Blood Clots

VTE Prophylaxis is a Must for Preventing VTE Readmissions in Orthopedic Patients: AAOS & ACCP Guidelines

The guidelines for preventing VTE after total joint arthroplasty (such as, knee and hip replacement) by the Academy of Orthopaedic Surgeons and American College of Chest Physicians are unanimous – both pharmacological and mechanical prophylaxis are needed.

x-ray-scanThe AAOS recommends the use of pharmacological and/or mechanical compression devices for both total hip arthroplasty (THA) and total knee replacement (TKA) patients who are not at an elevated risk for VTE or bleeding, as well as for patients with a known bleeding disorder and/or active liver disease.

The ACCP’s guidelines also call for VTE prophylaxis for THA, TKA, and hemifacial spasm (HFS) patients, adding that prophylaxis should be administered for a minimum of 10 to 14 days.  This minimum can extend up to 35 days for postoperative THA/TKA patients.

These guidelines are particularly essential because the Centers for Medicare & Medicaid Services (CMS) Hospital Readmissions Reduction Program will with hold payments from hospitals that have more patients than expected return within a month.  The plan, now effective as of October 1, 2016, is estimated to have far-reaching implications for hospitals across the country; Kaiser Health News reported that the CMS reductions will total greater than $500 million this year, affecting more than half of U.S. hospitals.  

VTE is one of the many conditions included in the program’s measures.  The US Department of Health & Human Services (HHS) has identified the condition as the third most prevalent factor accounting for readmission 30-days after surgery (6.3%).

For orthopedic procedures, the new AAOS and ACCP guidelines are the key to lowering readmission rates.  TKA and THA procedures are very common, totaling more than 1 million procedures each year; this has been driven by a nearly 39% increase in the procedures between 2004 and 2013.  TKA/THA readmission rates drive the absolute number of at-risk procedures: 30-day readmission rate following hip and knee replacement is 4.3% and 3.9% respectively, with the 90-day readmission rate rising to 7.8% after surgery.

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