Venous Thromboembolism Prophylaxis in Orthopedic Surgery
Patient or Surgical Characteristics That May Affect the Risk of Venous Thromboembolism
Sixteen randomized controlled trials (N = 1,777), seven controlled observational studies (N = 18,152), and four nested observational studies (N = 2,469) evaluated the impact of patient, surgical, or postsurgical characteristics on the risk of venous thromboembolic or bleeding outcomes. All 16 randomized controlled trials evaluated surgical characteristics and were published as full-text manuscripts. Six trials compared general with regional anesthesia, one trial compared spinal with epidural anesthesia, three trials evaluated cemented arthroplasty techniques, three trials evaluated aspects of tourniquet use during surgery, two trials evaluated limb positioning, and one trial evaluated tissue fibrin adhesive. Six trials enrolled patients who had total hip replacement surgery (n = 773 patients), nine trials enrolled patients who had total knee replacement surgery (n = 964 patients), and one trial enrolled patients who had hip fracture surgery (n = 40 patients). The earliest trial was published 1981 and the most recent in 2008. The duration of followup ranged from the postoperative time period to 1 year. One trial was funded by industry, two trials were funded by government or foundations, two trials were funded by government or foundations and industry, two trials were unfunded, and seven trials did not disclose a funding source.
The mean age of patients ranged from 54.9 to 73.9 years. Females represented from 37.5 to 81.0 percent of the enrolled population. Mean weight ranged from 68.7 to 100 kilograms. History of venous thromboembolism ranged from 0 to 10 percent. Other baseline characteristics were scarcely reported. Eight studies exclusively evaluated patients who have had primary surgery. Mean hospital length of stay was reported in four trials and ranged from 10.4 to 12.7 days. Mean duration of surgery ranged from 51 to 161.3 minutes.
- Sobieraj DM, Coleman CI, Tongbram V, et al. Venous Thromboembolism in Orthopedic Surgery. Comparative Effectiveness Review No. 49 (Prepared by the University of Connecticut/Hartford Hospital Evidence-based Practice Center under Contract No. 290-2007-10067-I). Rockville, MD: Agency for Healthcare Research and Quality; March 2012. AHRQ Publication No. 12-EHC020-EF. Available at www.effectivehealthcare.ahrq.gov/thrombo.cfm.
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