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Treatment of VTE risk factors in TKA patients may cost more than readmission

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ORLANDO, Fla. — The cost to manage the treatment of risk factors related to venous thromboembolism for patients undergoing total knee arthroplasty may be greater than the cost of readmission for the complication, according to a presenter, here.

"When we used a multimodal prophylactic approach in preventing blood clots, [venous thromboembolisms] VTEs and infrequent cause of hospital readmission following total knee arthroplasty (TKA), it accounted for 3.3% of all our readmissions, and for each total knee arthroplasty performed the incidence was only 0.2% with our conventional strategy," James A. Keeney, MD, said. "So the cost of treating complications that are potentially associated with VTE prophylaxis substantially exceeds the cost of readmission for those events."

Keeney's paper won the OREF/CCJR Clinical Award Paper at the Current Concepts in Joint Replacement Winter Meeting.

 

James A. Keeney

Keeney and colleagues identified 2,221 TKA procedures performed during a 5-year period and found 152 hospital readmissions, according to the study abstract. Apart from VTE, they found 18% of readmissions were due to limited motion, 14% were due to noninfectious wound complications, 10% were related to surgical site infection, and 10% due to bleeding. The researchers noted that VTE occurred despite standard prophylactic care.

"The identification of venous thromboembolic events as a ‘never event’ places emphasis on the wrong target," Keeney said. "Focusing on further reductions in venous thromboembolic events is a counterproductive effort, especially if this promotes the use of more aggressive chemoprophylactic agents, which are frequently not monitored. Instead, efforts should be focused on limiting wound complications, and this will have a greater impact on the quality of care and cost containment." – by Jeff Craven

Reference:

Keeney JA. Paper #27. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 12-14, 2013; Orlando, Fla.