Post-operative Venous Thromboembolism Prophylaxis for Non-arthroplasty Knee Surgery: A Closed Loop Clinical Audit

Venous thromboembolism (VTE) is a preventable complication following orthopaedic surgery. While most guidelines focus on arthroplasty, a significant number of knee surgeries fall under non-arthroplasty procedures, where post-operative VTE prophylaxis recommendations vary depending on anaesthetic time and weight-bearing status. National guidelines and available literature suggest the use of VTE prophylaxis for these cases, yet adherence in clinical practice remains inconsistent. To evaluate and improve compliance with NICE (National Institute for Health and Care Excellence) guidelines on VTE prophylaxis following non-arthroplasty knee surgery at a tertiary orthopaedic centre.

A closed-loop audit was conducted. Patient data from two six-month cycles (January-June 2023 and July-December 2023) were retrospectively reviewed. Inclusion criteria were patients aged ≥18 years undergoing non-arthroplasty knee procedures under the joint replacement unit. Compliance with NICE standards was assessed, and outcomes were compared pre- and post-intervention, which included a teaching session for the surgical team.

In the first cycle (n=46), compliance with VTE prophylaxis was 50% for arthroscopic cases with anaesthetic time >90 minutes, and 36% for other non-arthroplasty surgeries. Post-intervention (n=66), compliance improved to 55% and 68% respectively. The 5% improvement in arthroscopic procedures was not statistically significant (p=1.0), whereas the 32% improvement in other non-arthroplasty procedures was statistically significant (p=0.02).

The audit identified significant gaps in adherence to VTE prophylaxis guidelines for non-arthroplasty knee procedures. Targeted education led to a notable improvement in compliance, particularly in non-arthroscopic cases. Sustained efforts, including documentation standardisation and ongoing training, are essential to maintain and further improve prophylactic practices.