Surgical site infections and other postoperative complications following prophylactic anticoagulation in total joint arthroplasty.

<h4>Background</h4>Anticoagulants reduce the risk of venous thromboembolism (VTE) after total joint replacement. However, concern remains that pharmacologic VTE prophylaxis can lead to bleeding, which may impact on postoperative complications such as infections and reoperations.<h4>...

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Autores principales:	Zhong Wang, Frederick A Anderson, Michael Ward, Timothy Bhattacharyya
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/9f4031583b3440efa5dffaeca5694efe
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spelling	oai:doaj.org-article:9f4031583b3440efa5dffaeca5694efe2021-11-18T08:24:16ZSurgical site infections and other postoperative complications following prophylactic anticoagulation in total joint arthroplasty.1932-620310.1371/journal.pone.0091755https://doaj.org/article/9f4031583b3440efa5dffaeca5694efe2014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24717837/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Anticoagulants reduce the risk of venous thromboembolism (VTE) after total joint replacement. However, concern remains that pharmacologic VTE prophylaxis can lead to bleeding, which may impact on postoperative complications such as infections and reoperations.<h4>Methods and findings</h4>From the Global Orthopedic Registry (GLORY), we reviewed 3,755 patients in US who elected for primary total hip or knee arthroplasty, received either warfarin or low molecular weight heparin (LMWH) as VTE prophylactics, and had up-to-90-day follow-up after discharge. We compared incidence rates of VTE, infections and other complications between LMWH and warfarin groups, and used multivariate analyses with propensity score weighting to generate the odds ratio (OR). Patients receiving LMWH tended to be older and higher in the American Society of Anesthesiologists grade scores. In contrast, warfarin was used more frequently for hip arthroplasty with longer duration among patients with more pre-existing comorbidity (all P<0.02). A weight variable was created with propensity score to account for differences in covariate distributions. Propensity score-weighted analyses showed no differences in VTE complications. However, compared to warfarin, LMWH was associated with significantly higher rates of bleeding (6.2% vs. 2.1%; OR = 3.82, 95% confidence interval [CI], 2.64 to 5.52), blood transfusion (29.4% vs. 22.0%; OR = 1.75, 95% CI, 1.51 to 2.04), reoperations (2.4% vs. 1.3%; OR = 1.77, 95% CI, 1.07 to 2.93) and infections (1.6% vs. 0.6%; OR = 2.79, 95% CI, 1.42 to 5.45). Similar results were obtained from compliant uses of warfarin (26%) and LMWH (62%) according to clinical guidelines. While surgical site infections were mostly superficial, current study was underpowered to compare incidence rates of deep infections (<1.0%).<h4>Conclusions</h4>Surgical site infections and reoperations in 3 months following primary total joint arthroplasty may be associated with anticoagulant use that exhibited higher bleeding risk. Long-term complications and deep wound infections remain to be studied.Zhong WangFrederick A AndersonMichael WardTimothy BhattacharyyaPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 4, p e91755 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Zhong Wang Frederick A Anderson Michael Ward Timothy Bhattacharyya Surgical site infections and other postoperative complications following prophylactic anticoagulation in total joint arthroplasty.
description	<h4>Background</h4>Anticoagulants reduce the risk of venous thromboembolism (VTE) after total joint replacement. However, concern remains that pharmacologic VTE prophylaxis can lead to bleeding, which may impact on postoperative complications such as infections and reoperations.<h4>Methods and findings</h4>From the Global Orthopedic Registry (GLORY), we reviewed 3,755 patients in US who elected for primary total hip or knee arthroplasty, received either warfarin or low molecular weight heparin (LMWH) as VTE prophylactics, and had up-to-90-day follow-up after discharge. We compared incidence rates of VTE, infections and other complications between LMWH and warfarin groups, and used multivariate analyses with propensity score weighting to generate the odds ratio (OR). Patients receiving LMWH tended to be older and higher in the American Society of Anesthesiologists grade scores. In contrast, warfarin was used more frequently for hip arthroplasty with longer duration among patients with more pre-existing comorbidity (all P<0.02). A weight variable was created with propensity score to account for differences in covariate distributions. Propensity score-weighted analyses showed no differences in VTE complications. However, compared to warfarin, LMWH was associated with significantly higher rates of bleeding (6.2% vs. 2.1%; OR = 3.82, 95% confidence interval [CI], 2.64 to 5.52), blood transfusion (29.4% vs. 22.0%; OR = 1.75, 95% CI, 1.51 to 2.04), reoperations (2.4% vs. 1.3%; OR = 1.77, 95% CI, 1.07 to 2.93) and infections (1.6% vs. 0.6%; OR = 2.79, 95% CI, 1.42 to 5.45). Similar results were obtained from compliant uses of warfarin (26%) and LMWH (62%) according to clinical guidelines. While surgical site infections were mostly superficial, current study was underpowered to compare incidence rates of deep infections (<1.0%).<h4>Conclusions</h4>Surgical site infections and reoperations in 3 months following primary total joint arthroplasty may be associated with anticoagulant use that exhibited higher bleeding risk. Long-term complications and deep wound infections remain to be studied.
format	article
author	Zhong Wang Frederick A Anderson Michael Ward Timothy Bhattacharyya
author_facet	Zhong Wang Frederick A Anderson Michael Ward Timothy Bhattacharyya
author_sort	Zhong Wang
title	Surgical site infections and other postoperative complications following prophylactic anticoagulation in total joint arthroplasty.
title_short	Surgical site infections and other postoperative complications following prophylactic anticoagulation in total joint arthroplasty.
title_full	Surgical site infections and other postoperative complications following prophylactic anticoagulation in total joint arthroplasty.
title_fullStr	Surgical site infections and other postoperative complications following prophylactic anticoagulation in total joint arthroplasty.
title_full_unstemmed	Surgical site infections and other postoperative complications following prophylactic anticoagulation in total joint arthroplasty.
title_sort	surgical site infections and other postoperative complications following prophylactic anticoagulation in total joint arthroplasty.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/9f4031583b3440efa5dffaeca5694efe
work_keys_str_mv	AT zhongwang surgicalsiteinfectionsandotherpostoperativecomplicationsfollowingprophylacticanticoagulationintotaljointarthroplasty AT frederickaanderson surgicalsiteinfectionsandotherpostoperativecomplicationsfollowingprophylacticanticoagulationintotaljointarthroplasty AT michaelward surgicalsiteinfectionsandotherpostoperativecomplicationsfollowingprophylacticanticoagulationintotaljointarthroplasty AT timothybhattacharyya surgicalsiteinfectionsandotherpostoperativecomplicationsfollowingprophylacticanticoagulationintotaljointarthroplasty
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Surgical site infections and other postoperative complications following prophylactic anticoagulation in total joint arthroplasty.

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