Venous thromboembolic events: How low can you go?

Autor: Jones CE; University of Alabama at Birmingham, Department of Surgery, USA., Hollis RH; University of Alabama at Birmingham, Department of Surgery, USA., Gullick AA; University of Alabama at Birmingham, Department of Surgery, USA., Wahl T; University of Alabama at Birmingham, Department of Surgery, USA., Richman JS; University of Alabama at Birmingham, Department of Surgery, USA., Graham LA; University of Alabama at Birmingham, Department of Surgery, USA., Lucy AT; University of Alabama at Birmingham, Department of Surgery, USA., Chu DI; University of Alabama at Birmingham, Department of Surgery, USA., Morris MS; University of Alabama at Birmingham, Department of Surgery, USA. Electronic address: msmorris@uabmc.edu.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2017 Apr; Vol. 213 (4), pp. 706-710. Date of Electronic Publication: 2017 Jan 13.
DOI: 10.1016/j.amjsurg.2016.10.037
Abstrakt: Background: We evaluated postoperative venous thromboembolism (VTE) chemical prophylaxis adherence to assess the preventability of VTEs.
Methods: A case-control study was performed using the 2011-2015 ACS-NSQIP single institution database. Cases were identified as patients who experienced postoperative VTE within 30 days following surgery. Controls were matched 2:1 on procedure, age, and BMI. Association between inpatient chemical prophylaxis adherence and postoperative VTE was evaluated with conditional logistic regression.
Results: Seventy-three cases were matched to 145 controls. Complete inpatient VTE chemical prophylaxis adherence did not differ between cases and controls (45.2% vs. 46.2%, p = 1.00). Odds of postoperative VTE increased if a patient's prophylaxis was interrupted (OR 6.34, 95% CI 1.82-22.13). However, 53.7% of instances of interrupted prophylaxis were medically justified by concern for bleeding, spine operation, or for additional upcoming procedure.
Conclusions: Nearly half of patients who experienced postoperative VTEs received appropriate guideline-driven care. Most interruptions in chemical prophylaxis were justified medically. This further questions the preventability of postoperative VTEs and the utility of this outcome as a valid measure of hospital quality.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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