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Large Joints Feature

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New Study Looks at Planes vs Boats for Patients

Biloine W. Young • Tue, March 27th, 2018

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Given the choice of a 75-minute plane flight versus taking a boat from a remote island off the coast of Scotland to a Glasgow hospital for surgery, many patients would choose the quicker plane flight. Until they learn, that is, that even short air travel flights add an additional risk of venous thromboembolism (VTE) following lower limb arthroplasty.

According to the press release, “VTE is a serious complication that can follow hip and knee arthroplasty in the form of a blood clot and is a leading cause of death and disability worldwide. Although the exact incidence of VTE is unknown, researchers believe that 10 million cases occur annually.”

The study, “Flying in the early post-operative period following lower limb arthroplasty—is it safe?,” looked at lower limb surgeries performed at the national arthroplasty unit at the Golden Jubilee National Hospital in Glasgow. Research was presented at the 2018 American Academy of Orthopaedic Surgeons annual meeting.

The hospital services a large geographic area that includes several remote islands. This requires patients to either fly to and from the hospital for surgery or take a boat. The researchers looked at two groups–those who traveled by air and those who traveled by land. All patients received pharmacological and mechanical thromboprophylaxis medication.

A total of 243 patients flew at a mean of six days following arthroplasty (range 1-24 days) during the three-year study period. There were 5,498 patients in the control group. The mean flight time was 74 minutes (range 40-85 minutes). Four patients in the flight group developed a VTE. There were two pulmonary emboli and two deep vein thromboses. Thirty-two patients suffered a VTE in the control group (25 pulmonary emboli, seven deep vein thromboses).

“We don’t quite understand the mechanisms behind why there is an increased risk of VTE with flying, but there are a number of hypotheses,” said Fahd Mahmood, clinical research fellow at the Golden Jubilee National Hospital. “This study demonstrates that there is an association between flying and an increased risk of VTE, but we can’t demonstrate causality. Based on the data we have at the moment, we can counsel our patients that if they are flying to and from the institution, we think there may be an increased risk of blood clots, but we need more evidence.”

The press release states, “This is the first study to identify such a risk. Previous studies found no additional risk from perioperative air travel in patients following lower limb arthroplasty.”

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