None listed
Conditions
Brief summary
This retrospective observational study will be conducted by the Department of anaesthesia. Total hip arthroplasty (THA) can result in a significant surgical stress, which in turn can trigger a hypercoagulable state. These patients are at significant risk for the development of thromboembolic complications. Despite venous thromboembolism (VTE) chemoprophylaxis being administered to all patients who undergo THA at Austin Health, VTE remains a common cause of preventable death and a well recognised complication after total THA. Despite combining extended VTE chemoprophylaxis with early mobilization, compression stockings and intermittent pneumatic compression devices, many patients at Austin Health who undergo THA remain at high risk for VTE because of advanced age, extensive surgical procedures, and greater medical comorbidities. Furthermore, a large multicenter study showed that most VTE’s occur due to prophylaxis failure rather than failure to provide prophylaxis. Although several agents have been shown to reduce the risk of thromboembolic disease, there is no clear preference for thromboembolic chemoprophylaxis for patients undergoing elective total hip arthroplasty. Thromboelastography (TEG) measures whole blood coagulation and fibrinolysis providing a global view of the interaction between all components of clot formation, retraction and lysis. TEG is one of the most sensitive methods currently available for the assessment of a perioperative hypercoagulable state with numerous reports in surgical patients demonstrating an association between TEG measured variables, anaesthetic techniques, and postoperative thrombotic events. Studies have demonstrated that major joint arthroplasty is associated with activation of coagulation (hypercoagulable state) as measured by TEG, however there have been few comparisons of the effects of general and regional anaesthesia techniques on coagulation. Therefore, we propose to perform a retrospective audit of patients who underwent THA at Austin Health, who received a TEG as part of routine care. The primary aims of this retrospective review are to determine if VTE chemoprophylaxis with low molecular weight heparin prevents hypercoagulability after THA (as assessed by TEG) and if general or spinal anaesthesia had similar effects on perioperative coagulability as measured by TEG. Notably, there will be NO CLINICAL or patient contact at any point. All data collected has already been collected as part of routine clinical care according to standard anaesthesia and surgical processes. No new data will be collected.
Interventions
This retrospective observational study will include the records of patients who have undergone elective total hip arthroplasty under general and spinal anaesthesia who have had a thromboelastograph done as part of routine clinical care. We aim to review thromboelastograph from the time of surgery until patient discharge. As this is a retrospective audit of the medical records, no patient involvement is required. Patients will not be contacted in any way, and all information extracted from the re
This retrospective observational study will include the records of patients who have undergone elective total hip arthroplasty under general and spinal anaesthesia who have had a thromboelastograph done as part of routine clinical care. We aim to review thromboelastograph from the time of surgery until patient discharge. As this is a retrospective audit of the medical records, no patient involvement is required. Patients will not be contacted in any way, and all information extracted from the records will be de-identified and aligned with hospital governance processes for clinical audit and retrospective data collection.
Sponsors
Austin Health
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Adult patients (age greater 18 years), undegoing elective primary total hip arthoplasty under a general or spinal anaesthetic
Exclusion criteria
Emergency hip arthroplasty Patients who have not had a thromboelastogram performed as part of routine clinical care
Outcome results
None listed