Current trends for venous thromboembolic prophylaxis for hip arthroscopy: a modified Delphi and nominal group technique consensus study

Abstract

The overall risk of venous thromboembolism (VTE) after hip arthroscopy (HA) is reported to range from 0.2% to 9.5%, but a clear set of recommendations for VTE prophylaxis in HA patients remains scarce. The aim is to survey high-volume hip arthroscopists about their current trends regarding VTE prophylaxis use. A combination of two consensus group methods was used in this study: nominal group technique (NGT) and modified Delphi. A preliminary questionnaire was prepared, and rounds of discussion were completed between NGT members. The final version of the survey was administered to 35 high-volume hip surgeons. Delegates’ mean volume of annual hip arthroscopic surgery was 109. Approximately 22% of their patients are revision HA procedures. A total of 91.4% of delegates use chemoprophylaxis, 28.6% use sequential compression devices and 91.4% believed that chemoprophylaxis is necessary for more prolonged and complex procedures (strong consensus). Aspirin was the choice for all participants, and the duration was 2–3 weeks (31.4%), 1 month (65.7%) and 2–3 months (2.9%). History of VTE, hypercoagulable status, and malignancy were considered risk factors. No consensus was achieved for the discontinuation of oral contraceptive and smoking preoperatively. However, the optimal length of VTE prophylaxis is unclear. A total of 97.1% of the experts responded that they administer aspirin between 2 and 4 weeks. High-volume arthroscopic surgeons do consider VTE prophylaxis to be important and warranted in the postoperative setting. Aspirin is the mainstay of chemoprophylaxis, although the appropriate duration is unknown.