The incidence of venous thromboembolism in total joint replacement during COVID-19 pandemic

Khan, Sheeba; Logan, Peter; Asokan, Ajay; Handford, C. Robertson; Rajgor, Harshadkumar Dhirajlal; Khadabadi, Nikhil Aravind; Moores, Thomas; Targett, J. H.

doi:10.1302/2633-1462.112.bjo-2020-0144.r1

Cited by 13 publications

(11 citation statements)

References 23 publications

(14 reference statements)

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“…Because of the latter concern and the potential for increased risk for mortality, some studies have proposed that elective surgical intervention be delayed in patients with active COVID - 19 infection 2245,2246 . On the other hand, there is also some data to suggest that patients who had a delay in receiving their total joint arthroplasty due to COVID - 19 protocols may be at risk of VTE 2247 .…”

Section: - Are Patients With Prior History Of Covid - 19 Who Undergo ...mentioning

confidence: 99%

Recommendations from the ICM-VTE: General

2022

Journal of Bone and Joint Surgery

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Section: - Are Patients With Prior History Of Covid - 19 Who Undergo ...mentioning

confidence: 99%

Recommendations from the ICM-VTE: General

2022

Journal of Bone and Joint Surgery

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“…There are conflicting studies reporting on the prolonged duration of increased DVT, cardiac abnormalities, and PE rates in COVID patients after inoculation, and our study aims to demonstrate asymptomatic patients, >6 months since the last positive PCR test, have no increased risks of UTI, PJI, PE, DVT, and cardiac arrhythmias after joint arthroplasty [13]. Many of our patients had delayed procedures due to positive testing, and they are at increased risk for thromboembolism due to worsened arthritis and reduced mobility during the self-isolation period [14]. Despite theories on increased coagulopathy in prior positive patients, our findings of no increased risks for thromboembolic disease suggest more aggressive prophylactic anticoagulation regimens may not be necessary and otherwise increase the risk for hematoma formation [6,15].…”

Section: Discussionmentioning

confidence: 93%

Prior Diagnosis of COVID Has No Increased Complications in Total Joint Arthroplasty

Lung¹,

Taka²,

Donnelly³

et al. 2022

Cureus

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IntroductionAlthough a substantial portion of the United States population has been infected with and recovered from Coronavirus , many patients may have persistent symptoms and complications from disease-driven respiratory disease, arrhythmias, and venous thromboembolism (VTE). With institutions resuming elective total joint arthroplasties (TJA), it is unclear whether a prior resolved diagnosis of COVID has any implications on postoperative outcomes. MethodsAll elective TJA performed in 2021 at our institution were retrospectively reviewed and a history of prior COVID+ result recorded. Baseline demographics, days from prior COVID+ result to surgery date, preoperative methicillin-resistant Staphylococcus aureus (MRSA) nares colonization, and laboratory markers were obtained to determine baseline characteristics. Postoperative estimated blood loss (EBL), length of stay (LOS), rate of revision surgery, and discharge destination were compared between groups. Perioperative and postoperative rates of VTE, urinary tract infection (UTI), pneumonia, postoperative oxygen supplementation, cardiac arrhythmia, renal disease, sepsis, and periprosthetic joint infections within six months of surgery were recorded. ResultsOf the 155 elective TJA performed in 2021, 24 patients had a prior COVID+ diagnosis with a mean of 253 days from positive result to surgery date. There were no significant differences in baseline demographics, comorbidities, and preoperative lab markers between groups. Surgeries on patients with a prior COVID+ had a significantly higher EBL (260 vs 175cc), but postoperative outcomes of VTE, UTI, pneumonia, oxygen supplementation requirement, nares MRSA+, cardiac disease, and infection rates between groups were similar. Bivariate logistic regression revealed increased days from COVID+ diagnosis (>6 months) to surgery date were associated with a shorter LOS. ConclusionAlthough a prior COVID+ diagnosis had increased intraoperative blood loss, there were no significant differences in respiratory, infectious, cardiac, and thromboembolic complications up to six months after elective TJA. This study suggests that asymptomatic C+ patients receiving elective TJA do not require more aggressive prophylactic anticoagulation or antibiotic regimens to prevent VTE or perioperative infections. As institutions around the nation resume pre-COVID rates of arthroplasty surgeries, a prior diagnosis of COVID appears to have no effects on postoperative complications.

