Abstract
Introduction: Thromboembolic complications are common in both elective and trauma orthopaedic practice. Despite the many studies reported in the literature, there remain a number of unanswered questions regarding the use of thrombophylaxis. The aim of this study was to establish the current practice amongst Irish consultant orthopaedic surgeons regarding thromboprophylaxis.
Materials and Methods: A detailed confidential written questionaire was sent to all consultant orthopaedic surgeons in the republic of Ireland. Surgeons were asked to indicate the type of mechanical and chemothromboprophylaxis in the setting of total hip arthroplasty, knee arthroplasty and hip fracture. They were also questioned regarding 1) time of commencement of therapy 2) duration of therapy 3) method of diagnosis of DVT 4) Estimated incidence of mortality from pulmonary embolism in the last five years 5) Whether there was established protocol for DVT prophylaxis in their unit. 6) Reason for not using chemothromboprophylaxis if not used and 7) whether their method of treatment was influenced by anaesthetic concerns.
Results: The response rate was seventy percent. Over ninetyfive percent of surgeons used a combination of physical and chemical modalities. There was a wide variation between type of therapy, commencement time and duration of prophylaxis. There was a higher rate of intervention and duration of therapy in elective practice. A unit policy regarding thromboprophylaxis existed in a majority of hospitals (54.7%). Forty-seven per cent of respondents felt that there had been no post-operative mortality in their practice in the previous five years from pulmonary embolism. Twenty-six percent of respondents felt that anaesthetists influenced the type of prophylaxis used. The results of this survey shows that venous thromboembolism is regarded as a significant complication of orthopaedic surgery and that most orthopaedic surgeons take active steps to try and prevent its occurrence. There was a higher rate of intervention in this groug of surgeons compared to previous surveys of British orthopaedic surgeons. This may reflect a higher standard of care or a concern regarding the high rate of litigation in the republic of Ireland. However there is no consensus as to the optimum therapy which reflects the conflicting evidence available in the many publications on this subject.
The abstracts were prepared by Mr Ray Moran. Correspondence should be addressed to him at the Irish Orthopaedic Association, Secretariat, c/o Cappagh Orthopaedic Hospital, Finglas, Dublin
