Internal Validation of a Risk Scoring System for Venous Thromboembolism After Total Hip or Knee Arthroplasty

Overview

Journal Clin Appl Thromb Hemost

Publisher Sage Publications

Specialty Cardiology & Vascular Diseases

Date 2022 Jun 1

PMID 35642285

Authors

Akihiko Akamine

Naonobu Takahira

Masayuki Kuroiwa

Atsushi Tomizawa

Koichiro Atsuda

Affiliations

Soon will be listed here.

Abstract

We developed a computerized clinical decision support system (CCDSS) for venous thromboembolism (VTE) risk assessment. We aimed to demonstrate its relevance and evaluate associations between risk level and VTE incidence in patients undergoing total hip/knee arthroplasty. In this case-control study, VTE was confirmed using ultrasonography/computed tomography angiography in 1098 adults at a tertiary care hospital over five years (2013-2018). Postoperative VTE incidence was classified into three risk levels (moderate, high, and highest). The overall VTE incidence was 11.7%, which increased with a risk level of 0%, 5.8%, and 12.8% in moderate-risk, high-risk, and highest-risk patients, respectively. Highest-risk patients were significantly more likely to develop VTE than high-risk patients (odds ratio [OR] 2.4; 95% confidence interval [CI] 1.2-5.5; p = 0.01). VTE development was more likely in patients with risk scores ≥4 relative to those with risk scores of 2-3 (OR 1.8; 95% CI 1.2-2.7; p = 0.003) and -1 to 1 (OR 3.3; 95% CI 1.6-7.7; p < 0.001). This study indicates that risk level and VTE incidence are associated; our scoring system appears useful for patients undergoing total hip/knee arthroplasty.

References

Gould M, Garcia D, Wren S, Karanicolas P, Arcelus J, Heit J . Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e227S-e277S. PMC: 3278061. DOI: 10.1378/chest.11-2297. View

Douketis J, Eikelboom J, Quinlan D, Willan A, Crowther M . Short-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of prospective studies investigating symptomatic outcomes. Arch Intern Med. 2002; 162(13):1465-71. DOI: 10.1001/archinte.162.13.1465. View

Hong J, Lee J, Yhim H, Choi W, Bang S, Lee H . Incidence of venous thromboembolism in Korea from 2009 to 2013. PLoS One. 2018; 13(1):e0191897. PMC: 5785001. DOI: 10.1371/journal.pone.0191897. View

Bahl V, Hu H, Henke P, Wakefield T, Campbell Jr D, Caprini J . A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg. 2009; 251(2):344-50. DOI: 10.1097/SLA.0b013e3181b7fca6. View

Obi A, Pannucci C, Nackashi A, Abdullah N, Alvarez R, Bahl V . Validation of the Caprini Venous Thromboembolism Risk Assessment Model in Critically Ill Surgical Patients. JAMA Surg. 2015; 150(10):941-8. DOI: 10.1001/jamasurg.2015.1841. View

Moja L, Kwag K, Lytras T, Bertizzolo L, Brandt L, Pecoraro V . Effectiveness of computerized decision support systems linked to electronic health records: a systematic review and meta-analysis. Am J Public Health. 2014; 104(12):e12-22. PMC: 4232126. DOI: 10.2105/AJPH.2014.302164. View

Baser O, Supina D, Sengupta N, Wang L, Kwong L . Clinical and cost outcomes of venous thromboembolism in Medicare patients undergoing total hip replacement or total knee replacement surgery. Curr Med Res Opin. 2011; 27(2):423-9. DOI: 10.1185/03007995.2010.545940. View

Kurtz S, Ong K, Lau E, Mowat F, Halpern M . Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89(4):780-5. DOI: 10.2106/JBJS.F.00222. View

Wang Y, Zhu L, Deng H, Yang X, Wang L, Xu Y . Quality appraisal of clinical guidelines for venous thromboembolism prophylaxis in patients undergoing hip and knee arthroplasty: a systematic review. BMJ Open. 2020; 10(12):e040686. PMC: 7733196. DOI: 10.1136/bmjopen-2020-040686. View

10.

Guyatt G, Akl E, Crowther M, Gutterman D, Schuunemann H . Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):7S-47S. PMC: 3278060. DOI: 10.1378/chest.1412S3. View

11.

Jha A, Larizgoitia I, Audera-Lopez C, Prasopa-Plaizier N, Waters H, Bates D . The global burden of unsafe medical care: analytic modelling of observational studies. BMJ Qual Saf. 2013; 22(10):809-15. DOI: 10.1136/bmjqs-2012-001748. View

12.

Pandor A, Tonkins M, Goodacre S, Sworn K, Clowes M, Griffin X . Risk assessment models for venous thromboembolism in hospitalised adult patients: a systematic review. BMJ Open. 2021; 11(7):e045672. PMC: 8323381. DOI: 10.1136/bmjopen-2020-045672. View

13.

Xiong X, Chi J, Gao Q . Prevalence and risk factors of thrombotic events on patients with COVID-19: a systematic review and meta-analysis. Thromb J. 2021; 19(1):32. PMC: 8132033. DOI: 10.1186/s12959-021-00284-9. View

14.

Farfan M, Bautista M, Bonilla G, Rojas J, Llinas A, Navas J . Worldwide adherence to ACCP guidelines for thromboprophylaxis after major orthopedic surgery: A systematic review of the literature and meta-analysis. Thromb Res. 2016; 141:163-70. DOI: 10.1016/j.thromres.2016.03.029. View

15.

Zhai Z, Kan Q, Li W, Qin X, Qu J, Shi Y . VTE Risk Profiles and Prophylaxis in Medical and Surgical Inpatients: The Identification of Chinese Hospitalized Patients' Risk Profile for Venous Thromboembolism (DissolVE-2)-A Cross-sectional Study. Chest. 2018; 155(1):114-122. DOI: 10.1016/j.chest.2018.09.020. View

16.

Wang K, Yap E, Goto S, Zhang S, Siu C, Chiang C . The diagnosis and treatment of venous thromboembolism in asian patients. Thromb J. 2018; 16:4. PMC: 5774147. DOI: 10.1186/s12959-017-0155-z. View

17.

Falck-Ytter Y, Francis C, Johanson N, Curley C, Dahl O, Schulman S . Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e278S-e325S. PMC: 3278063. DOI: 10.1378/chest.11-2404. View

18.

Kawamoto K, McDonald C . Designing, Conducting, and Reporting Clinical Decision Support Studies: Recommendations and Call to Action. Ann Intern Med. 2020; 172(11 Suppl):S101-S109. DOI: 10.7326/M19-0875. View

19.

Xu S, Chen J, Zheng Q, Shi L, Tan A . Is chemoprophylaxis required after total knee and total hip arthroplasty in the Asian population? A systematic review and network meta-analysis. Thromb Res. 2020; 198:86-92. DOI: 10.1016/j.thromres.2020.11.033. View

20.

Reynolds S, Hagedorn A, Yeom J, Saito Y, Yokoyama E, Crimmins E . A tale of two countries--the United States and Japan: are differences in health due to differences in overweight?. J Epidemiol. 2008; 18(6):280-90. PMC: 3013295. DOI: 10.2188/jea.je2008012. View