Rate of venous thromboembolism among surgical patients in Australian hospitals: a multicentre retrospective cohort study (original) (raw)
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Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2017
Venous thromboembolism, risk of which is increased in surgical patients, is a preventable cause of morbidity and death. The primary objective of this study was to estimate the incidence of symptomatic postoperative venous thromboembolism in adults at a tertiary university hospital, overall and by surgical specialty. The secondary objective was to analyze severity of and mortality from thromboembolic events. We performed a retrospective study to identify cases of in-hospital postoperative venous thromboembolism, encoded by the International Classification of Diseases, Ninth Revision, according to the Joint Commission International criteria. Adult patients admitted for surgery in 2008-2012 were included. Among 67 635 hospitalizations, 90 cases of postoperative symptomatic venous thromboembolism were identified, corresponding to an incidence of 1.33/1000 admissions (95% confidence interval [CI] 1.1-1.6/1000). Neurosurgery had the highest risk (4.07/1000), followed by urological surgery...
Pakistan Journal of Medical Sciences, 2018
Objective: To investigate the prevalence of and risk factors for Venous Thromboembolism (VTE) in postoperative patients. Methods: This descriptive, cross-sectional, retrospective study was conducted from August 2016 to October 2016 at two university hospitals and one public hospital. Total 217,354 patients records who underwent surgery in between 2010 and 2015 were examined. The study sample consisted of 123 patients who had postoperative venous thrombosis and pulmonary embolism, and whose discharge details, consultation data, diagnostic reports, and tests were examined in detail. Results: The prevalence of VTE in postoperative patients was 5.6/10,000. The mean age of the patients was 60.22±18.56 years. Of 123 patients, 51.20% were male, 30.90% were smokers, 46.30% had a comorbid disease, and 27.60% were diagnosed with cancer. Of the patients who had postoperative VTE, 65.0% had major surgery. Pharmacologic thromboprophylaxis was used in only 24.4% of patients (n=30). Conclusion: The prevalence of VTE in the present study is lower than that in other studies. Because surgery is a risk factor for VTE, patients who will be operated should be assessed. Considering the present results, we can assume that patients' conditions are not being assessed appropriately. In addition, findings indicate that a standard for preventing VTE has not yet been established.
Annals of Surgery, 2012
Authorship This manuscript represents the aggregate efforts of ten authors. Peri-operative risk stratification for venous thromboembolism after outpatient surgery is a broad topic that has relevance to a wide range of clinicians, administrators, and policymakers. Our author list reflects a cross section of the clinical care team to whom our manuscript is targeted, and has representation from general surgery, plastic and reconstructive surgery, vascular surgery, anesthesiology, hospital administration, and our office of clinical affairs. Each of the ten authors has fulfilled the criteria for authorship established by Annals of Surgery. Their specific contributions are listed below. All authors have reviewed this manuscript and give their final approval for submission. Specific contributions of each author: • Pannucci: Conception and design, analysis and interpretation of data, drafting of manuscript, statistical analysis • Kheterpal: Conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, administrative, technical, or material support, supervision Conflicts of Interest For the remaining authors none were declared.
Phlebology / Venous Forum of the Royal Society of Medicine, 2011
Venous thromboembolism (VTE) still remains a significant public health problem due to gaps between recommendations and clinical practice in VTE prophylaxis. This is the first clinical study designed to evaluate the applicability of a standard 'VTE prophylaxis and risk factor assessment form (VTE-PRAF)' and prescription of VTE prophylaxis among hospitalized patients in the daily practice of general surgeons in Turkey. A total of 1472 patients (mean age: 52.4 ± 16.9 years; 50.6% were men) were included in cross-sectional (n = 537), first longitudinal (n = 452) or the second longitudinal (n = 483) phases. Data on demographics, hospitalization, surgical intervention and prophylaxis were collected during the cross-sectional phase, whereas utilization of form was evaluated during longitudinal phases. While 62.1% of patients were identified to be at 'high+ highest' risk, prophylaxis was evident only for 65.9%. Utilization of the form was higher in the second longitudinal ph...
