There is no general use of thromboprophylaxis and prolonged antibiotic prophylaxis in anterior cruciate ligament reconstruction: a nation-wide survey of ACL surgeons in Sweden
| Autor: | Victor Ekdahl, Magnus Forssblad, Gunnar Edman, Jesper Kraus Schmitz, Kristian Samuelsson, Anders Stålman |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Anterior cruciate ligament reconstruction medicine.medical_treatment Anterior cruciate ligament Transplants Antithrombins Risk Factors Vancomycin Thromboembolism medicine Humans Surgical Wound Infection Orthopedics and Sports Medicine Knee Antibiotic prophylaxis Medical prescription Practice Patterns Physicians' Thromboprophylaxis Retrospective Studies Surgeons Sweden Tourniquet Anterior Cruciate Ligament Reconstruction business.industry General surgery Anterior Cruciate Ligament Injuries Antibiotic Prophylaxis Tourniquets medicine.disease Thrombosis ACL reconstruction medicine.anatomical_structure surgical procedures operative Cross-Sectional Studies Health Care Surveys Orthopedic surgery Practice Guidelines as Topic Surgery Female business medicine.drug |
| Zdroj: | Knee Surgery, Sports Traumatology, Arthroscopy |
| ISSN: | 1433-7347 |
| Popis: | PurposeThe use of prophylaxis for thromboembolism and infection in anterior cruciate ligament (ACL) reconstruction is not well documented and no general guidelines have been established. The aim of this study was to evaluate the ACL surgeons’ individual strategies of thromboprophylaxis, use of prolonged antibiotic prophylaxis and vancomycin-soaked ACL grafts, and if its use is supported in the current literature. Additionally, the rationale for use of tourniquet was analysed.MethodsQuestionnaires were distributed to all Swedish ACL surgeons who are registered in the Swedish Knee Ligament Register (SKLR), asking about prescription of thromboprophylaxis, prolonged antibiotic prophylaxis, the use of vancomycin-soaked graft and the use of a tourniquet during surgery. The responses were assessed for agreement and the thromboprophylaxis data were analysed in relation to the 2016 SKLR data.Results115 (75%) ACL surgeons responded to the survey. 81.7% prescribed thromboprophylaxis only when risk factors, such as history of thrombosis and the use of oral contraceptives, were present. Female gender, older age and admitted patient were considered the risk factors with the lowest impact. The respondents were generally restrictive regarding the use of prolonged antibiotic prophylaxis. The use of vancomycin-soaked graft was used by only nine (8%) surgeons representing 406 (13%) of the surgeries.ConclusionSwedish ACL surgeons are generally restrictive using thromboprophylaxis and only when risk factors are present. However, there is a lack of consensus in how to weigh the different risk factors and it does not completely adhere to the existing literature.Prolonged antibiotic prophylaxis is rarely used and the use of vancomycin soaking of graft is very limited and applies only to a small number of surgeons. The use of tourniquet is common. There is a need for ACL-specific guidelines regarding the use of thromboprophylaxis.Level of evidenceIV. |
| Databáze: | OpenAIRE |
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