Comparative Study of Compliance for Venous Thromboembolism Prophylaxis (American College of Chest Physicians Guideline and American College of Orthopedic Surgeons Guideline) in High Risk Patients with a Venous Thromboembolism

You-Sung Suh; Jae-Hwi Nho; Byung-Woong Jang; Deokwon Kang; Sung-Hun Won

doi:10.4055/jkoa.2019.54.4.317

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Suh, Nho, Jang, Kang, and Won: Comparative Study of Compliance for Venous Thromboembolism Prophylaxis (American College of Chest Physicians Guideline and American College of Orthopedic Surgeons Guideline) in High Risk Patients with a Venous Thromboembolism

Original Article

Journal of the Korean Orthopaedic Association 2019; 54(4): 317-326.

Published online: 21 August 2019

DOI: https://doi.org/10.4055/jkoa.2019.54.4.317

Comparative Study of Compliance for Venous Thromboembolism Prophylaxis (American College of Chest Physicians Guideline and American College of Orthopedic Surgeons Guideline) in High Risk Patients with a Venous Thromboembolism

You-Sung Suh, M.D., Ph.D., Jae-Hwi Nho, M.D., Ph.D., Byung-Woong Jang, M.D., Deokwon Kang, M.D., Sung-Hun Won, M.D., Ph.D.

Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.

Correspondence to: Sung-Hun Won, M.D., Ph.D. Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea. TEL: +82-2-709-9250, FAX: +82-2-796-3682, orthowon@gmail.com

Received 11 July 2018 Revised 1 October 2018 Accepted 22 October 2018

The Korean Orthopaedic Association

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare and analyze the rate of prevention of two venous thromboembolism prophylaxis guidelines in patients with artificial joint arthroplasty and hip joint fracture. Proper prophylaxis for preventing thromboembolism in orthopedic surgery is significant because of this fetal complication.

Materials and Methods

This study compared and retrospective analyzed the rate of prevention using the medical records and radiographs of patients who underwent orthopedic surgery from March 2009 to February 2011 according to the American College of Chest Physicians (ACCP) guidelines and from March 2012 to February 2014 according to the American Academy of Orthopedic Surgeons (AAOS) guidelines.

Results

The guidelines for venous thromboembolism prophylaxis have been applied to patients with artificial joint replacement and hip joint fracture, the compliance rate of the ACCP guidelines was 56.0% before surgery, 67.0% after surgery with chemical prophylaxis, and 80.5% with mechanical prophylaxis. In addition, the compliance rate of the AAOS guidelines was 74.1% with chemical prophylaxis, and 88.3% with mechanical prophylaxis, which was higher than the ACCP guidelines. The compliance rates of mechanical and chemical prophylaxis before and after surgery of the ACCP guidelines, and the compliance rate of mechanical and chemical prophylaxis of the AAOS guidelines were compared and analyzed. The results revealed statistical significance (p<0.05) before and after total knee replacement arthroplasty and hip joint fracture internal fixation and total high risk orthopedic surgery.

Conclusion

Raising the compliance rate of prophylaxis of venous thromboembolism in high risk orthopedic surgery is necessary and people should follow the guidelines for a unified direction depending on which situation they are in.

Keywords: compliance, venous thromboembolism, guideline, orthopedic procedure

Figures and Tables

Figure 1

Flow chart of patients treated according to the American College of Chest Physicians guidelines. TKRA, total knee replacement arthroplasty; THRA, total hip replacement arthroplasty; HFS, hip fracture surgery.

Figure 2

Flow chart of patients treated according to the American College of Orthopedic Surgeons guidelines. TKRA, total knee replacement arthroplasty; THRA, total hip replacement arthroplasty; HFS, hip fracture surgery.

Table 1

Guideline of the ACCP (Thromboprophylaxis for High Risk Orthopaedic Surgery)

ACCP, American College of Chest Physicians; LMWH, low molecular weight heparin; VKA, vitamin K antagonist; INR, international normalized ratio.

Table 2

Guideline of the AAOS (Grade of Recoomendation for Thromboprophylaxis)

AAOS, American College of Orthopedic Surgeons.

Table 3

Baseline Characteristics of Patients (2009. 3–2011. 2) at High Risk of Venous Thromboembolism with the ACCP Guideline

Values are presented as mean only or number (%). ACCP, American College of Chest Physicians; TKRA, total knee replacement arthroplasty; THRA, total hip replacement arthroplasty; HFS, hip fracture surgery; GFR, glomerular filtration rate.

Table 4

Baseline Characteristics of Patients (2012. 3–2014. 2) at High Risk of Venous Thromboembolism with the AAOS Guidelines

Values are presented as mean only or number (%). AAOS, American College of Orthopedic Surgeons; TKRA, total knee replacement arthroplasty; THRA, total hip replacement arthroplasty; HFS, hip fracture surgery; GFR, glomerular filtration rate.

Table 5

Patterns of Thromboprophylaxis of ACCP Guidelines for Patients at High Risk of Venous Thromboembolism

Values are presented as number (%) or median (range). ACCP, American College of Chest Physicians; TKRA, total knee replacement arthroplasty; THRA, total hip replacement arthroplasty; HFS, hip fracture surgery; GCS, graduated compression stockings.

Table 6

Compliance for the ACCP Guideline and Outcomes

Values are presented as number (%) or percent only. ACCP, American College of Chest Physicians; TKRA, total knee replacement arthroplasty; THRA, total hip replacement arthroplasty; HFS, hip fracture surgery; PE, pulmonary embolism; DVT, deep vein thrombosis.

Table 7

Patterns of Thromboprophylaxis of the AAOS Guidelines for Patients at High Risk for Venous Thromboembolism

Values are presented as number (%). AAOS, American College of Orthopedic Surgeons; TKRA, total knee replacement arthroplasty; THRA, total hip replacement arthroplasty; HFS, hip fracture surgery; GCS, graduated compression stockings.

Table 8

Compliance for the AAOS Guidelines and Outcomes

Values are presented as number (%) or percent only. AAOS, American College of Orthopedic Surgeons; TKRA, total knee replacement arthroplasty; THRA, total hip replacement arthroplasty; HFS, hip fracture surgery; PE, pulmonary embolism; DVT, deep vein thrombosis.

Table 9

Compliance and Outcome Analysis of the Guidelines

Values are presented as number (%). ^*p-value by Pearson chi-squared test, ^†p-value by Fisher's exact test. ACCP, American College of Chest Physicians; AAOS, American Acardemy of Orthopedic Surgeons; TKRA, total knee replacement arthroplasty; THRA, total hip replacement arthroplasty; HFS, hip fracture surgery.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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ORCID iDs: Sung-Hun Won
https://orcid.org/0000-0002-5471-7432
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