Surgery, 2008
Background. There is a national effort to decrease the incidence of venous thromboembolism (VTE) in surgical patients by encouraging compliance with established guidelines for prophylaxis. Reported compliance with these guidelines has been poor. The outcome of noncompliance in terms of morbidity and mortality in surgical patients is unknown. We sought to determine if there has been a decrease in the incidence of symptomatic VTE since implementation of the guidelines and whether there has been compliance with the guidelines in individual patients; we also analyzed the outcome of a cohort with VTE. Methods. We reviewed the records of all patients with symptomatic VTE on 3 surgery services over the 10-year period since initial publication of the guidelines. We determined in each patient whether there was compliance with the guidelines. We weighted the morbidity of each episode of VTE based on the likelihood of short-term mortality and long-term morbidity to determine the disease burden. Results. Of 37,615 patients, 172 developed a VTE (0.46%), and the incidence increased gradually over the years of the study. There was partial or complete compliance with the guidelines in 84% of the patients, but 37% of the VTEs were considered to be preventable. The disease burden was greatest in the higher-risk patients---there were 20 deaths (6%), 4 of which were caused by a pulmonary embolus. Conclusions. Despite one of the highest published rates of compliance with the guidelines for prophylaxis, the rate of symptomatic VTE is increasing. (Surgery 2008;144:3-11.) From the
Blood Advances
Background:Venous thromboembolism (VTE) is a common source of perioperative morbidity and mortality.Objective:These evidence-based guidelines from the American Society of Hematology (ASH) intend to support decision making about preventing VTE in patients undergoing surgery.Methods:ASH formed a multidisciplinary guideline panel balanced to minimize bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline-development process, including performing systematic reviews. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment.Results:The panel agreed on 30 recommendations, including for major surgery in general (n = 8), orthopedic surgery (n = 7), major general surgery (n = 3), major neurosurgical procedures (n = 2), urological surgery (n = 4), cardiac surgery and major vascular surgery (n = 2), major trauma (n = 2), and major gyneco...
Prevention of venous thromboembolism: Improving practice in surgical patients
International Journal of Surgery, 2009
Aims: Venous thromboembolism (VTE) is the most common preventable cause of hospital-related mortality. There are major inadequacies internationally in administering appropriate prophylaxis. Our initial aim was to show whether our local effectiveness of administration was equally poor. With local inadequacy confirmed, our second aim was to design, implement and evaluate the efficacy of a new VTE protocol nested within a surgical clerking proforma. Methods: A pilot audit of the prescription and administration of enoxaparin and thromboembolic deterrent stockings for VTE prophylaxis in 51 acutely admitted surgical inpatients (Round 1) was performed against local guidelines derived from the American College of Chest Physicians (ACCP) criteria. The authors then designed and implemented a VTE prevention protocol incorporating risk assessment and decision support within a new clerking proforma for acute surgical admissions. Local practice was audited against the same criteria in Round 2, which comprised 60 consecutive acute surgical admissions in the same district general hospital. Results: In the pilot study, only (19/51) 37% of subjects received appropriate VTE prophylaxis. Over half of patients were at high risk for VTE; 18/29 high risk patients and 4/10 medium risk patients were not adequately protected. Following implementation of the quality improvement intervention, (53/60) 88% of subjects received appropriate prophylaxis (p < 0.001). Conclusions: Implementation of a VTE protocol as part of a clerking proforma for acute surgical admissions is a simple and effective way of ensuring that surgical patients receive appropriate thromboprophylaxis. A similar strategy could be employed to broaden the scope of the National Institute of Clinical Excellence (NICE) guidelines to address VTE prevention in all hospitalised patients.
10 Approaching Venous Thrombosis in General Surgery Patients
2012
Venous thromboembolism (VTE) manifesting as deep vein thrombosis(DVT) or pulmonary embolism (PE), is one of the most common complications of hospitalization and is associated with short and long-term morbidity, mortality and resource expenditure. Routine use of thromboprophylaxis reduces adverse patient outcomes while at the same time decreasing overall costs. Almost all hospitalized patients have at least one associated risk factor for VTE, and approximately 40% have three or more risk factors (Table 1)(1).
Venous Thromboembolism Risk and Prophylaxis in the Acute Care Hospital Setting (ENDORSE Survey)
Annals of Surgery, 2010
Abstract Objective: To evaluate venous thromboembolism (VTE) risk in patients who underwent a major operation, including the use of, and factors influencing, American College of Chest Physicians-recommended types of VTE prophylaxis. Summary background data: The Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting (ENDORSE) survey, conducted in 358 hospitals in 32 countries, reported that globally, more than 40% of at-risk patients do not receive VTE prophylaxis. Limited data are available regarding VTE prophylaxis practices according to surgery type and patient characteristics. Methods: Patients aged ≥18 years undergoing major surgery were included in this prespecified subanalysis. VTE risk and use of prophylaxis were determined from hospital medical records according to the 2004 American College of Chest Physicians guidelines. Multivariable analyses were performed to identify factors associated with VTE prophylaxis use. Results: Of the 18,461 patients in ENDORSE who had undergone major surgery, 17,084 (92.5%) were at-risk for VTE and 10,638 (62.3%) received prophylaxis. Use of prophylaxis varied according to major surgery type from 86.0% for orthopedic surgery to 53.8% in urologic/gynecologic and 53.6% in other procedures. Major orthopedic surgery was most strongly associated with prophylaxis use (hip replacement: odds ratio 6.2, 95% confidence interval [CI] 5.0-7.6; knee replacement: odds ratio 5.9, 95% CI 4.6-7.8).