Anti-embolism stockings and proximal indentation

Thompson, A. R.; Walter, Sophie; Brunton, L.; Pickering, Greg; Mehendale, Sanchit; Smith, Alison; Bannister, Gordon

doi:10.12968/bjon.2011.20.22.1426

Cited by 6 publications

(15 citation statements)

References 14 publications

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“…Incorrect use related to wearing incorrectly sized stockings or to the stocking rolling down, binding or wrinkling. In a study involving an audit and a trial of knee-length GCSs, 85 74% of patients were wearing stockings that were incorrectly sized. Implementation of a standardised protocol within the study setting resulted in statistically significant reduction in this proportion to 34%.…”

Section: Results Of Clinical Evidence Reviewsmentioning

confidence: 99%

“…21,24,25,32,37,60,63,65 One additional RCT 14 and seven observational studies (eight articles) were identified. 15,16,[80][81][82][83][84][85] These additional studies did not meet criteria for inclusion in the review of RCTs of clinical effectiveness, but did provide some data on patient adherence and/or preference.…”

Section: Patient Adherence and Preferencementioning

confidence: 99%

“…Nine RCTs 14,21,24,25,32,37,60,63,65 and seven observational studies 15,16,[80][81][82][83][84][85] were identified that reported data on patient adherence and/or preference. Patient adherence was higher in the RCTs than the observational studies but across all studies the proportion of patients not wearing stockings or wearing stockings incorrectly appeared to be generally higher in patients receiving thigh-length stockings than in those receiving knee-length stockings.…”

Section: Summary Of Findings Of the Clinical Evidence Reviewmentioning

confidence: 99%

Section: Summary Of Findingsmentioning

confidence: 99%

“…15,16,[80][81][82][83][84][85] The observational studies reflect adherence only in a hospital setting in which patients are observed by health-care professionals.…”

mentioning

confidence: 99%

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Graduated compression stockings for the prevention of deep-vein thrombosis in postoperative surgical patients: a systematic review and economic model with a value of information analysis

Wade

Sideris

Paton

et al. 2015

Health Technol Assess

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BackgroundDeep-vein thrombosis (DVT) can occur in surgical patients. Routine prophylaxis can be pharmacological and/or mechanical [e.g. graduated compression stockings (GCSs)]. GCSs are available in knee length or thigh length.ObjectiveTo establish the expected value of undertaking additional research addressing the relative effectiveness of thigh-length GCSs versus knee-length GCSs, in addition to pharmacoprophylaxis, for prevention of DVT in surgical patients.DesignSystematic review and economic model, including value of information (VOI) analysis.Review methodsRandomised controlled trials (RCTs) assessing thigh- or knee-length GCSs in surgical patients were eligible for inclusion. The primary outcome was incidence of DVT. DVT complications and GCSs adverse events were assessed. Random-effects meta-analysis was performed. To draw on a wider evidence base, a random-effects network meta-analysis (NMA) was undertaken for the outcome DVT. A review of trials and observational studies of patient adherence was also conducted. A decision-analytic model was developed to assess the cost-effectiveness of thigh- and knee-length GCSs and the VOI.ResultsTwenty-three RCTs were included in the review of effectiveness. There was substantial variation between trials in terms of the patient characteristics, interventions and methods of outcome assessment. Five trials comparing knee-length with thigh-length GCSs with or without pharmacoprophylaxis were pooled; the summary estimate of effect indicated a non-significant trend favouring thigh-length GCSs [odds ratio (OR) 1.48, 95% confidence interval (CI) 0.80 to 2.73]. Thirteen trials were included in the NMA. In the base-case analysis, thigh-length GCSs with pharmacoprophylaxis were more effective than knee-length GCSs with pharmacoprophylaxis (knee vs. thigh OR 1.76, 95% credible interval 0.82 to 3.53). Overall, thigh-length stockings with pharmacoprophylaxis was the most effective treatment, with a 0.73 probability of being the most effective treatment in a new trial of all the treatments. Patient adherence was generally higher with knee-length GCSs, and patients preferred knee-length GCSs. Thigh-length GCSs were found to be cost-effective in all but the subgroup with the lowest baseline risk, although the absolute differences in costs and effects were relatively small. The expected value of perfect information ranged from £0.2M to £178.0M depending on the scenario and subgroup. The relative effect parameters had the highest expected value of partial perfect information and ranged from £2.0M to £39.4M. The value of further research was most evident in the high-risk subgroups.LimitationsThere was substantial variation across the included trials in terms of patient and intervention characteristics. Many of the included trials were old and poorly reported, which reduces the reliability of the results of the review.ConclusionsGiven that the results from both the standard meta-analysis and the NMA lacked precision (CIs were wide) owing to the heterogeneous evidence base, a new definitive trial in high-risk patients may be warranted. However, the efficiency of any further research (i.e. whether this represents value for money) is dependent on several factors, including the acquisition price of GCSs, expected compliance with thigh-length GCSs wear, and whether or not uncertainty can be resolved around possible effect modifiers, as well as the feasibility and actual cost of undertaking the proposed research.Study registrationThis study is registered as PROSPERO CRD42014007202.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Results Of Clinical Evidence Reviewsmentioning

