT  - JOURNAL ARTICLE
AU  - Elham Rahme, PhD
AU  - Kaberi Dasgupta, MD MSc
AU  - Mark Burman MD
AU  - Hongjun Yin, PhD
AU  - Sasha Bernatsky, MD PhD
AU  - Greg Berry MD
AU  - Hacene Nedjar, MSc
AU  - Susan R. Kahn, MD MSc
TI  - Postdischarge thromboprophylaxis and mortality risk after hip-or knee-replacement surgery
AID  - 10.1503/cmaj.071388
DP  - 2008 Jun 03
TA  - Canadian Medical Association Journal
PG  - 1545--1554
VI  - 178
IP  - 12
4099  - http://www.cmaj.ca/content/178/12/1545.short
4100  - http://www.cmaj.ca/content/178/12/1545.full
SO  - CMAJ2008 Jun 03; 178
AB  - 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.