More than 40 orthopaedic society presidents and presidential representatives from around the world convened Wednesday morning at the International Presidents Breakfast & World Opinion Forum.

AAOS Now

Published 3/25/2022
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Leah Lawrence

International Presidents Breakfast Showcases Collaboration, Highlights New VTE Guidance

The importance of the global community of orthopaedic surgeons was evident at the International Presidents Breakfast & World Opinion Forum held Wednesday at the AAOS 2022 Annual Meeting.

“As orthopaedic surgeons, we face many of the same challenges regardless of where we practice,” said AAOS International Committee Chair Coleen Sabatini, MD, MPH, FAAOS. “These gatherings highlight our resolve for tackling future obstacles and opportunities together.”

Dr. Sabatini welcomed more than 40 presidents and delegates from international orthopaedic societies at the breakfast. Next, AAOS President Daniel K. Guy, MD, FAAOS, thanked the International Committee and all the attendees for traveling to Chicago to attend the Annual Meeting.

“Orthopaedics is global, and today more than ever, so is this Academy,” Dr. Guy said. “We continue to expand outreach to colleagues across the globe. This expansion is greatly due to the commitment and ongoing dialogue among all of you.”

The future of orthopaedics and the public’s ability to access the highest-quality musculoskeletal care, both locally and around the world, depends on participation in these global associations, he said.

Next, Javad Parvizi, MD, FAAOS, FRCS, the James Edwards professor of orthopaedics at Thomas Jefferson University and director of clinical research at Rothman Orthopaedic Institute, discussed the development process for global guidelines for the prevention of venous thromboembolism (VTE) by the International Consensus Meeting (ICM) on Venous Thromboembolism.

“We all know that VTE is one of the feared complications after orthopaedic procedures,” Dr. Parvizi said. “In particular, orthopaedics has been highlighted as one of those surgical disciplines with a high rate of VTE—whether that is true or not.”

There are a lot of complexities related to VTE, particularly in the United States, where surgeons face legal issues related to administration of VTE prophylaxis.

However, Dr. Parvizi cited several studies that have shown no change in symptomatic or fatal pulmonary embolism or VTE in the last 10 to 15 years despite the availability and administration of potent anticoagulation agents. In fact, numerous studies have shown higher mortality with administration of aggressive anticoagulation, he said.

There are several VTE guidelines available to guide orthopaedic surgeons, but many are related only to hip and knee, some are contradictory, and many cite data that are outdated, Dr. Parvizi said.

To address this knowledge gap, the ICM, a nonprofit organization with global membership and based in Philadelphia, brought together doctors and scientists to assess the most up-to-date research related to preventing VTE in orthopaedic surgery.

The ICM convened a group of experts from around the world to generate guidelines and recommendations. The group included delegates from 135 international societies and 68 countries and represented a variety of medical specialties, including orthopaedics, hematology, cardiology, internal medicine, and anesthesia.

Each delegate was asked to send five to 10 questions related to VTE, and the ICM received 670 questions. These questions were reviewed by a steering committee that narrowed the list to 200 questions. The remaining questions were rewritten according to a strict Delphi process, and a preliminary literature review was conducted.

A document was created for each question and then assigned to at least two delegates for review. Next, a systematic review was conducted with the help of the Cochrane Group and Thomas Jefferson University Library. Interdelegate discussions allowed for critique or suggestions, and the documents were revised and sent for a second review.

All the documents were merged and reviewed again, and then posted as guidelines on ICM’s website ICMPhilly.com. In September 2021, the guidelines underwent a final evaluation by participating delegates, with additional input from experts before being submitted for publication.

The guidelines addressed several new subspecialties, including spine, trauma, pediatrics, and sports medicine. The guidelines are endorsed by all 135 societies and will be translated into numerous languages.

“We were very fortunate to have the opportunity to have Marc Swiontkowski, MD, FAOA, the lead author, publish it in its entirety in the Journal of Bone & Joint Surgery,” Dr. Parvizi said. “It has all 200 questions with all the subspecialities and is already out as an epub [article].”

The document is also available on ICMPhilly.com and through the ICM Philly app. The ICM Philly website also includes a VTE risk calculator.

“If you ever doubt the risk of a patient or whether you should give them aspirin or something stronger, you can use this risk calculator,” Dr. Parvizi said.

He closed by thanking everyone for recognizing the importance of this process.

“You did an incredible job to get this done,” he said.

After the presentation, attendees participated in roundtable discussions about important topics facing the specialty, including effective education, the value of society memberships, and the importance of diversity in orthopaedics.

“I hope we are able to learn from the challenges we are facing as orthopaedic surgeons and leaders, and discuss strategies for success,” Dr. Sabatini said.

Leah Lawrence is a freelance writer for AAOS Now.