Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery

<h4>Background</h4> Total hip and total knee replacement (THR/TKR) are common and effective surgeries to reduce the pain and disability associated with arthritis but are associated with small but significant risks of preventable complications such as surgical site infection (SSI) and ven...

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Autores principales:	Helen Mary Badge, Tim Churches, Justine M. Naylor, Wei Xuan, Elizabeth Armstrong, Leeanne Gray, John Fletcher, Iain Gosbell, Christine Lin, Ian A. Harris
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/0cd9504c40644c1d80b4226e7405ea8f
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spelling	oai:doaj.org-article:0cd9504c40644c1d80b4226e7405ea8f2021-11-25T06:19:42ZNon-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery1932-6203https://doaj.org/article/0cd9504c40644c1d80b4226e7405ea8f2021-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601457/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4> Total hip and total knee replacement (THR/TKR) are common and effective surgeries to reduce the pain and disability associated with arthritis but are associated with small but significant risks of preventable complications such as surgical site infection (SSI) and venous-thrombo-embolism (VTE). This study aims to determine the degree to which hospital care was compliant with clinical guidelines for the prevention of SSI and VTE after THR/TKR; and whether non-compliant prophylaxis is associated with increased risk of complications. <h4>Methods and findings</h4> A prospective multi-centre cohort study was undertaken in consenting adults with osteoarthritis undergoing elective primary TKR/THR at one of 19 high-volume Australian public or private hospitals. Data were collected prior to surgery and for one-year post-surgery. Four adjusted logistic regression analyses were undertaken to explore associations between binary non-compliance and the risk of surgical complications: (1) composite (simultaneous) non-compliance with both (VTE and antibiotic) guidelines and composite complications [all-cause mortality, VTE, readmission/reoperation for joint-related reasons (one-year) and non-joint-related reasons (35-days)], (2) VTE non-compliance and VTE outcomes, (3) antibiotic non-compliance and any SSI, and (4) antibiotic non-compliance and deep SSI. Data were analysed for 1875 participants. Guideline non-compliance rates were high: 65% (VTE), 87% (antibiotics) and 95% (composite guideline). Composite non-compliance was not associated with composite complication (12.8% vs 8.3%, adjusted odds ratio [AOR] = 1.41, 95%CI 0.68–3.45, p = 0.40). Non-compliance with VTE guidelines was associated with VTE outcomes (5% vs 2.4%, AOR = 2.83, 95%CI 1.59–5.28,p < 0.001). Non-compliance with antibiotic guidelines was associated with any SSI (14.8% vs 6.1%, AOR = 1.98, 95%CI 1.17–3.62,p = 0.02) but not deep infection (3.7% vs 1.2%,AOR = 2.39, 95%CI 0.85–10.00, p = 0.15). <h4>Conclusions</h4> We found high rates of clinical variation and statistically significant associations between non-compliance with VTE and antibiotic guidelines and increased risk of VTE and SSI, respectively. Complications after THR/TKR surgery may be decreased by improving compliance with clinical guidelines.Helen Mary BadgeTim ChurchesJustine M. NaylorWei XuanElizabeth ArmstrongLeeanne GrayJohn FletcherIain GosbellChristine LinIan A. HarrisPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Helen Mary Badge Tim Churches Justine M. Naylor Wei Xuan Elizabeth Armstrong Leeanne Gray John Fletcher Iain Gosbell Christine Lin Ian A. Harris Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery
description	<h4>Background</h4> Total hip and total knee replacement (THR/TKR) are common and effective surgeries to reduce the pain and disability associated with arthritis but are associated with small but significant risks of preventable complications such as surgical site infection (SSI) and venous-thrombo-embolism (VTE). This study aims to determine the degree to which hospital care was compliant with clinical guidelines for the prevention of SSI and VTE after THR/TKR; and whether non-compliant prophylaxis is associated with increased risk of complications. <h4>Methods and findings</h4> A prospective multi-centre cohort study was undertaken in consenting adults with osteoarthritis undergoing elective primary TKR/THR at one of 19 high-volume Australian public or private hospitals. Data were collected prior to surgery and for one-year post-surgery. Four adjusted logistic regression analyses were undertaken to explore associations between binary non-compliance and the risk of surgical complications: (1) composite (simultaneous) non-compliance with both (VTE and antibiotic) guidelines and composite complications [all-cause mortality, VTE, readmission/reoperation for joint-related reasons (one-year) and non-joint-related reasons (35-days)], (2) VTE non-compliance and VTE outcomes, (3) antibiotic non-compliance and any SSI, and (4) antibiotic non-compliance and deep SSI. Data were analysed for 1875 participants. Guideline non-compliance rates were high: 65% (VTE), 87% (antibiotics) and 95% (composite guideline). Composite non-compliance was not associated with composite complication (12.8% vs 8.3%, adjusted odds ratio [AOR] = 1.41, 95%CI 0.68–3.45, p = 0.40). Non-compliance with VTE guidelines was associated with VTE outcomes (5% vs 2.4%, AOR = 2.83, 95%CI 1.59–5.28,p < 0.001). Non-compliance with antibiotic guidelines was associated with any SSI (14.8% vs 6.1%, AOR = 1.98, 95%CI 1.17–3.62,p = 0.02) but not deep infection (3.7% vs 1.2%,AOR = 2.39, 95%CI 0.85–10.00, p = 0.15). <h4>Conclusions</h4> We found high rates of clinical variation and statistically significant associations between non-compliance with VTE and antibiotic guidelines and increased risk of VTE and SSI, respectively. Complications after THR/TKR surgery may be decreased by improving compliance with clinical guidelines.
format	article
author	Helen Mary Badge Tim Churches Justine M. Naylor Wei Xuan Elizabeth Armstrong Leeanne Gray John Fletcher Iain Gosbell Christine Lin Ian A. Harris
author_facet	Helen Mary Badge Tim Churches Justine M. Naylor Wei Xuan Elizabeth Armstrong Leeanne Gray John Fletcher Iain Gosbell Christine Lin Ian A. Harris
author_sort	Helen Mary Badge
title	Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery
title_short	Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery
title_full	Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery
title_fullStr	Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery
title_full_unstemmed	Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery
title_sort	non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/0cd9504c40644c1d80b4226e7405ea8f
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Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery

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