Issue: February 2014
February 01, 2014
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Cost of treating VTE risk factors may outweigh associated readmission costs

Issue: February 2014
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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 at the Current Concepts in Joint Replacement Winter Meeting.

“When we used a multimodal prophylactic approach in preventing blood clots and [venous thromboembolisms] VTEs, an 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 readmission 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 research won the OREF/CCJR Clinical Award Paper at the meeting.

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% were 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, who also is an assistant professor of orthopedic surgery at Washington University School of Medicine, St. Louis, Mo., 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.
For more information:
James A. Keeney, MD, can be reached at the Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Ave., Campus Box 8233, St Louis, MO 63110; email: keeneyj@wudosis.wustl.edu.
Disclosure: Keeney is a paid consultant for OrthoSensor.