Patterns of Failure of a Standardized Perioperative Venous Thromboembolism Prophylaxis Protocol

被引:10
作者
Cassidy, Michael R. [1 ]
Macht, Ryan D. [1 ]
Rosenkranz, Pamela [1 ]
Caprini, Joseph A. [2 ]
McAneny, David [1 ]
机构
[1] Boston Univ, Sch Med, Boston Med Ctr, Dept Surg, Boston, MA 02118 USA
[2] Univ Chicago, Dept Surg, NorthShore Univ Hlth Syst, Evanston, IL USA
关键词
DEEP-VEIN THROMBOSIS; SURGICAL-PATIENTS; RISK-ASSESSMENT; ENOXAPARIN; TRAUMA; THROMBOPROPHYLAXIS; PREVENTION; SURGERY; PROGRAM; GUIDE;
D O I
10.1016/j.jamcollsurg.2015.12.022
中图分类号
R61 [外科手术学];
学科分类号
摘要
BACKGROUND: Venous thromboembolism (VTE) is a leading contributor to morbidity after operations. We previously implemented a standardized VTE risk assessment, based on the Caprini score, along with risk-stratified prophylaxis. This system reduced the odds ratio of a VTE event from 3.02 to 0.75. We investigated patterns of failure to determine characteristics of patients in whom VTE develops despite the protocol. METHODS: We reviewed all nontrauma general surgery patients with evidence of VTE after the inception of a VTE risk assessment and prophylaxis program. Characteristics were recorded, including demographics, diagnoses, operations, risk profile, prophylaxis prescribed, and regimen compliance. RESULTS: Twenty-seven patients failed the protocol and manifested VTE, representing an overall VTE rate of 0.3%. Of these patients, 63% had emergency operations and 52% underwent multiple operations, compared with 13% and 2.0% of the nontrauma general surgery population in whom VTE did not develop, respectively (p < 0.001). Of patients with VTE, 52% had pre-existing or postoperative infections, 22% had malignancies, but only 15% had missed 1 or more doses of pharmacologic prophylaxis during hospitalization. Five VTEs manifested after discharge; one of those patients was prescribed extended prophylaxis beyond hospitalization, and an extended course was not provided to 3 who were eligible. One patient had underestimation of the Caprini score due to lack of awareness of a family history of VTE. CONCLUSIONS: Emergency and multiple operations seem to confer dramatic hazards for VTE, despite standard prophylaxis. These factors are not currently captured in the Caprini model, but might be significant modifiers of risk that should prompt reassessment, perhaps with a weighted numeric value along with enhanced prophylaxis. It is encouraging that most patients received appropriate prophylaxis in compliance with the protocol. ((C) 2016 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.)
引用
收藏
页码:1074 / 1080
页数:7
相关论文
共 25 条
[1]   Thromboprophylaxis rates in US medical centers: success or failure? [J].
Amin, A. ;
Stemkowski, S. ;
Lin, J. ;
Yang, G. .
JOURNAL OF THROMBOSIS AND HAEMOSTASIS, 2007, 5 (08) :1610-1616
[2]  
Amin Alpesh N, 2009, J Hosp Med, V4, pE15, DOI 10.1002/jhm.526
[3]  
ARCELUS JI, 1991, SEMIN THROMB HEMOST, V17, P313
[4]  
CAPRINI JA, 1991, SEMIN THROMB HEMOST, V17, P304
[5]   Risk assessment as a guide for the prevention of the many faces of venous thromboembolism [J].
Caprini, Joseph A. .
AMERICAN JOURNAL OF SURGERY, 2010, 199 (1A) :S3-S10
[6]   Reducing Postoperative Venous Thromboembolism Complications with a Standardized Risk-Stratified Prophylaxis Protocol and Mobilization Program [J].
Cassidy, Michael R. ;
Rosenkranz, Pamela ;
McAneny, David .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2014, 218 (06) :1095-1104
[7]   Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study [J].
Cohen, Alexander T. ;
Tapson, Victor F. ;
Bergmann, Jean-Francois ;
Goldhaber, Samuel Z. ;
Kakkar, Ajay K. ;
Deslandes, Bruno ;
Huang, Wei ;
Zayaruzny, Maksim ;
Emery, Leigh ;
Anderson, Frederick A., Jr. .
LANCET, 2008, 371 (9610) :387-394
[8]  
Dente C, 2013, AM J SURG, V206, P915
[9]   A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma [J].
Geerts, WH ;
Jay, RM ;
Code, KI ;
Chen, EL ;
Szalai, JP ;
Saibil, EA ;
Hamilton, PA .
NEW ENGLAND JOURNAL OF MEDICINE, 1996, 335 (10) :701-707
[10]   Prevention of venous thromboembolism [J].
Geerts, William H. ;
Bergqvist, David ;
Pineo, Graham F. ;
Heit, John A. ;
Samama, Charles M. ;
Lassen, Michael R. ;
Colwell, Clifford W. .
CHEST, 2008, 133 (06) :381S-453S