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 veno...

Descripción completa

Guardado en:
Detalles Bibliográficos
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:
R
Q
Acceso en línea:https://doaj.org/article/d73364dc0bed4debafd831828fedfd21
Etiquetas: Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
id oai:doaj.org-article:d73364dc0bed4debafd831828fedfd21
record_format dspace
spelling oai:doaj.org-article:d73364dc0bed4debafd831828fedfd212021-12-02T20:12:43ZNon-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery.1932-620310.1371/journal.pone.0260146https://doaj.org/article/d73364dc0bed4debafd831828fedfd212021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0260146https://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, p e0260146 (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/d73364dc0bed4debafd831828fedfd21
work_keys_str_mv AT helenmarybadge noncompliancewithclinicalguidelinesincreasestheriskofcomplicationsafterprimarytotalhipandkneejointreplacementsurgery
AT timchurches noncompliancewithclinicalguidelinesincreasestheriskofcomplicationsafterprimarytotalhipandkneejointreplacementsurgery
AT justinemnaylor noncompliancewithclinicalguidelinesincreasestheriskofcomplicationsafterprimarytotalhipandkneejointreplacementsurgery
AT weixuan noncompliancewithclinicalguidelinesincreasestheriskofcomplicationsafterprimarytotalhipandkneejointreplacementsurgery
AT elizabetharmstrong noncompliancewithclinicalguidelinesincreasestheriskofcomplicationsafterprimarytotalhipandkneejointreplacementsurgery
AT leeannegray noncompliancewithclinicalguidelinesincreasestheriskofcomplicationsafterprimarytotalhipandkneejointreplacementsurgery
AT johnfletcher noncompliancewithclinicalguidelinesincreasestheriskofcomplicationsafterprimarytotalhipandkneejointreplacementsurgery
AT iaingosbell noncompliancewithclinicalguidelinesincreasestheriskofcomplicationsafterprimarytotalhipandkneejointreplacementsurgery
AT christinelin noncompliancewithclinicalguidelinesincreasestheriskofcomplicationsafterprimarytotalhipandkneejointreplacementsurgery
AT ianaharris noncompliancewithclinicalguidelinesincreasestheriskofcomplicationsafterprimarytotalhipandkneejointreplacementsurgery
_version_ 1718374853027823616