Compliance with Australian Orthopaedic Association guidelines does not reduce the risk of venous thromboembolism after total hip and knee arthroplasty
Journal article
Hawke, Helen, Churches, Tim, Maree Naylor, Justine, Xuan, Wei, Armstrong, Elizabeth, Gray, Leeanne, Fletcher, John, Gosbell, Iain, Christine Lin, Chung-Wei and Harris, Ian A.. (2024). Compliance with Australian Orthopaedic Association guidelines does not reduce the risk of venous thromboembolism after total hip and knee arthroplasty. Scientific Reports. 14(5955), pp. 1-11. https://doi.org/10.1038/s41598-024-54916-x
Authors | Hawke, Helen, Churches, Tim, Maree Naylor, Justine, Xuan, Wei, Armstrong, Elizabeth, Gray, Leeanne, Fletcher, John, Gosbell, Iain, Christine Lin, Chung-Wei and Harris, Ian A. |
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Abstract | 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. |
Keywords | Primary total hip arthroplasty; Primary total knee arthroplasty; Clinical guidelines; Venous thromboembolism; Prophylaxis; Surgical complications |
Year | 01 Jan 2024 |
Journal | Scientific Reports |
Journal citation | 14 (5955), pp. 1-11 |
Publisher | Nature Publishing Group |
ISSN | 2045-2322 |
Digital Object Identifier (DOI) | https://doi.org/10.1038/s41598-024-54916-x |
Web address (URL) | https://www.nature.com/articles/s41598-024-54916-x |
Open access | Published as ‘gold’ (paid) open access |
Research or scholarly | Research |
Page range | 1-11 |
Publisher's version | License File Access Level Open |
Output status | Published |
Publication dates | |
Online | 12 Mar 2024 |
Publication process dates | |
Accepted | 18 Feb 2024 |
Deposited | 11 Jun 2024 |
Supplemental file | License File Access Level Open |
Additional information | © The Author(s) 2024. |
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . | |
The study was funded via a grant through the HCF Health and Medical Research Foundation (Grant number IHIIAMR2012073043). HB is supported by an Australian Government Research Training Program Scholarship. CL is supported by a fellowship from the National Health and Medical Research Council, Australia. The funding bodies had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. | |
Place of publication | United Kingdom |
https://acuresearchbank.acu.edu.au/item/909yq/compliance-with-australian-orthopaedic-association-guidelines-does-not-reduce-the-risk-of-venous-thromboembolism-after-total-hip-and-knee-arthroplasty
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Supplemental file
SM1_Hawke_2024_Compliance_with_Australian_Orthopaedic_Association_guidelines.docx | |
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File access level: Open |
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