273 ADHERENCE TO AMERICAN UROLOGICAL ASSOCIATION (AUA) BEST PRACTICE RECOMMENDATIONS FOR USE OF THROMBOEMBOLIC PROPHYLAXIS AMONGST AUA MEMBERS
| Autor: | Jay Simhan, Christopher J. Long, Karthik Devarajan, Robert G. Uzzo, Tianyu Li, Anthony Corcoran, Ervin Teper, Serge Ginzberg, Ryan N. Fogg, Steven Sterious, Marc C. Smaldone, Alexander Kutikov, Boris Gershman, Sylwester Ratowt, Jose M. Reyes |
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| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.drug_class Urology Best practice medicine.medical_treatment Specialty Low molecular weight heparin Urologic Oncology Odds ratio Perioperative urologic and male genital diseases Thromboembolic prophylaxis Cystectomy Internal medicine Physical therapy Medicine business |
| Zdroj: | Journal of Urology. 187 |
| ISSN: | 1527-3792 0022-5347 |
| DOI: | 10.1016/j.juro.2012.02.331 |
| Popis: | INTRODUCTION AND OBJECTIVES: Thromboprophylaxis (TP) with subcutaneous heparin or low molecular weight heparin may be underutilized in urologic practice. In 2008, the AUA released a best practice statement (BPS) regarding the use of TP following urologic procedures. Here we surveyed urologists to determine familiarity with AUA BPS and to assess actual practice patterns regarding perioperative TP use. METHODS: An 11 question survey instrument was designed to assess familiarity with AUA BPS and determine practice patterns amongst urologists regarding the use of TP following a variety of urologic procedures. The survey was sent to all AUA members with a valid email address (n 10,966). We assessed the association between adherence to AUA BPS and factors such as specialty, year of graduation, and familiarity with guidelines. An association by procedure was assessed using the Chi-square test. Also, a common odds ratio amongst all procedures was calculated using the Cochran-Mantel-Haenszel test. RESULTS: The total survey response rate was 11% (1,210/ 10,966). Of these 26% self-reported to be either urologic oncologists and/or laparoscopic/robotic specialists (UOLRS). These individuals were much more likely to employ TP when compared to non-oncologic/ laparoscopic urologists in high-risk patients (OR 1.58, p 0.0001). The strongest AUA BPS recommendations for TP use are for patients undergoing radical cystectomy (RC) where UOLRS were much more likely to employ TP (p 0.0001). Nevertheless, 19% of UOLRS and 34% of non-UOLRS urologists reported averting routine TP use in patients undergoing RC. 72% of responders graduating after the year 2000 used TP in RC patients in contrast to only 52% of those graduating prior to 2000 (p 0.0001). Only 72% of responders reported having read the AUA BPS, which strongly correlated with routine use of TP (OR 1.36, P 0.0001). CONCLUSIONS: Over a quarter of AUA member responders reported avoidance of TP use for patients in whom AUA BPS strongly recommends routine use of subcutaneous heparin or low molecular weight heparin. Although younger age and self reported urologic oncology and/or laparoscopic specialist status correlated strongly with TP use, adherence to AUA BPS remains low. These data, for the first time, quantify practice patterns with regard to adherence to AUA BPS for use of thromboembolic prophylaxis and identify potential quality of care concerns. |
| Databáze: | OpenAIRE |
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