Miguel Farfan1, Maria Bautista2, Guillermo Bonilla3, Jorge Rojas2, Adolfo Llinás4, José Navas2. 1. Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá. School of Medicine, Universidad del Rosario. Bogotá, Colombia. 2. Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá. Bogotá, Colombia. 3. Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá. School of Medicine, Universidad de Los Andes. School of Medicine, Universidad del Rosario. Bogotá, Colombia. Electronic address: bonillaguillermo@yahoo.com. 4. Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá. School of Medicine, Universidad de Los Andes. School of Medicine, Universidad del Rosario. Bogotá, Colombia.
Abstract
INTRODUCTION: Increased risk of venous thromboembolism following major orthopedic surgery (MOS) is well described. The American Academy of Chest Physician (ACCP) has generated evidence-based recommendations for thromboprophylaxis; however, there is a gap between guidelines recommendations and clinical practice. The aim of this study is to compare worldwide adherence rates to the last 4 editions of ACCP guidelines for thromboprophylaxis after MOS. MATERIALS AND METHODS: A systematic review of literature and meta-analysis was performed. Studies reporting adherence to ACCP guidelines between January 2004 and October 2014 were included. Adherence rates after MOS for in-hospital (IH), extended (EXT), and global thromboprophylaxis (in-hospital plus extended) were assessed. RESULTS: Of 3993 titles, 13 studies reporting data of 35,303 patients were selected. Studies assessing the 6th, 7th or 8th editions of ACCP guidelines were found. No studies evaluating the 9th edition were available. For MOS, global adherence rates for the 6th, 7th and 8th editions were 62% (95% CI: 61%-63%), 70% (95% CI: 69%-71%), and 42% (95% CI: 41%-43%), respectively. Likewise, in-hospital adherence was 52% (95% CI: 50%-54%), 51% (95% CI: 50%-52%) and 85% (95% CI: 84%-86%). For extended prophylaxis, adherence rates were reported only for the 8th edition (59%; 95% CI: 58%-60%). CONCLUSIONS: Adherence to ACCP recommendations for thromboprophylaxis during hospitalization has increased over time. Nevertheless, adherence rates to global thromboprophylaxis decrease due to an insufficient implementation of recommendations after discharge.
INTRODUCTION: Increased risk of venous thromboembolism following major orthopedic surgery (MOS) is well described. The American Academy of Chest Physician (ACCP) has generated evidence-based recommendations for thromboprophylaxis; however, there is a gap between guidelines recommendations and clinical practice. The aim of this study is to compare worldwide adherence rates to the last 4 editions of ACCP guidelines for thromboprophylaxis after MOS. MATERIALS AND METHODS: A systematic review of literature and meta-analysis was performed. Studies reporting adherence to ACCP guidelines between January 2004 and October 2014 were included. Adherence rates after MOS for in-hospital (IH), extended (EXT), and global thromboprophylaxis (in-hospital plus extended) were assessed. RESULTS: Of 3993 titles, 13 studies reporting data of 35,303 patients were selected. Studies assessing the 6th, 7th or 8th editions of ACCP guidelines were found. No studies evaluating the 9th edition were available. For MOS, global adherence rates for the 6th, 7th and 8th editions were 62% (95% CI: 61%-63%), 70% (95% CI: 69%-71%), and 42% (95% CI: 41%-43%), respectively. Likewise, in-hospital adherence was 52% (95% CI: 50%-54%), 51% (95% CI: 50%-52%) and 85% (95% CI: 84%-86%). For extended prophylaxis, adherence rates were reported only for the 8th edition (59%; 95% CI: 58%-60%). CONCLUSIONS: Adherence to ACCP recommendations for thromboprophylaxis during hospitalization has increased over time. Nevertheless, adherence rates to global thromboprophylaxis decrease due to an insufficient implementation of recommendations after discharge.
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