Survey of prophylaxis against venous thromboembolism in adults undergoing hip surgery.

Venous thromboembolic disease (VTED) is the most common and potentially the most serious immediate postoperative complication of hip surgery. Prophylaxis of VTED remains controversial and its practice is widely variable. Since the last survey of VTED prophylaxis as practiced by American orthopedists, published in 1974, the literature has expanded tremendously and the number of orthopedists has doubled. The authors surveyed 10% of American orthopedists and the chiefs of training programs and/or major teaching hospitals to assess current practices. The average practicing orthopedist responding was 44-years-old and had performed 17.6 total hip arthroplasties and treated operatively 30.6 hip fractures per year during the last five years. The average responding chief surgeon, was 49 years old and had performed 49 total hip arthroplasties and treated operatively 20.5 hip fractures per year during the last five years. Most surgeons use pharmacologic prophylaxis or external pneumatic compression for total hip arthroplasty patients (84.4%) and hip fracture patients (74%). Warfarin has been tried and abandoned by 50% of all respondents, largely because of bleeding complications. Aspirin was the most popular agent. However, more than 25% of the respondents stated that at least one of their patients who had elective total hip arthroplasties had died of pulmonary embolism during the last five years.