Application of "trinity" co-management mode in prevention of perioperative venous thromboembolism in patients treated with major orthopedic surgery / 中华创伤杂志

ABSTRACT

Objective:To explore the effect of “trinity”co-management mode in prevention of venous thromboembolism（VTE）during perioperative period in patients undergone major orthopedic surgery.Methods:A retrospective case-control study was conducted to analyze the clinical data of 120 patients undergone major orthopedic surgery in Second Affiliated Hospital of Wenzhou Medical University from January 2019 to August 2019，including 46 males and 74 females at age range of 43-89 years［（63.7 ±11.3）years］. Of all，58 patients were with intertrochanteric fracture，52 with femoral neck fracture and 10 with gonarthrosis. Hip fracture operation was performed in 58 patients，total hip replacement in 37，artificial femoral head replacement in 15 and total knee replacement in 10. A total of 60 patients were treated with traditional care，including traditional prevention of thrombosis，conventional VTE risk assessment，treatment and related health education（traditional care group），and 60 patients a with “trinity” co-management care（co-management care group）on the basis of the traditional care，including the trinity of health education，establishing VTE prevention group and VTE tracking table，strengthening postoperative rehabilitation care and exercise，optimization of medicine，nutrition and pain management. Swelling rate of injured limb，D-dimer level on admission and at postoperative days 3 and 7，incidence of VTE at postoperative day 7，length of hospital stay and patient satisfaction were compared between the two groups.Results:Three days and seven days after operation，swelling rate of the injured limb in co-management care group［13%（8/60），8%（5/60）］was significantly lower than that in traditional care group［42%（25/60），30%（18/60）］（ P < 0.05）. There was no significant difference in level of D-dimer between the two groups on admission（ P > 0.05）. Three days and seven days after operation，level of D-dimer［3.40（2.11，6.10）μg/ml，3.70（2.61，6.82）μg/ml］in co-management care group was significantly lower than that in traditional care group［6.37（3.60，9.81）μg/ml，6.42（3.62，9.83）μg/ml］（ P < 0.01）. Seven days after operation，incidence of VTE in co-management care group［3%（2/60）］was significantly lower than that in traditional care group［13%（8/60）］（ P < 0.05）. Length of hospital stay in co-management care group［（10.1 ± 2.2）days］was shorter than that in traditional care group［（11.4 ± 4.3）days］（ P < 0.05）. Nursing satisfaction was 93%（56/60）in co-management care group，higher than 72%（43/69）in traditional care group（ P < 0.05）. Conclusion:For patients undergone major orthopedic surgery，“trinity” co-management mode is effective to reduce the incidence of postoperative limb swelling，level of D-dimer as well as incidence of VTE，shorten the length of hospital stay and improve patients’ satisfaction during perioperative period.