Methods
bleeding, death, swelling, osteoarthritis, DVTs, DVT, pain, VTE, TKA, non-VTE, tenderness, THA
BLEEDING, HAND INFECTION, OSTEOARTHRITIS, COMPLICATIONS, DVT
We used data collected from the Evidence Based Processes and Outcomes of Care (EPOC) Study. EPOC was a multi-center prospective observational cohort study aimed at investigating the association between rates of compliance with evidence-based guidelines for the prevention of VTE and infection and related outcomes for patients undergoing elective primary THA and TKA. Ethical approval was obtained from the nine relevant human research ethics committees and informed consent was obtained for each patient recruited.The EPOC study collected data from patients aged 18 or older undergoing primary, elective THA or TKA for osteoarthritis at 19 participating high-volume arthroplasty centers throughout Australia between 2013 and 2015. High volume centers were defined as those performing greater than 275 THA and TKA procedures annually [Baseline data in this study included age, sex, type of arthroplasty (THA or TKA), bilateral arthroplasty, body-mass index (BMI), American Society of Anesthesiologist’s (ASA) grade [Postoperative data included the type and duration of chemoprophylaxis used, the postoperative day that patients were first mobilized, the duration of mechanical prophylaxis used and whether patients underwent routine duplex ultrasound (DUS) for DVT. One participating institution and one surgeon at a second institution performed routine DUS for DVT postoperatively. Mechanical prophylaxis (calf compressors for the first 24 h, followed by graduated compression stockings) were universally used amongst all institutions. The decision on duration of prophylaxis and on whether to prescribe aspirin, LMWH, DOACs (rivaroxaban) or warfarin for VTE prophylaxis was based on surgeon preference and was not assigned by this study. Aspirin was administered at 100 mg, orally daily, dalteparin at 5000 IU subcutaneously, daily, enoxaparin at 40 mg, subcutaneously, daily and rivaroxaban at 10 mg, orally, once daily.The primary outcome of this study was symptomatic VTE within 90 days of surgery (including infra-popliteal DVT). Patients at institutions where routine DUS was used were adjudicated to have a symptomatic DVT only if they also demonstrated persistent calf swelling, tenderness and pain. Not all DVTs diagnosed by routine DUS were considered to be symptomatic. No institution performed routine ventilation/perfusion scans or computer tomography pulmonary angiograms for the detection of PE. Secondary outcomes included non-VTE related complications within 90 days of surgery; major bleeding (bleeding resulting in readmission, re-operation or death), reoperation on the operated joint and death.