Air travel and thromboembolic events after orthopedic surgery: Where are we and where do we need to go?

Introduction: As medical tourism expands, guidelines must be established to allow for appropriate patient counseling, as there is already an inherent increased venous thromboembolism risk with air travel. We review orthopedic literature to determine if there are post-operative air travel recommendations that can be made and where additional focus should be directed that may decrease thromboembolic complication rates in this already at-risk population. Methods: A systematic review of the Medline and Cochrane databases was conducted for articles related to air-travel and orthopaedics. As joint arthroplasty research focuses heavily on venous thromboembolisms and their prevention, we initially directed our review to this field using the search terms- "thromboembolism OR flight OR flying AND arthroplasty". Criteria for inclusion were abstracts and articles related to the topic of venous thromboembolism in orthopaedic procedures, which were relevant to the study question. A meta-analysis for risk estimation of thromboembolism was to be conducted. Results: The query identified 1542 studies. 6 articles were assessed for eligibility, 2 proved to be relevant. None of the studies were prospective or randomized. Conclusion: Due to the small sample and heterogeneity of the studies available, a meta-analysis could not be performed. Acute post-operative air travel appears safe following joint arthroplasties and upper extremity fractures, but is unclear for spine and trauma patients. Further research should be directed towards the growing trend of air travel following surgical procedures.