February 2003 Bulletin

OREF study summarizes DVT phophylaxis practice patterns

By Gene R. Wurth, President CEO, OREF

The variety of practice patterns used by orthopaedic surgeons to address potential venous thrombosis disease in their patients undergoing total hip and total knee arthroscopy procedures are summarized in a recent study conducted by the Orthopaedic Research and Education Foundation (OREF).

Venous thrombosis and pulmonary embolism (PE) have been associated with an estimated 300,000 to 600,000 hospitalizations per year in the United States, with as many as 50,000 individuals dying each year as a result of PE. Patients undergoing lower extremity orthopaedic surgery are at risk of developing deep venous thrombosis (DVT). DVT rates can range from 45 percent to 70 percent of patients undergoing hip and knee reconstruction surgery. In hip replacement patients, clinically significant PE has been reported to be as high as 20 percent, with a 1 percent to 3 percent incidence of fatal PE. Although rates of clinical and fatal PE may be lower in total knee replacement patients, they remain problematic nonetheless. (Prevention of Venous Thrombosis and Pulmonary Embolism. NIH Consensus Statement Online 1986 Mar 24-26; 6(2): 1-8.)

The goal of the OREF survey was to gather information about orthopaedic surgeons’ use of agents and devices to treat venous thromboembolic disease in patients who undergo total hip (THA) and total knee arthroplasty (TKA) procedures. A questionnaire on DVT and various prophylactic agents and devices was prepared and made available to orthopaedic surgeons on the OREF Web site in July 2002. Throughout August and September, OREF and the Academy promoted the survey to AAOS members through various media (e.g., the AAOS Bulletin, e-mail newsletters, etc.) in order to encourage surgeon response to it. By the end of September 2002, a total of 434 orthopaedic surgeons representing 48 states, the District of Columbia, Puerto Rico, Canada, Egypt and Pakistan had completed the survey. Surgeons who participated in the survey had been in practice for an average of 19 years.

Survey findings

Some of the survey’s key findings are:

The data gathered in this study is being evaluated to determine if other, more detailed research projects about DVT are suggested, and to see if other surveys of practice patterns of orthopaedic surgeons might be similarly evaluated. A more detailed summary of the study, including a number of charts, is available on the OREF Web site at www.oref.org under the heading "What’s New at OREF?"

This research project was conducted under the supervision of Clifford W. Colwell Jr., MD, who provided insights into the results of the survey and its implications for orthopaedic surgeons. The survey was designed by Knowledge Enterprises, Inc., which also compiled the survey results.

This project was made possible by a grant from Pharmacia.

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