An observational study for venous thromboembolism risk assessment among hospitalized patients in general surgery clinics across Turkey (original) (raw)
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Background: Venous thromboembolism (VTE) is a major worldwide problem. Objectives: The primary objectives of this survey were to identify patients at risk for VTE, to define the rate of patients receiving appropriate VTE prophylaxis and to examine the frequency of the presence of guidelines and their application. Patients and methods: Ten countries, 101 hospitals and a total of 4983 patients were included in this multinational cross-sectional survey. Standardized case report forms were filled out by trained individuals on one predefined day. Risks were categorized according to the Caprini Risk Assessment Model. Logistic regressions were carried out to assess factors that determined VTE prophylaxis. Results: Of 4983 patients, 3368 (68%) and 1615 (32%) were surgical and medical, respectively. Seven hundred and seventy-two (15.5%) were considered to be at low risk, 1001 (20%) at moderate risk, 1289 (26%) at high risk and 1921 (38.5%) at very high risk for VTE. Of 3575 (72%) patients who were eligible to receive VTE prophylaxis, 2747 (77%) received any drug prophylaxis. Among these patients 720/1056 (68%) and 2027/2519 (80%) were medical and surgical patients, respectively. The overall compliance with ACCP guidelines was 38%, being 24% for medical patients and 44% for surgical patients. Conclusions: The results of this large multinational survey, although indicating overall improvement in VTE prophylaxis, identify a considerable number of patients who either did not receive any VTE prophylaxis or received it inappropriately. Although more medical patients were at risk for VTE, they were given prophylaxis less frequently than surgical patients. Concordance with VTE prophylaxis guidelines was higher in surgical patients, but overall application of these tools was unacceptably low.
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).
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
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.
The European Journal of Surgery, 2001
Objective: To assess the use of venous thromboembolism prophylaxis in surgical patients. Design: Retrospective multicentre study. Setting: Eight acute-care teaching hospitals with more than 400 beds, Spain. Patients: Medical records of all consecutive patients undergoing operations in the general surgical and trauma and orthopaedic services during the month of April, 1997, were randomly selected. Intervention: The sample size for each type of operation (general, trauma-orthopaedic) was calculated from the number of operations done at each hospital (with an absolute precision of 5%, and an a error of 5%) and the prevalence of the use of venous thromboembolism prophylaxis obtained from a random sample of 50 records (25 from patients in general surgery and 25 from patients in orthopaedic surgery) from each centre. Main outcome measures: Appropriate and inappropriate pharmacological prophylaxis de ned according to a combination of risk categories for venous thromboembolism, doses of antithrombotic agents given, time of starting prophylaxis, and its duration. Results: A total of 1848 medical records (general surgery, n = 1025; trauma-orthopaedic surgery, n = 823) were included. Physical methods (elastic stockings, intermittent pneumatic compression) were used in only 0.3% of patients. Pharmacological prophylaxis consisted of low molecular weight heparin in 99% of cases. The percentage given heparin-based prophylaxis was 54%. Overall, appropriate prophylaxis was given in 1175 patients (64%). Use of thromboprophylaxi s ranged from 27% to 70% among the participating hospitals. Prophylaxis was more likely to be appropiate in orthopaedic patients (577, 70%) than in general surgical patients (598, 58%) in both the high and moderate risk categories. Conclusions: Given the large variability between the participating hospitals, more speci c protocols and recommendations about prophylaxis of thromboembolism in surgical patients are needed.
2021
Background There is a growing body of evidence showing substantial underuse of appropriate venous thromboembolism (VTE) prophylaxis in patients at risk. In the present study, our goal was to assess the current practices in the use rate of VTE prophylaxis among hospitalized patients in Jordan and Lebanon. Methods A cross-sectional, multicenter, observational study was conducted on 40 centers across Lebanon and Jordan. We included patients who were admitted to the participating hospitals for the treatment of a serious medical or surgical illness. The patients’ records were screened for the fulfillment of inclusion/exclusion criteria during a single assessment visit. The proportion of medical and surgical patients who were at risk of VTE and the thrombo-prophylactic measures employed by physicians for these patients were assessed according to the American College of Chest Physicians (ACCP 2016) guidelines. Results The present study included 704 patients (400 from Jordan and 304 from Le...
