Badge Helen, Churches Tim, Naylor Justine M, Xuan Wei, Armstrong Elizabeth, Gray Leeanne, Fletcher John, Gosbell Iain, Lin Chung-Wei Christine, Harris Ian A
Whitlam Orthopaedic Research Centre, 1 Campbell Street, Liverpool, 2071, Australia.
South Western Sydney Clinical School, UNSW, 1 Elizabeth Street, Liverpool, 2071, Australia.
Sci Rep. 2024 Mar 12;14(1):5955. doi: 10.1038/s41598-024-54916-x.
Preventing avoidable venous-thrombo-embolism (VTE) is a priority to improve patient and service outcomes after total hip and total knee arthroplasty (THA, TKA), but compliance with relevant clinical guidelines varies. This study aims to determine the degree to which prophylaxis was compliant with Australian Orthopaedic Association (AOA) VTE prophylaxis guidelines and whether non-compliance is associated with increased risk of VTE. A prospective multi-centre cohort study of adults with osteoarthritis undergoing primary TKA/THA was completed at 19 high-volume public and private hospitals. Data were collected prior to surgery and for one-year post-surgery. Logistic regression was undertaken to explore associations between non-compliance with AOA VTE prophylaxis guidelines and symptomatic 90-day VTE outcomes. Data were analysed for 1838 participants from 19 sites. The rate of non-compliance with all clinical guideline recommendations was 20.1% (N = 369), with 14.1% (N = 259) non-compliance for risk-stratified prophylaxis, 35.8% (N = 658) for duration, and 67.8% (N = 1246) for other general recommendations. Symptomatic VTE was experienced up to 90-days post-surgery by 48 people (2.6%). Overall guideline non-compliance (AOR = 0.93, 95%CI = 0.4 to 1.3, p = 0.86) was not associated with a lower risk of symptomatic 90-day VTE. Results were consistent when people with high bleeding risk were excluded (AOR = 0.94, 95%CI = 0.44 to 2.34, p = 0.89). Non-compliance with the AOA VTE prophylaxis guidelines was not associated with risk of 90-day VTE after arthroplasty. This counterintuitive finding is concerning and necessitates a rigorous review of the AOA VTE prevention clinical guideline.
预防可避免的静脉血栓栓塞症（VTE）是改善全髋关节置换术和全膝关节置换术（THA，TKA）后患者及服务结局的首要任务，但对相关临床指南的依从性存在差异。本研究旨在确定预防措施符合澳大利亚骨科协会（AOA）VTE预防指南的程度，以及不依从是否与VTE风险增加相关。在19家大型公立和私立医院完成了一项对接受初次TKA/THA的骨关节炎成年患者的前瞻性多中心队列研究。在手术前及术后一年收集数据。采用逻辑回归分析来探讨不遵守AOA VTE预防指南与90天有症状VTE结局之间的关联。对来自19个地点的1838名参与者的数据进行了分析。所有临床指南建议的不依从率为20.1%（N = 369），风险分层预防的不依从率为14.1%（N = 259），持续时间的不依从率为35.8%（N = 658），其他一般建议的不依从率为67.8%（N = 1246）。48人（2.6%）在术后90天内出现有症状的VTE。总体指南不依从（优势比[AOR]=0.93，95%置信区间[CI]=0.4至1.3，p = 0.86）与90天有症状VTE的较低风险无关。排除高出血风险人群后结果一致（AOR = 0.94，95%CI = 0.44至2.34，p = 0.89）。不遵守AOA VTE预防指南与关节置换术后90天VTE风险无关。这一违反直觉的发现令人担忧，有必要对AOA VTE预防临床指南进行严格审查。
