title: The rate of symptomatic venous thromboembolism in patients undergoing elective Ilizarov surgery and the cost of chemical prophylaxis.
abstract: Recent recommendations by the National Institute for Health and Care Excellence (NICE) suggest that all patients undergoing elective orthopaedic surgery should be assessed for the risk of venous thromboembolism (VTE). Little is known about the incidence of symptomatic VTE after elective external fixation. We studied a consecutive series of adult patients who had undergone elective Ilizarov surgery without routine pharmacological prophylaxis to establish the incidence of symptomatic VTE. A review of a prospectively maintained database of consecutive patients who were treated between October 1998 and February 2011 identified 457 frames in 442 adults whose mean age was 42.6 years (16.0 to 84.6). There were 425 lower limb and 32 upper limb frames. The mean duration of treatment was 25.7 weeks (1.6 to 85.3). According to NICE guidelines all the patients had at least one risk factor for VTE, 246 had two, 172 had three and 31 had four or more. One patient (0.23%) developed a pulmonary embolus after surgery and was later found to have an inherited thrombophilia. There were 27 deaths, all unrelated to VTE. The cost of providing VTE prophylaxis according to NICE guidelines in this group of patients would be £89 493.40 (£195.80 per patient) even if the cheapest recommended medication was used. The rate of symptomatic VTE after Ilizarov surgery was low despite using no pharmacological prophylaxis. This study leads us to question whether NICE guidelines are applicable to these patients.
authors.affiliation: Oxford University Hospitals NHS Trust, The Limb Reconstruction Unit, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7LD, UK.
authors.forename: J Y
authors.initials: JY
authors.lastname: Ferguson
authors.forename: M
authors.initials: M
authors.lastname: Sutherland
authors.forename: H G
authors.initials: HG
authors.lastname: Pandit
authors.forename: M
authors.initials: M
authors.lastname: McNally
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D018889:Ilizarov Technique; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Venous thromboembolism; Pulmonary embolism; Deep vein thrombosis; Ilizarov; external fixator; Elective; Prevention