The Use of Intermittent Pneumatic Compression in Orthopaedic Surgery: An Umbrella Review and Meta-Analysis.

Abstract

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major complication following orthopaedic surgery, contributing to increased morbidity, mortality, and healthcare costs. Intermittent pneumatic compression (IPC) devices are widely used as a nonpharmacological prophylactic intervention, yet the evidence regarding their effectiveness remains varied across studies. An umbrella review of published meta-analyses was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Reviews comparing IPC devices to no prophylaxis, chemoprophylaxis, or combination regimens in orthopaedic surgery populations were identified through systematic searches of PubMed, Embase, and Cochrane databases. Data on DVT, PE, bleeding complications, and mortality were extracted. Study quality, overlap of primary studies, and reporting bias were evaluated. A meta-analysis of primary studies was performed. IPC significantly reduced the risk of all DVT (odds ratio [OR] 0.40), proximal DVT (OR 0.58), distal DVT (OR 0.45), PE (OR 0.45), and bleeding complications (OR 0.57), with no effect on mortality. Subgroup analyses showed that IPC was effective across most surgery and intervention types, with particular benefit over aspirin and low molecular weight heparin. IPC alone performed comparably or better than chemoprophylaxis, especially for bleeding risk. IPC devices are effective in reducing the incidence of VTE and bleeding complications in patients undergoing orthopaedic procedures, with safety outcomes being more favorable compared with pharmacological agents. However, heterogeneity in existing evidence and methodological limitations highlight the need for standardized, high-quality randomized trials. These findings support the continued use of IPC, particularly in patients at high bleeding risk or when chemoprophylaxis is contraindicated. Level IV, systematic review. See Instructions for Authors for a complete description of levels of evidence.