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“…Although SD discharge rates were more than double relative to baseline, the data illustrate that we maintained a high level of care, as reflected in the comparable rates of 30-day readmissions (30R) pre- and post-implementation of the Pivot Plan. Further, no patients experienced deep vein thrombosis (DVT) or pulmonary embolism (PE), despite the fact that previous groups have reported an increased incidence of venous thromboembolism (VTE) in patients undergoing elective arthroplasty during the pandemic, possibly due to the need to self-quarantine for a prolonged time before surgery [ 13 ]. In six out of seven months studied, we noted that the 30R was lower than the pre-COVID average, with the lowest recorded rate of 0.5% in the month of November 2020 at MMC and 0% in the months of May, June, September, October, and November 2020 at SVMC.…”

Section: Discussionmentioning

confidence: 99%

A COVID-19 Pivot Plan to Resume Elective Surgeries at the Hartford Healthcare Connecticut Orthopaedic Institute

Vaidya¹,

Berluti²,

Irving³

et al. 2021

Cureus

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BackgroundThe Connecticut Orthopaedic Institute (COI) conceptualized a Pivot Plan during an elective surgery moratorium at the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic with the goal of planning and executing orthopedic procedures safely. With the resumption of elective surgeries and the continued planning of surgical recovery over the months (and possibly years) to follow, facilities must brace themselves for repeat waves of COVID-19. Thereby, herein we share the Pivot Plan, its implementation process, evaluation of patient safety, and program performance during a pandemic. This could inform the efforts of other institutions seeking to restart non-emergent surgeries during similarly trying times in the future. MethodsThe COI formed a multidisciplinary team of leaders that met weekly to design a Pivot Plan and a dashboard to guide the resumption of surgeries and assess the performance of the Pivot Plan. The plan revolved around four domains: safety, space, staff, and supplies. It was implemented in two COI-affiliated facilities: MidState Medical Center (MMC) and St. Vincent's Medical Center (SVMC). Monthly metrics from May to November 2020 were compared to the six-month averages for the pre-pandemic baseline period from September 2019 to February 2020. ResultsThe total number (N) of elective orthopaedic cases prior to the pandemic pre-COVID averaged 372 cases per month for MMC and 197 cases for SVMC. During the pandemic post-COVID, N averaging at 361 for MMC and 243 for SVMC illustrates COI was able to perform elective surgeries amid a worsening pandemic. Sameday (SD) discharge rates for total joint arthroplasty (TJA) pre-COVID averaged 8% for MMC and 3% for SVMC. Post-COVID, the SD average was 16.7% for MMC and 11.4% for SVMC. This data indicates that orthopaedic providers were cognizant of length of stay in order to reduce the risk of in-hospital exposure to COVID-19. The 30-day readmission (30R) rate for TJA pre-COVID averaged 1.4% for MMC and 2.7% for SVMC. A high level of care and follow-up is reflected in a lower average 30R post-COVID, 1.1% for both MMC and SVMC. Transitions for TJA patients to their home settings after surgery also reflect the quality of care and the efficiency of the patient throughput process with necessary precautions in place. Post-COVID, the patient transition to home (T) averaged 98.1% for MMC and 97.5% for SVMC compared to T = 96.8% for MMC and 88% for SVMC pre-COVID. No patients experienced deep vein thrombosis or pulmonary embolism during the time period of the project. Positive COVID-19 diagnosis 23 days after discharge was 0% at MMC and 0.2% at SVMC. ConclusionThe COI Pivot Plan was successfully implemented at two different hospitals offering elective orthopaedic surgeries to a varied patient population. The precautions taken by COI were effective in controlling the spread of the SARS-CoV-2 virus while returning to elective orthopaedic surgery. Furthermore, data collected before and after the onset of the COVID-19 pandemic indicated ...

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The incidence of venous thromboembolism in total joint replacement during COVID-19 pandemic

Cited by 13 publications

References 23 publications

Recommendations from the ICM-VTE: General

Recommendations from the ICM-VTE: General

Prior Diagnosis of COVID Has No Increased Complications in Total Joint Arthroplasty

A COVID-19 Pivot Plan to Resume Elective Surgeries at the Hartford Healthcare Connecticut Orthopaedic Institute

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