Patient ethnicity and use of venous thromboembolism prophylaxis.
OBJECTIVE
Patients at highest risk for developing venous thromboembolism include those undergoing major orthopedic surgery. However, physicians vary in their strategies to prevent venous thromboembolism. We evaluated whether the use of venous thromboembolism prophylaxis after orthopedic surgery is related to patient ethnicity.


METHODS
Retrospective cohort study, 1998-2002.


METHODS
Tertiary care, university-affiliated hospital in Hawaii.


METHODS
1811 adults (1085 women; 743 Asians; 206 Pacific Islanders; mean age 70.6 +/- 14.7 years) who underwent hip replacement, hip fracture surgery, or total knee replacement.


METHODS
Use of venous thromboembolism prophylaxis as recommended by the American College of Chest Physicians. Multivariable logistic regression was used to identify factors associated with prophylaxis use.


RESULTS
Overall, 49.4% of patients received venous thromboembolism prophylaxis. After adjustment for patient age, sex, thromboembolism and bleeding risk factors, type of surgery, and anesthesia, Japanese patients were less likely to receive prophylaxis [odds ratio (OR) = 0.7; 95% confidence interval (CI) = 0.5-0.9; P = 0.01], whereas other ethnic groups were treated similarly to whites. Relative to patients undergoing hip replacement, those with hip fracture surgery were less likely (OR = 0.4; 95% CI = 0.3-0.5; P < 0.01), and those receiving total knee replacement more likely (OR = 4.5; 95% CI = 3.6-5.7; P < 0.01) to receive appropriate prophylaxis.


CONCLUSIONS
Despite consensus recommendations, venous thromboembolism prophylaxis use among high-risk patients remains low. Japanese patients and those undergoing hip fracture surgery are at particular risk for not receiving appropriate prophylaxis in our population. Further research is needed to clarify the reasons for our findings and to determine if this variation is associated with increased risk of thromboembolic complications.
Gelber
Rebecca P
RP
Department of Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, 96813, USA. rgelber@hsph.harvard.edu
Seto
Todd B
TB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001213:Asian; D018890:Chemoprevention / Q000706:statistics & numerical data*; D017723:Drug Utilization Review; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006254:Hawaii; D006620:Hip Fractures / Q000208:ethnology / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D007564:Japan / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander; D010139:Pacific Islands / Q000208:ethnology; D012189:Retrospective Studies; D013923:Thromboembolism / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000517:prevention & control*
D005343:Fibrinolytic Agents