PDF(Pubmed)
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.
摘要：
预防可避免的静脉血栓栓塞（VTE）是改善全髋关节和全膝关节置换术后患者和服务结果的优先事项（THA，TKA),但对相关临床指南的遵守情况各不相同。本研究旨在确定预防符合澳大利亚骨科协会（AOA）VTE预防指南的程度，以及不依从性是否与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原发性TKA/THA的骨关节炎成人的前瞻性多中心队列研究。在手术前和手术后一年收集数据。进行Logistic回归以探讨不遵守AOAVTE预防指南与有症状的90天VTE结局之间的关联。分析了来自19个地点的1838名参与者的数据。不符合所有临床指南建议的比率为20.1%(N=369),14.1%(N=259)不遵守风险分层预防，35.8%(N=658)的持续时间，其他一般性建议为67.8%(N=1246)。48人（2.6％）在手术后90天内经历了症状性VTE。总体指南不依从性（AOR=0.93，95CI=0.4至1.3，p=0.86）与有症状的90天VTE风险较低无关。当排除高出血风险人群时，结果是一致的（AOR=0.94，95CI=0.44至2.34，p=0.89）。不遵守AOAVTE预防指南与关节置换术后90天VTE的风险无关。这一违反直觉的发现令人担忧，需要对AOAVTE预防临床指南进行严格审查。
