Postoperative Risk Factors

Optimize your patients' preoperative risk factors to reduce postoperative complications and improve outcomes.
  • Many efforts have been made to reduce VTE events, some of which have been associated with hospital and physicians well as reimbursement.
  • Deep Vein Thromboses (DVT) usually develop in the legs after surgery due to patients not being as mobile and sometimes having weight bearing restrictions on affected extremity.
  • A small percentage of patients may develop a pulmonary embolism (PE) from the blood clot traveling to the lungs. Certain patients are at greater risk for developing a VTE than others based on their comorbidities as well as the type of surgery being performed. 

Risks:

  • The risk of VTE and prophylaxis are different in orthopaedic versus abdominal or heart surgery largely due to restricted weight bearing status and location of orthopaedic operations. It is important to recognize the factors prior to orthopaedic surgery, and plan accordingly for proper VTE prophylaxis.
  • Caution should be taken for those patients with clotting disorders – both increased and decreased clotting ability. 
  • Some of the more potent anticoagulants have a higher association with blood forming in the joint or in the surrounding tissues and causing wound complications.

A patient could have history of hypercoagulable state if they have hereditary clotting disorders such as the following:

  • Antithrombin Deficiency
  • Factor V Leiden
  • Protein C and Protien S Defficiencies
  • Prothrombin Mutation (Factor II)

     

Surgeon Tools/Recommendations:

Recognize risk factors prior to orthopaedic surgery and plan accordingly for proper VTE prophylaxis. Ask patients about any history in themselves or family of blood clotting disorder.

Patients may also have an increased risk of bleeding (hypercoagulable state) if they have one or many blood disorders. 

Risk Stratification remains controversial within orthopaedics especially with the various types of procedures performed.

  • The VTEstimator is a simple resource and app developed by Orthopaedic surgeons that allows you to input patient’s risk factors and medical history then provides a risk category (i.e. risk stratification) and subsequent recommendations for anticoagulant choice.
  • Recognize risk factors prior to orthopaedic surgery and plan accordingly for proper VTE prophylaxis.
  • Patients may also have an increased risk of bleeding if they have an underlying blood clotting disorder.
    Ask your patients about any history in themselves or family of blood clotting or bleeding disorders.

Anticoagulation

  • When deciding on whether to administer anticoagulation, the timing and which anticoagulant to give, it is important to remember that there are some conditions in which patients cannot receive a specific anticoagulant or antiplatelet agent:
    • Low platelet count ( <90,000)
    • History of gastrointestinal bleeding - Caution with Aspirin, consult PCP
    • Active peptic ulcer disease – Should NOT receive Aspirin
    • History of peptic ulcer disease - Caution with using Aspirin, Consult PCP
    • Allergy to Aspirin
VTE Prophylaxis General Recommendation
Risk and Anticoagulant Considerations Timing & Duration
Low Risk Aspirin ETC 81mg or 325mg BID Starting evening of surgery or next morning for 4-6 weeks
Medium Risk Aspirin ETC 325mg BID
Lovenox(LMWH)
Apixaban
Rivaroxiban
Start evening of surgery or next morning for 4-6 weeks
High Risk Warfarin
Lovenox Apixaban
Rivaroxibanfarin
Consider IVC filter
POD 1 Morning

Sleep is extremely important to our overall health as it allows our patient's bodies to rebuild and replenish. Proper sleep or enough sleep is imperative for physical, mental and emotional resilience and rejuvenation. It is very difficult for patients to recover from surgery effectively when sleep has been compromised. Patients sleep patterns are disrupted while in the hospital and can be disrupted for many weeks or months after surgery.


Considerations:

Associated conditions that can become compromised without proper sleep:

  • Immune system function
  • Cell recovery
  • Muscle function
  • Coordination and propioception
  • Eating Habits
  • Emotional stability and resilience

Surgeon Tools/Recommendations:

Stress affects each of our patients and usually in different ways. Stress causes many harmful effects on the body and mind. Healthy habits can help protect us from these harmful effects and developing an action plan to combat stress can be very helpful.


Considerations:

    Physical signs of stress:

  • Headaches
  • Stomachaches
  • Tense muscles or soreness
  • Emotional signs such ass feeling helpless, fearful, angry, out of control, anxious or depressed

Surgeon Tools/Recommended Patient Tools & Resources:


Socioeconomic factors affect outcomes after surgical procedures. It is important to optimize these factors before and after surgery, especially prior to discharge


Surgeon Tools/Recommendations:


  • Ensure that patients have the appropriate support in the home environment by having a team in place, such as a nurse coordinator and discharge planner.
  • Provide patients with prevention programs and tips to organize homes and outdoor environments to reduce the risk of falls.

  • Questions to ask patients and their families:
  • Is there anyone to help you at home?
  • What is your home environment like?
  • How many stairs do you have to get to living room/bedroom?
  • Where is the bathroom located?
  • How are you going to get groceries/necessary items?

Advertisements


Advertisement