Medical Principles and Practice, 2012
Objectives: To assess the prevalence of venous thromboembolism (VTE) risk in acutely ill surgical and medical patients in selected acute care centres in the Arabian Gulf States, and to determine the proportion of at-risk patients who received effective prophylaxis in accordance with 2004 American College of Chest Physicians (ACCP) guidelines. Materials and Methods: Eight hospitals from 3 countries (Kuwait, Kingdom of Saudi Arabia, and United Arab Emirates) contributed to the global ENDORSE (Epidemiological International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting) study. Medical records were reviewed for all the in-patients aged ≥40 years admitted to medical wards, and in patients aged ≥18 admitted to surgical wards. The VTE risk and recommended prophylaxis were assessed according to the 2004 ACCP guidelines. Results: Of 1,291 evaluable patients, 801 were considered at risk of VTE; 391 (48.8%) surgical patients and 410 (51...
Venous thromboembolism (VTE): risk assessment in hospitalized patients
PubMed, 2014
Objective: To determine the number of hospitalized patients at risk for developing venous thromboembolism (VTE) / deep vein thrombosis (DVT), identifying the most common risk factor and to document the use of thromboprophylaxis. Study design: Observational and cross-sectional study. Place and duration of study: Chandka Medical College Hospital, Larkana, from October to December 2011. Methodology: A total of 170 patients underwent this study and these included 51 (30%) from general medical, and 119 (70%) from surgical units. Inclusion and exclusion criteria were defined and data was collected on printed format. VTE risk assessment was done according to Caprini Model and criteria defined by the American College of Chest Physicians- ACCP. Results: Out of 170 patients, 91 were male and 79 female with mean age of 39 ± 16 years. According to ACCP criteria for VTE risk assessment, 20% (n=34) patients were identified to be at low risk, 20% (n=34) at moderate risk, 47.65% (n=81) at high risk and 12.35% (n=21) at very high risk of developing VTE. The commonest risk factor significantly identified was immobility (54.7%, p < 0.005), followed by advancing age (41.17%, p < 0.005) and obesity (18.23%). The most common risk factor in all types of surgical patients was anaesthesia for more than 45 minutes 82.35% (n=98/119) and in medical patients advancing age 45% (n=23/51). Only 6 (3.5%) patients received thromboprophylaxis, all were surgical patients of very high-risk category. Conclusion: Majority of studied hospitalized patients were at high risk of developing VTE. Immobility was the commonest risk factor for developing VTE, followed by advancing age and obesity. Very few hospitalized patients actually received thromboprophylaxis.
Prevention of Venous Thromboembolism in General Surgery at Gabriel Touré University Hospital in Mali
Surgical Science, 2021
Through its impact on morbidity and mortality and the cost of medical care, Venous Thromboembolism (VTE) has a significant influence on the quality of care in a surgical environment. The objectives were to determine the risk of postoperative venous thromboembolism and to assess its prophylactic management in the general surgery department of Gabriel Toure University Hospital. This was a prospective observational study from May 01, 2018 to December 31, 2018. It included all patients of 18 years old and over, operated in regulated surgery, under general anesthesia in the department. For all of these patients, Caprini score was used to assess the risk of VTE. The ninth American College of Chest Physicians' Consensus was used as guidelines to assess Thromboprophylaxis practices in the ward. The Caprini score was evaluated in 80 patients for 8 months. The average age was 50.2 years. The sex ratio was 0.48. The risk level of VTE was low in three patients (3.8%), moderate in 13 patients (16.3%), high in 34 patients (42.5%) and highest in 30 patients (37.5%). The main risk factors found were major surgery (87.5%), age > 40 years (72.5%), cancer (33.8%), bed rest (31.2%), obesity (27.5%) and minor surgery (12.5%). Early mobilization was performed in all patients. Pharmacologic prophylaxis was required in 80% of our patients but only 38.8% had received low molecular weight heparin. VTE complicated 5 procedures, including 3 cases of deep vein thrombosis of the limbs and 2 cases of pulmonary embolism who died. Venous thromboembolism is serious and common in surgical settings. Its prevention remains insufficient in our context.