title: Worldwide adherence to ACCP guidelines for thromboprophylaxis after major orthopedic surgery: A systematic review of the literature and meta-analysis.
abstract: BACKGROUND
  Increased risk of venous thromboembolism following major orthopedic surgery (MOS) is well described. The American Academy of Chest Physician (ACCP) has generated evidence-based recommendations for thromboprophylaxis; however, there is a gap between guidelines recommendations and clinical practice. The aim of this study is to compare worldwide adherence rates to the last 4 editions of ACCP guidelines for thromboprophylaxis after MOS.
  
  
  METHODS
  A systematic review of literature and meta-analysis was performed. Studies reporting adherence to ACCP guidelines between January 2004 and October 2014 were included. Adherence rates after MOS for in-hospital (IH), extended (EXT), and global thromboprophylaxis (in-hospital plus extended) were assessed.
  
  
  RESULTS
  Of 3993 titles, 13 studies reporting data of 35,303 patients were selected. Studies assessing the 6th, 7th or 8th editions of ACCP guidelines were found. No studies evaluating the 9th edition were available. For MOS, global adherence rates for the 6th, 7th and 8th editions were 62% (95% CI: 61%-63%), 70% (95% CI: 69%-71%), and 42% (95% CI: 41%-43%), respectively. Likewise, in-hospital adherence was 52% (95% CI: 50%-54%), 51% (95% CI: 50%-52%) and 85% (95% CI: 84%-86%). For extended prophylaxis, adherence rates were reported only for the 8th edition (59%; 95% CI: 58%-60%).
  
  
  CONCLUSIONS
  Adherence to ACCP recommendations for thromboprophylaxis during hospitalization has increased over time. Nevertheless, adherence rates to global thromboprophylaxis decrease due to an insufficient implementation of recommendations after discharge.
authors.affiliation: Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá. School of Medicine, Universidad del Rosario. Bogotá, Colombia.
authors.forename: Miguel
authors.initials: M
authors.lastname: Farfan
authors.affiliation: Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá. Bogotá, Colombia.
authors.forename: Maria
authors.initials: M
authors.lastname: Bautista
authors.affiliation: Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá. School of Medicine, Universidad de Los Andes. School of Medicine, Universidad del Rosario. Bogotá, Colombia. Electronic address: bonillaguillermo@yahoo.com.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Bonilla
authors.affiliation: Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá. Bogotá, Colombia.
authors.forename: Jorge
authors.initials: J
authors.lastname: Rojas
authors.affiliation: Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá. School of Medicine, Universidad de Los Andes. School of Medicine, Universidad del Rosario. Bogotá, Colombia.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Llinás
authors.affiliation: Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá. Bogotá, Colombia.
authors.forename: José
authors.initials: J
authors.lastname: Navas
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D019983:Guideline Adherence; D006620:Hip Fractures / Q000601:surgery; D006801:Humans; D019637:Orthopedic Procedures / Q000009:adverse effects*; D054556:Venous Thromboembolism / Q000209:etiology* / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Arthroplasty; Guideline adherence; Hip fractures; Prevention & control; Venous thromboembolism