Background: Post operative VTE is higher among orthopedic surgeries when compared to other surgical fields. Within orthopedic surgery, hip and knee surgeries have the highest risk of post-op VTE. This risk is highest in the first 10 days but persists up to three months after surgery. Current American Academy of Orthopedic Surgeons (AAOS) guidelines recommend that for patients undergoing total hip arthroplasty, patients without contraindications (thrombocytopenia, unacceptable bleeding risk) should be administered pharmacological VTE prophylaxis (preferably rivaroxaban 10 mg or weight based low molecular weight heparin) 12 hours or more pre-operatively and 12 hours or more post operatively for minimum 10-14 days and up to 35 days. Guidelines recommend against aspirin as a single agent for VTE prophylaxis. The purpose of this quality improvement project was to standardize post-operative VTE prophylaxis within our hospital with the secondary end goal of decreasing incidence of post-operative VTE.
Methods: Baseline information regarding existing practices involving VTE established with 89 patients between 10/1/20 to 3/1/20. 43 patients who were admitted to Baptist Memorial Golden Triangle (GTR) with femoral fractures undergoing surgical fixation between 8/5/2021-11/5/2021 were reviewed for this study. There were no excluding factors. An order set was created for discharging patients post operatively on 10 mg rivaroxaban for 21 days. Patient charts were analyzed at three months from their original admission dates to determine if they had readmission during this time frame directly for VTE or bleeding events.
Results: Between 10/1/20 to 3/1/20 , 85% (n=76) patients were discharged with either no VTE prophylaxis or only aspirin. 14% were discharged with a DOAC. Of the 43 patients who were admitted to GTR between 8/5/21-11/5/21 , 67% were discharged with appropriate VTE prophylaxis. There were zero readmissions at the three-month mark for DVT or GI bleeds after receiving DVT prophylaxis for 21 days.
Conclusions: Our data showed an increased number of patients received appropriate VTE prophylaxis after hip surgery after an order set was implemented to standardize post-op care. Additionally, there was no incidence of hospital admission due VTE or bleeding event as a result of pharmacologic VTE prophylaxis up to three months post-op. Our data was limited by small sample size and was limited to one institution. By standardizing our post-operative VTE prophylaxis through an order set, we were able to ensure patients undergoing hip fracture repair received guideline directed medical therapy. Incorporating standard of practice guidelines via order sets is possible to do across institutions offering orthopedic services.