ArticlePloS one2021
Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 25 citations in OpenAlex.
- Analysis of risk factors and clinical application of cardiovascular complications following lower limb joint replacement surgery in elderly patients.BMC surgery · 2025Article
- Proper Patient Selection and Choosing the Right Treatment: The Recipe for Good Clinical Outcomes.Arthroscopy, sports medicine, and rehabilitation · 2025Article
- Risk factors for general complications after hip or knee replacement surgery in elderly patients: a single-center study.BMC musculoskeletal disorders · 2025Article
- Blood loss in primary total hip arthroplasty occurs mainly postoperatively, but current formulas for calculating blood loss are inaccurate: a retrospective study of 208 cases.Archives of orthopaedic and trauma surgery · 2025Article
- Compliance with Australian Orthopaedic Association guidelines does not reduce the risk of venous thromboembolism after total hip and knee arthroplasty.Scientific reports · 2024Article
- Establishment and validation of a nomogram predicting the risk of deep vein thrombosis before total knee arthroplasty.Thrombosis journal · 2024Article
- Diagnosis and Prevention of Periprosthetic Joint Infections by Staphylococcus aureus after Hip Fracture: A Systematic Review of the Literature.Revista brasileira de ortopedia · 2024Article
- Surgical Antibiotic Prophylaxis: A Proposal for a Global Evidence-Based Bundle.Antibiotics (Basel, Switzerland) · 2024Review
- Novel Interdisciplinary Enhanced Recovery after Surgery Protocol Implementation in Paediatric Orthopaedics.Journal of personalized medicine · 2023Article
- A formula for survival in surgery.Patient safety in surgery · 2023Article
- Appropriateness of choice and duration of surgical antibiotic prophylaxis and the incidence of surgical site infections: A prospective study.Journal of Taibah University Medical Sciences · 2023Article
- Discharge to inpatient rehabilitation following arthroplasty is a strong predictor of persistent opioid use 90 days after surgery: a prospective, observational study.BMC musculoskeletal disorders · 2023Observational
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Authors and funding
10 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTotal 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. METHODS AND
findingsA 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).
conclusionsWe 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.
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