None. Who uses IV antibiotics before simple knee arthroscopies? 3/9/2018. Anticoagulants or Antibiotics Are they Necessary for Simple Knee Scopes?

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1 Anticoagulants or Antibiotics Are they Necessary for Simple Knee Scopes? Rachel M. Frank, MD Assistant Professor, Department of Orthopaedic Surgery Sports Medicine, Cartilage Restoration, and Shoulder Surgery University of Colorado School of Medicine None Who uses IV antibiotics before simple knee arthroscopies? 1

2 Risk factors intraoperative steroids, smoking, obesity, male sex, diabetes, # of procedures, time Level IV Systematic Review of 13 studies of surgery, tourniquet time >60 min Infection incidence to 1.1% Most common organism Staph Preoperative antibiotic use (or lack thereof) not associated with infection Retrospective review of 1326 patients undergoing routine knee arthroscopy without an implant No significant difference in SSI rate in patients Prophylactic ABX 46% (N=614) receiving No Prophylactic versus not ABX receiving 54% (N=712) ABX Risk Postop factor infection Age rate > % years (N=7) (P=0.009) 5 superficial, 2 deep 2

3 2007 Retrospective review of 3231 patients over 3 years No significant Prophylactic difference ABX 34% in infections in patients No Prophylactic ABX 66% receiving versus not receiving ABX Postop infections 4 total patients No risk Received factors ABX for infection 0.15% identified No ABX 0.16% 2017 Retrospective review of patients over 6 years Deep Prophylactic infections ABX 80.5% No 0.08% Prophylactic with ABX vs 0.14% 19.5% without ABX (P=0.10) Postop Superficial infection infections rate 0.50% (N=202) Received 0.41% ABX with ABX 0.48% vs 0.40% (N=159) without ABX (P=0.93) No ABX 0.54% (N=43) Who uses chemical anticoagulation after routine simple knee arthroscopy? 3

4 Review of 90 day outcomes in 20,770 patients VTE rates higher in patients >50 years Incidence VTE rates of DVT higher in 0.25% females (N=51) on OCPs Incidence of PE 0.17% (N=35) 9 deaths Patient within sex or 90 CPT days code of surgery not significant (0.04%), factors with one noted to be related to PE Review of 537 patients undergoing simple, ACLR, PCLR, or ACL+PCL Risk factors older patient age and ligament All patients underwent venography on POD3 surgery (compared to simple scope) VTE incidence 14.9% (N=80 patients) Patient Of these, sex, only BMI, 20 patients operative with time, clinical tourniquet signs of DVT duration Thus, 60 asymptomatic not significant cases factors (11.2%) No PEs or deaths Review of 16,558 ACLR over 6 years VTE incidence 0.53% (N=87) Risk 55 DVT factors: and 35 age PE (335 with years, both history DVT and of PE) nicotine use, anticoagulant use, concomitant HTO, and concomitant PCL reconstruction 4

5 RCT of 170 patients undergoing knee arthroscopy Treatment: ASA325 daily for 14 days N=66 No Control: DVT or No PE intervention diagnoses in either N=104 group Bilateral No role LE for venous ASA325 duplex in low risk performed patient population days 3 month cumulative incidence of asymptomatic proximal DVT, symptomatic DVT, and all cause mortality: Stocking group 3.2% 7 day LMWH group 0.9% PROTECTIVE 14 day LMWH group 0.9% RCT of 1761 undergoing knee arthroscopy over 4 years Bleeding Randomization events: to either: Stocking Compression group stockings 0.3% x7 days 660 patients 7 day LMWH LMWH (nadroparin) group daily 0.9% x7 days 657 patients 7 day LMWH LMWH daily group x14 days 0.5% 444 patients Stopped prematurely 2 parallel RCTs (one for knee arthroscopy, one for LLC) patients in randomized each group after with knee major arthroscopy bleeding to: No anticoagulant 720 patients LMWH (nadroparin) x8 days 731 patients Conclusions prophylaxis not necessary VTE after incidence knee control arthroscopy 0.4% (N=3) VTE incidence treatment 0.7% (N=5) 5

6 Risks associated with arthroscopically assisted surgery generally considered to be low Recommend What against defines routine a basic use of thromboprophylaxis arthroscopy after arthroscopic procedures and a major procedure? Recommend for routine use of thromboprophylaxis after major orthopaedic procedures Prophylactic antibiotics before simple scopes are probably not needed, HOWEVER specific risk factors are poorly understood Chemical prophylaxis after simple knee arthroscopy is probably not indicated, HOWEVER not all scopes are simple, and a patient specific approach is best 6