Outcome of venous thromboembolism prophylaxis combined with enhanced recovery after surgery protocol for acute care surgery patients: a retrospective study of a tertiary center

Background: Emergency general surgery has limitations with respect to venous thromboembolism (VTE) risk assessment and prophylaxis. The enhanced recovery after surgery (ERAS) protocol has not been established for emergency surgery. Combining certain elements of ERAS and VTE prophylaxis protocols may decrease risks and improve outcomes. Methods: The authors retrospectively compared the periods before and after implementation of VTE prophylaxis protocol in patients undergoing emergency general surgery. The primary outcomes were the incidence of VTE events and death. The secondary outcome was compliance with the VTE prophylaxis protocol in emergency surgery. Results: This study involved 244 patients with a mean age of 57 +/- 20 years. Compliance with the VTE prophylaxis protocol, implemented by a multidisciplinary team, was 99%. Postoperative prophylaxis was provided pharmacologically in two (1%) patients, mechanically in 66 (27%), and by early ambulation in 159 (65%). The univariable analysis showed that application of the VTE prophylaxis protocol was associated with a significantly lower mortality rate, but the multivariable analysis showed no significant difference (adjusted OR, 0.84; 95% CI: 0.12-5.82; P=0.862). The incidence of VTE events was significantly lower when the VTE prophylaxis protocol was applied in both the univariable and multivariable analyses (OR, 0.01; 95% CI: 0.00-0.11; P<0.001) (adjusted OR, 0.04 95% CI: 0.00-0.40; P=0.006). Conclusions: Use of a VTE prophylaxis protocol along with ERAS protocol can lower the incidence of postoperative VTE incidence, the pulmonary embolism rate, and the mortality rate in patients undergoing emergency general surgery. Early ambulation is effectively reduced VTE events and mortality.