Sometimes, the answer to a complicated medical challenge isn’t complicated at all. In a Blue Cross-sponsored collaboration of Michigan hospitals, health care providers found that plain old aspirin worked as well as expensive blood thinners to prevent blood clots after knee replacement surgery.
“There are tens of thousands of people in Michigan who have had total knee replacement surgeries. Not everyone is an appropriate match for aspirin therapy, so even if we switched half of these people to aspirin, we would save $6 million each year in drug costs,” says Brian Hallstrom, MD, co-director of the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), a collaboration of Michigan hospitals that aims to improve quality and safety of knee and hip replacement surgery.
That’s because aspirin costs pennies a day, or roughly $2 total for a month of post-surgical blood clot prevention. Compare that to a standard month-long course of blood thinners that can cost anywhere from $380 to $890.
Plus, there are some additional care requirements when patients take blood thinners, also called anticoagulants.
“Patients taking anticoagulants like Warfarin also must monitor blood levels, so there is the extra cost and resources for lab testing,” says Rochelle Igrisan, MBA, MSN, RN, senior project manager for MARCQI.
The collaboration analyzed data from 41,537 Michigan patients undergoing total knee replacement from April 1, 2013 to October 31, 2015.
The primary total knee replacement patients who got only aspirin for their blood clot prevention had an equivalent incidence of blood clot or death and an equivalent bleeding rate as those on anticoagulants. The results have recently been published in JAMA Surgery.
As part of the MARCQI project, the group has collected information from more than 141,000 total knee and total hip cases as of the end of 2016. There are 58 hospitals and two outpatient surgery centers across the state that participate in the collaboration and contribute data.
The group is studying a variety of ways to improve patient safety and the quality of hip and knee joint replacement procedures in Michigan, with five-year results that include:
• Reducing the need for blood transfusions, from 10 percent to 1 percent, a savings of $4 million annually
• Reducing the unnecessary discharge to a skilled nursing facility after surgery, from 21.5 percent to 10 percent, a savings of $20 million annually
• Reducing blood clots by 40 percent.
In addition, the group conducts surveillance of hip and knee implants, and evaluates their risk of needing additional surgery. They also conduct patient surveys, and have been able to use patient-reported outcomes to develop ways to reduce their post-surgical pain.
“Our goal is to make Michigan the best place in the world to have a joint replacement. We’re making great progress,” says Dr. Hallstrom.
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