Thromboprophylaxis after major orthopedic surgery: Improving compliance with clinical practice guidelines

Bautista, María; Llinás, Adolfo; Bonilla, Guillermo; Mieth, Klaus; Diaz, Mario; Rodríguez, Felipe

doi:10.1016/j.thromres.2015.10.020

Cited by 16 publications

(14 citation statements)

References 29 publications

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“…Although patient care may need to be varied from recommended care to address patient-specific issues, unwarranted variation may increase costs and negatively impact patient outcomes and service capacity [ 19 , 20 ]. Consequently, programs to improve compliance with clinical guidelines are being implemented internationally due to the potential to improve the value of THR and TKR [ 21 – 23 ].…”

Section: Introductionmentioning

confidence: 99%

Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery

et al. 2021

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Background Total hip and total knee replacement (THR/TKR) are common and effective surgeries to reduce the pain and disability associated with arthritis but are associated with small but significant risks of preventable complications such as surgical site infection (SSI) and venous-thrombo-embolism (VTE). This study aims to determine the degree to which hospital care was compliant with clinical guidelines for the prevention of SSI and VTE after THR/TKR; and whether non-compliant prophylaxis is associated with increased risk of complications. Methods and findings A prospective multi-centre cohort study was undertaken in consenting adults with osteoarthritis undergoing elective primary TKR/THR at one of 19 high-volume Australian public or private hospitals. Data were collected prior to surgery and for one-year post-surgery. Four adjusted logistic regression analyses were undertaken to explore associations between binary non-compliance and the risk of surgical complications: (1) composite (simultaneous) non-compliance with both (VTE and antibiotic) guidelines and composite complications [all-cause mortality, VTE, readmission/reoperation for joint-related reasons (one-year) and non-joint-related reasons (35-days)], (2) VTE non-compliance and VTE outcomes, (3) antibiotic non-compliance and any SSI, and (4) antibiotic non-compliance and deep SSI. Data were analysed for 1875 participants. Guideline non-compliance rates were high: 65% (VTE), 87% (antibiotics) and 95% (composite guideline). Composite non-compliance was not associated with composite complication (12.8% vs 8.3%, adjusted odds ratio [AOR] = 1.41, 95%CI 0.68–3.45, p = 0.40). Non-compliance with VTE guidelines was associated with VTE outcomes (5% vs 2.4%, AOR = 2.83, 95%CI 1.59–5.28,p < 0.001). Non-compliance with antibiotic guidelines was associated with any SSI (14.8% vs 6.1%, AOR = 1.98, 95%CI 1.17–3.62,p = 0.02) but not deep infection (3.7% vs 1.2%,AOR = 2.39, 95%CI 0.85–10.00, p = 0.15). Conclusions We found high rates of clinical variation and statistically significant associations between non-compliance with VTE and antibiotic guidelines and increased risk of VTE and SSI, respectively. Complications after THR/TKR surgery may be decreased by improving compliance with clinical guidelines.

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Section: Introductionmentioning

confidence: 99%

Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery

et al. 2021

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“…However, even if statistical significance could be demonstrated, this difference would only represent a clinical problem if the frequency of thromboembolic disease in revision surgery were 3 times higher than in primary surgery. Another potential limitation is that compliance to postoperative thromboprophylaxis was not assessed; however, due to a quality improvement program previously published by our group, 23 our current compliance is over 90%, and given the fact that both primary and revision patients received the same recommendations, a difference in the rate of compliance between groups is not expected. Lastly, due to an increase in the number of surgeons and patients operated during the study period, there is a higher proportion of patients who received rivaroxaban; furthermore, the primary group received more rivaroxaban, while the revision group received more enoxaparin, resulting in a slight difference in outcomes of both thromboembolic and bleeding events.…”

Section: Discussionmentioning

confidence: 92%

Thromboprophylaxis for Hip Revision Arthroplasty: Can We Use the Recommendations for Primary Hip Surgery? A Cohort Study

Bautista

Muskus

Tafur

et al. 2019

Clin Appl Thromb Hemost

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The risk of thromboembolic events after hip revision arthroplasty might be higher than in primary hip arthroplasty. However, evidence regarding the use of thromboprophylaxis in revisions is scarce. The purpose of this study is to determine whether thromboprophylaxis recommendations for primary arthroplasty produce similar results in hip revision arthroplasty. This comparative cohort study retrospectively analyzed consecutive patients undergoing primary hip arthroplasty and hip revision surgery between March 2004 and December 2015, who received thromboprophylaxis according to local clinical practice guidelines for primary hip arthroplasty. The prevalence of deep vein thrombosis and pulmonary embolism and the presence of major bleeding events were assessed during hospitalization and at 3 months after discharge and compared between groups. The overall prevalence of thromboembolic events in the hip revision surgery cohort and in the primary hip cohort was 1.62% and 1.35%, respectively ( P = .801). The 38.4% of hip revision patients and 20.3% of primary hip patients presented major bleeding events. Thromboembolic disease outcomes with the use of a standardized thromboprophylaxis regimen were similar in both cohorts, regardless of the high variability of hip revision surgery and the increased risk of complications. Implementation of this regimen is recommended in patients requiring joint replacement revision surgery.

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“…Another limitation is the inconsistent postoperative heparin use. Although most patients undergoing total hip replacement are postoperatively treated with antithrombotic agents such as enoxaparin according to the guidelines regardless of D-dimer levels [21][22][23], no standard guideline is available in patients undergoing skin surgery. It may be debatable whether heparin should have been used in non-symptomatic patients undergoing skin surgery with elevated D-dimer levels in this study.…”

Section: Discussionmentioning

confidence: 99%

Elevation in D-Dimer Levels after the Surgical Treatment of Stage IA Extramammary Paget’s Disease: A Risk of Deep Vein Thrombosis

2017

ARC Journal of Dermatology

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Thromboprophylaxis after major orthopedic surgery: Improving compliance with clinical practice guidelines

Cited by 16 publications

References 29 publications

Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery

Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery

Thromboprophylaxis for Hip Revision Arthroplasty: Can We Use the Recommendations for Primary Hip Surgery? A Cohort Study

Elevation in D-Dimer Levels after the Surgical Treatment of Stage IA Extramammary Paget’s Disease: A Risk of Deep Vein Thrombosis

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