ASSESSMENT OF EFFECTIVENESS

Transcription

1 W.M. Glinkowski 1,2,3,A.Górecki 1 WEB BASED DATABASE FOR THE ASSESSMENT OF EFFECTIVENESS OF THROMBOEMBOLIC PROPHYLAXIS IN ORTHOPAEDIC SURGERY. PRELIMINARY STUDY 1 Chair and Department of Orthopaedics and Traumatology of Locomotor System, Center of Excellence "TeleOrto", Medical University of Warsaw, Lindleya 4, Warsaw, Poland 2 Department of Descriptive and Clinical Anatomy, Center of Biostructure Research, Medical University of Warsaw, Warsaw, Poland 3 Polish Telemedicine Society, Warsaw, Poland 1

2 Introduction Over one million people in the EU each year are affected with venous thromboembolism b (VTE) that includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Over 540,000 VTE related deaths are estimated per year in Europe with VTE. Web based databases belong to ehealth domain that are not frequently used in orthopaedic trials. 2

3 The Aim of the study to show how the Web based erecord was working in practice to analyze data from the multicenter Web Based Orthopaedic eregistry (RECORD) to evaluate the prophylaxis level and assess how the guidelines of VTE prophylaxis recommendations influenced on VTE occurrence and present the usefulness of internet t based tools for orthopaedicsurgery. 3

4 Material and method Thromboembolic prophylaxis national registry in orthopaedicsurgery and traumatology has been invented since 2001 and provided consecutively. Data was collected using Internet accessible database. Personal data were anonimized to avoid problems with data protection regulations Web based collected data derived from 50 medical centers in 2001 and from 62 medical centers in Registry of primary venous thromboembolic prophylaxis in orthopaedic departments had collected data on patient s age, sex, height, weight, and patient's health status including VTE risk factors. 4

5 Material and Method Despite guidelines for venous thromboembolism (VTE) prevention in orthopaedic surgery elaborated on evidence based approach, many patients may not receive effective prophylaxis. patients admitted to orthopaedic departments for THA or TKA 1949 patients 2001 database 2061 patients 2007 database 5

6 Evidence based national guidelines for venous thromboembolism (VTE) in orthopaedic surgery were elaborated and accepted in 2002 as an official document undersigned by National Specialist of Orthopaedic and Traumatology of Locomotor System and President of Polish Society of Orthopaedics and Traumatology (PTOiTr) and reviewed and updated in 2004 and

7 Guidelines published in Ortop Traumatol Rehabil.

8 RECORD XRP4563G/5001 O O O

9 Results Averageone g day shorter hospital stay. Most of patients received a form of recommended prophylaxis mostly (Low Molecular Weight Heparin) LMWH. Deep venous thrombosis (DVT) symptoms were observed in 22 (0,5%) orthopaedic patients in 2001 mostly while receiving prophylactic regime. Similar symptoms have occurred in 13 patients only (0,3%) six years later. The VTE prophylaxis was prescribed to 97,17% of patients prior guidelines publication and to 98,38 of patients later. 9

10 Discussion Implementation strategies are key factors in determining the overall success of clinical guidelines. Guidelines are important for changing physician practices achieve a clinical improvement or cost savings. The dissemination of guidelines was postulated as influential on VTE prophylaxis hl practice. The web based database enables the collection important information that derives from multiple remote centers. Web based erecord allowed to scientifically review huge anonymized data collection otherwise unaccessible Having Web based database, sufficient evidence was available to make useful comparisons of regimen and medications utilization. 10

11 Conclusions This large scale prospective web based registry was found as a powerful ehealth clinically oriented tool. It has confirmed that dissemination of guidelines becomes useful instrument for the unifying and improving thromboembolic prophylaxis protocol. No considerable variation in venous thromboembolism prophylaxis practices employed by orthopedic surgeons in THA and TKA patients was found. Web based database observations reinforce the continuing i monitoring i of clinical i l practice and exploration the compliance with recommended prophylactic p regimens. 11

12 Acknowledgments The project was supported by Sanofi Aventis educational grant number XRP4563G/5001. Authors thanks to all contributors of RECORD project. 12

13 Thank you for your attention 13