confidence: 99%

Section: Patient Adherence and Preferencementioning

confidence: 99%

Section: Summary Of Findings Of the Clinical Evidence Reviewmentioning

confidence: 99%

Section: Summary Of Findingsmentioning

confidence: 99%

“…15,16,[80][81][82][83][84][85] The observational studies reflect adherence only in a hospital setting in which patients are observed by health-care professionals.…”

mentioning

confidence: 99%

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Graduated compression stockings for the prevention of deep-vein thrombosis in postoperative surgical patients: a systematic review and economic model with a value of information analysis

Wade

Sideris

Paton

et al. 2015

Health Technol Assess

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Is There a Difference in Infection Risk Between Single and Multiple Doses of Prophylactic Antibiotics? A Meta-analysis

Ryan

Kildow

Tan

et al. 2019

Clin Orthop Relat Res

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Background The prevention of surgical site infection guidelines issued by the Centers for Disease Control and Prevention (CDC) recently recommended that only a single dose of preoperative antibiotics be administered to patients undergoing clean-contaminated procedures based on data from a variety of surgical disciplines. For orthopaedic procedures, where postoperative infections can have significant consequences, the existing evidence for this recommendation is widely debated. Questions/purposes Is there a difference in postoperative infection risk when utilizing a single dose of preoperative antibiotics compared with multiple doses of perioperative antibiotics for orthopaedic procedures where implants are placed? Methods MEDLINE, EMBASE, Google Scholar, and Cochrane were systematically reviewed for randomized controlled trials (RCTs) of a single dose of preoperative antibiotics compared with pre- and postoperative prophylaxis from 1980 to 2017 for all orthopaedic procedures where implants were being placed. Infection (both superficial and deep) as a primary outcome through all available followup was required for inclusion. Fourteen RCTs detailing 9691 orthopaedic procedures were included for analysis, including seven arthroplasty, one spine, and six general orthopaedic trials (two specific to hip fracture fixation). Pooled infection outcomes were analyzed with random-effects modeling in light of study heterogeneity. Bias was evaluated using the Cochrane risk of bias tool as well as a funnel plot for publication bias, and quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Bias was largely uncertain; however, a high risk of bias was noted in four studies. No significant overall publication bias was noted. The quality of evidence was determined to be very low based on the GRADE tool, downgraded based on risk of bias, inconsistency, and imprecision. Despite the quality of evidence, the data were pooled in light of the current recommendations from the CDC to critically evaluate the recommendation that a single dose of antibiotics be utilized. Results There were no differences in infection risk between single- versus multiple-dose groups (single: 83 of 4263 [2%], multiple: 101 of 5428 [2%]; odds ratio, 0.92 [95% confidence interval, 0.56-1.51]; p = 0.740, I2 = 36% for statistical heterogeneity). Conclusions There is no difference in infection risk between a single dose and multiple doses of perioperative antibiotics for orthopaedic procedures where implants are utilized, consistent with recent recommendations. However, the quality of evidence for orthopaedic procedures is low, and a randomized study with a sufficient sample size is needed to examine the issue before universal adoption of a single antibiotic dose. Level of Evidence Level I, therapeutic study.

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Systematic review of patient preference and adherence to the correct use of graduated compression stockings to prevent deep vein thrombosis in surgical patients

Wade

Paton

Woolacott

2016

Journal of Advanced Nursing

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Patient adherence was generally higher with knee length than thigh length stockings. However, the studies reflect patient adherence in a hospital setting only, where patients are observed by healthcare professionals; it is likely that adherence reduces once patients have been discharged from hospital. Patients preferred knee length stockings over thigh length stockings. In many clinical settings, any difference in efficacy between thigh length and knee length stockings may be rendered irrelevant by patient preference for and likely better adherence to knee length stockings.

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Anti-embolism stockings and proximal indentation

Cited by 6 publications

References 14 publications

Graduated compression stockings for the prevention of deep-vein thrombosis in postoperative surgical patients: a systematic review and economic model with a value of information analysis

Graduated compression stockings for the prevention of deep-vein thrombosis in postoperative surgical patients: a systematic review and economic model with a value of information analysis

Is There a Difference in Infection Risk Between Single and Multiple Doses of Prophylactic Antibiotics? A Meta-analysis

Systematic review of patient preference and adherence to the correct use of graduated compression stockings to prevent deep vein thrombosis in surgical patients

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