Worldwide adherence to ACCP guidelines for thromboprophylaxis after major orthopedic surgery: A systematic review of the literature and meta-analysis
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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. © 2016 Elsevier Ltd. All rights reserved.
Article , Clinical practice , Hip , Human , Meta analysis , Orthopedic surgery , Patient compliance , Practice guideline , Priority journal , Systematic review , Thrombosis prevention , Adverse effects , Hip Fractures , Hip replacement , Knee replacement , Orthopedic surgery , Protocol compliance , Venous thromboembolism , Anticoagulant agent , Anticoagulants , Arthroplasty , Arthroplasty , Guideline Adherence , Hip Fractures , Humans , Orthopedic Procedures , Venous Thromboembolism , Arthroplasty , Guideline adherence , Hip fractures , Prevention and control , Venous thromboembolism