Ocena zdravljenja z zdravili pri bolnikih po operacijah kolka, kolena ali hrbtenice v Splošni bolnišnici Murska Sobota v letih od 2017 do 2021

Prelog, Urška (author), Vovk, Tomaž (mentor), Kovačič, Alenka (comentor)

Ortopedska operacija za pacienta prinaša tveganje za pojav venskih tromboembolizmov (VTE), zato se pri pacientih priporoča tromboprofilaksa. Poleg VTE se lahko po operaciji pojavijo še drugi zapleti, ki so med drugim lahko posledica jemanja zdravil. Pomembna zdravila v perioperativnem obdobju so poleg antikoagulantov tudi analgetiki in antibiotiki. Namen retrospektivne raziskave je bil pridobiti informacije o predpisovanju analgetikov in antikoagulantov ob odpustu pri bolnikih na oddelku za ortopedijo v Splošni bolnišnici Murska Sobota, izračunati pojavnost zapletov v obdobju 6 mesecev po operaciji ter oceniti vpliv zdravil na zaplet izliva krvi. Vključili smo paciente, ki so imeli med leti 2017 in 2021 totalno kolčno artroplastiko, totalno kolensko artroplastiko, odstranitev medvretenčne ploščice na eni višini ali dekompresijo ledvenega dela spinalnega kanala v eni višini. Ugotovili smo, da so najpogosteje predpisani analgetiki paracetamol, metamizol in tramadol. Paracetamol je prejelo več kot 90 % bolnikov po artroplastikah. Predpisovanje nizkomolekularnih heparinov (NMH) med bolniki po totalnih artroplastikah z leti pada, saj narašča uporaba direktnih peroralnih antikoagulantov (DOAK), najpogosteje rivaroksabana. Pri bolnikih po operaciji hrbtenice se predpisujejo NMH; DOAK so predpisani redko, kar je skladno s smernicami. Rezultati kažejo, da je najpogostejši zaplet po totalni artroplastiki izliv krvi; s pojavnostjo 12,2 % po totalni kolenski artoplastiki in 3,1 % po totalni kolčni artroplastiki v obdobju 6 mesecev po posegu. Pojavnost VTE je v skupinah bolnikov po obeh artroplastikah podobna. Ugotovili smo, da so se zapleti po operaciji kolena pogosteje pojavljali pri moških, medtem ko so ti bili po operaciji kolka pogostejši v skupini žensk. Pojavnost VTE v obdobju 6 mesecev po operaciji hrbtenice znaša 1,1 %. Iz podrobnega pregleda 45 pacientov z zapleti smo ugotovili, da bolniki prejemajo antibiotično profilakso v skladu s priporočili, to je cefazolin 2 g do 60 min pred operacijo, ki mu sledijo dodatni odmerki. Pojav izliva krvi po artroplastiki je pogostejši pri pacientih, ki so ob odpustu prejeli NMH, v primerjavi s pacienti, ki so prejeli DOAK, vendar med skupinama ni statistično značilne razlike. Ugotovili smo, da prejemanje nesteroidnega antirevmatika (NSAR) ali metamizola ob odpustu poveča tveganje za nastanek izliva krvi pri bolnikih po totalni kolenski artroplastiki, ne pa pri bolnikih po kolčni artroplastiki. Iz pregleda intervencij kliničnih farmacevtov smo ugotovili, da je bilo izmed vseh intervencij opravljenih največ farmakoterapijskih pregledov.

• Language: Slovenian
• Keywords: Totalna kolenska artroplastika, totalna kolčna artroplastika, operacija hrbtenice, analgetiki, antikoagulanti, perioperativni zapleti, venski tromboembolizem, izliv krvi
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2022
• PID: 20.500.12556/RUL-142615
• Publication date in RUL: 16.11.2022

Secondary language

• Language: English
• Title: Drug treatment evaluation in patients after hip, knee or spine surgery at the Murska Sobota General Hospital from 2017 to 2021

Abstract

Orthopedic surgery puts patients at risk for venous thromboembolism (VTE), therefore thromboprophylaxis is recommended for patients. In addition to VTE, other complications can occur after surgery that may be due to the use of medications. Important drugs in the perioperative period include anticoagulants, analgesics and antibiotics. The aim of the retrospective study was to obtain information on the prescription of analgesics and anticoagulants at discharge of patients in the Department of Orthopedics at Murska Sobota General Hospital, to calculate the incidence of complications in the period of 6 months after surgery, and to evaluate the effect of medications on the complication of bleeding. Patients who underwent total hip arthroplasty, total knee arthroplasty, single intervertebral discectomy or single level decompression of the lumbar portion of the spinal canal between 2017 and 2021 were included. Prescription of low-molecular-weight heparins (LMWHs) among patients undergoing total arthroplasty has declined over the years as the use of direct oral anticoagulants (DOACs), most commonly rivaroxaban, has increased. In patients undergoing spine surgery, LMWHs are commonly prescribed and DOACs are rarely prescribed, which is consistent with guidelines. Results show that the most common complication after total arthroplasty is hemorrhage: the incidence was 12.2% after total knee arthroplasty and 3.1% after total hip arthroplasty within 6 months of surgery. The incidence of VTE is similar in the two groups of patients after both arthroplasties. We found that complications after knee surgery were more common in men, whereas complications after hip surgery were more common in women. The incidence of VTE within 6 months after spine surgery was 1.1%. In a detailed review of 45 patients with complications, we found that patients received antibiotic prophylaxis as recommended, i.e. 2 g of cefazolin up to 60 minutes before surgery, followed by additional doses. Patients who received LMWH at discharge were more likely to experience postarthroplasty hemorrhage than patients who received DOAC, but there was no statistically significant difference between the groups. We found that administration of a nonsteroidal anti-inflammatory drug (NSAID) or metamizole at discharge increased the risk of bleeding in patients with total knee arthroplasty, but not in patients with hip arthroplasty. In reviewing clinical pharmacist interventions, we found that of all interventions, pharmacotherapy examinations were the most common.

• Keywords: Total knee arthroplasty, total hip arthroplasty, spine surgery, analgesics, anticoagulants, perioperative complications, venous thromboembolism, hemorrhage