Quality assessment of guidelines on thromboprophylaxis in orthopaedic surgery

Sabharwal, Sanjeeve; Gauher, Salman; Kyriacou, Steven; Patel, Vishal; Holloway, Ian; Athanasiou, Thanos

doi:10.1302/0301-620x.96b1.32943

Cited by 10 publications

(9 citation statements)

References 30 publications

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“…However, as stated above and also noted by several other researchers [ 44 – 49 ] AGREE II lacks detailed information on how to perform the 2 overall assessments. In addition, several researchers emphasize that these assessments are subjective [ 31 , 44 , 48 , 50 , 51 ]; some regard it as a weakness of AGREE II that items or domains are not weighted, but are all considered equally [ 45 – 47 , 50 , 52 ]. Before appraising a guideline with AGREE II, Lytras et al thus propose to weight domain items [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Guideline appraisal with AGREE II: Systematic review of the current evidence on how users handle the 2 overall assessments

et al. 2017

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IntroductionThe Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument is the most commonly used guideline appraisal tool. It includes 23 appraisal criteria (items) organized within 6 domains and 2 overall assessments (1. overall guideline quality; 2. recommendation for use). The aim of this systematic review was twofold. Firstly, to investigate how often AGREE II users conduct the 2 overall assessments. Secondly, to investigate the influence of the 6 domain scores on each of the 2 overall assessments.Materials and methodsA systematic bibliographic search was conducted for publications reporting guideline appraisals with AGREE II. The impact of the 6 domain scores on the overall assessment of guideline quality was examined using a multiple linear regression model. Their impact on the recommendation for use (possible answers: “yes”, “yes, with modifications”, “no”) was examined using a multinomial regression model.Results118 relevant publications including 1453 guidelines were identified. 77.1% of the publications reported results for at least one overall assessment, but only 32.2% reported results for both overall assessments. The results of the regression analyses showed a statistically significant influence of all domains on overall guideline quality, with Domain 3 (rigour of development) having the strongest influence. For the recommendation for use, the results showed a significant influence of Domains 3 to 5 (“yes” vs. “no”) and Domains 3 and 5 (“yes, with modifications” vs. “no”).ConclusionsThe 2 overall assessments of AGREE II are underreported by guideline assessors. Domains 3 and 5 have the strongest influence on the results of the 2 overall assessments, while the other domains have a varying influence. Within a normative approach, our findings could be used as guidance for weighting individual domains in AGREE II to make the overall assessments more objective. Alternatively, a stronger content analysis of the individual domains could clarify their importance in terms of guideline quality. Moreover, AGREE II should require users to transparently present how they conducted the assessments.

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Section: Discussionmentioning

confidence: 99%

Guideline appraisal with AGREE II: Systematic review of the current evidence on how users handle the 2 overall assessments

et al. 2017

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“…However, the methodologic quality of clinical practice guidelines across many fields of medicine is varied and often poor to moderate. [36][37][38][39][40][41][42] The FI and FQ are not currently included as standard assessment tools of the quality of RCT outcomes. The FI has been reported alongside the number needed to treat data for each trial outcome in a previous investigation 43 and in this investigation.…”

Section: Discussionmentioning

confidence: 99%

How Fragile Are Clinical Trial Outcomes That Support the CHEST Clinical Practice Guidelines for VTE?

Edwards

Wayant

Besas

et al. 2018

Chest

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“…Our study group has previously shown that non-compliance with the (then current) National Health and Medical Research Council (NHMRC) VTE prevention clinical guidelines 7 was associated with higher rates of VTE after THA/TKA. The NHMRC VTE clinical guideline is a high quality guideline developed using rigorous methods 8 , 9 . The quality of the AOA guideline cannot be determined as there is no published information on the methods used or quality evidence underpinning the recommendations.…”

Section: Introductionmentioning

confidence: 99%

Compliance with Australian Orthopaedic Association guidelines does not reduce the risk of venous thromboembolism after total hip and knee arthroplasty

Badge,

Churches,

Naylor

et al. 2024

Sci Rep

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Preventing avoidable venous-thrombo-embolism (VTE) is a priority to improve patient and service outcomes after total hip and total knee arthroplasty (THA, TKA), but compliance with relevant clinical guidelines varies. This study aims to determine the degree to which prophylaxis was compliant with Australian Orthopaedic Association (AOA) VTE prophylaxis guidelines and whether non-compliance is associated with increased risk of VTE. A prospective multi-centre cohort study of adults with osteoarthritis undergoing primary TKA/THA was completed at 19 high-volume public and private hospitals. Data were collected prior to surgery and for one-year post-surgery. Logistic regression was undertaken to explore associations between non-compliance with AOA VTE prophylaxis guidelines and symptomatic 90-day VTE outcomes. Data were analysed for 1838 participants from 19 sites. The rate of non-compliance with all clinical guideline recommendations was 20.1% (N = 369), with 14.1% (N = 259) non-compliance for risk-stratified prophylaxis, 35.8% (N = 658) for duration, and 67.8% (N = 1246) for other general recommendations. Symptomatic VTE was experienced up to 90-days post-surgery by 48 people (2.6%). Overall guideline non-compliance (AOR = 0.93, 95%CI = 0.4 to 1.3, p = 0.86) was not associated with a lower risk of symptomatic 90-day VTE. Results were consistent when people with high bleeding risk were excluded (AOR = 0.94, 95%CI = 0.44 to 2.34, p = 0.89). Non-compliance with the AOA VTE prophylaxis guidelines was not associated with risk of 90-day VTE after arthroplasty. This counterintuitive finding is concerning and necessitates a rigorous review of the AOA VTE prevention clinical guideline.

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Quality assessment of guidelines on thromboprophylaxis in orthopaedic surgery

Cited by 10 publications

References 30 publications

Guideline appraisal with AGREE II: Systematic review of the current evidence on how users handle the 2 overall assessments

Guideline appraisal with AGREE II: Systematic review of the current evidence on how users handle the 2 overall assessments

How Fragile Are Clinical Trial Outcomes That Support the CHEST Clinical Practice Guidelines for VTE?

Compliance with Australian Orthopaedic Association guidelines does not reduce the risk of venous thromboembolism after total hip and knee arthroplasty

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