Impact of clinical pharmacist services on anticoagulation management of total joint arthroplasty: A retrospective observational study

Implementing an innovative, patient-centered approach to day case arthroplasty: improving patient outcomes through remote preoperative pharmacist consultations

OBJECTIVE

Elective surgery suffered significant loss of capacity during the COVID-19 pandemic. To address this, hip and knee arthroplasties are being conducted as day case procedures. Pre-admission pharmacist consultations were introduced (the intervention) for these patients. This consultation aimed to address perioperative medicines issues, promote patient empowerment, improve prescribing quality and contribute to reduction in length of stay (LoS).

METHODS

All patients listed for a total/unicompartmental knee replacement (TKR/UKR) or total hip replacement (THR) at an ambulatory care hospital were identified by a pharmacist prescriber 1-2 weeks before the operation. Pharmacist consultations were conducted remotely with discharge prescriptions written electronically and dispensed before admission. Prescribing data were collected for both pre-intervention (n=80) and post-intervention (n=129) groups along with all interventions undertaken during consultations. Staff opinion was sought via online questionnaire and patient opinion was gathered via post-discharge telephone calls.

RESULTS

A total of 115 interventions took place during 129 patient consultations and >75% of interventions were of a significance expected to improve patient care. Prescribing standards were improved in the intervention group compared with patients whose arthroplasty was before the introduction of this service. The pharmacy service would have produced a different prescription in 38.8% of the pre-intervention group. Staff and patient feedback was extremely positive and all patients with previous surgical experience in the health board reported an improved experience. There was a statistically significant reduction in post-discharge healthcare encounters (such as general practitioner (GP) visits) in the intervention group.

CONCLUSION

This novel remote preoperative pharmacist consultation improved prescribing standards, enhanced the patient's surgical experience and reduced the burden on post-discharge healthcare systems.

Impact of antibiotic prophylaxis courses on postoperative complications following total joint arthroplasty: Finding from Chinese population

WHAT IS KNOWN AND OBJECTIVE

Prolonged antibiotic prophylaxis after total joint arthroplasty (TJA) may not assist in minimizing postoperative complications, however, data based on the Chinese population have been limited. The purpose of this study is to investigate the effect of antibiotic prophylaxis on postoperative complications after TJA in Chinese patients.

METHODS

We retrospectively reviewed 990 patients undergoing elective primary TJA surgery from January 2016 to June 2019. Patients who received a short course (≤3 days) of antibiotic prophylaxis were compared with those who received a longer course (>3 days). Logistic regression analysis and subgroup analysis were performed to control for potential confounders. Beyond that, survival analysis was used to determine the cumulative incidence of postoperative complications.

RESULTS AND DISCUSSION

Follow-up to 12 months after surgery, the prevalence of system complications in the longer course group and the short course group were 5.1% and 3.9%, respectively (p = 0.451). Similarly, no statistical differences in incisional complications (1.5% vs. 1.8%, p > 0.999) and periprosthetic joint infection (PJI) (1.0% vs. 1.0%, p > 0.999) were observed between the two groups. After performing logistic regression analysis and survival analysis, no potential association was found between the course of antibiotic prophylaxis and postoperative complications. In addition, prolonged antibiotic prophylaxis conferred no benefit for high-risk obese patients.

WHAT IS NEW AND CONCLUSION

Extended antibiotic prophylaxis did not result in a statistically significant and clinically meaningful reduction in postoperative complications. Therefore, we recommended that the duration of antibiotic prophylaxis in TJA should be shortened to 3 days or less in the Chinese population.