Venous thromboembolic events: How low can you go?
| Autor: | Tyler S. Wahl, Robert H. Hollis, Laura A. Graham, Joshua S. Richman, Allison A. Gullick, Daniel I. Chu, Adam T. Lucy, Melanie S. Morris, Caroline E. Jones |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Quality Assurance Health Care Hospital quality 03 medical and health sciences Postoperative Complications 0302 clinical medicine Internal medicine medicine Humans 030212 general & internal medicine Enoxaparin Single institution business.industry Anticoagulants Venous Thromboembolism General Medicine Middle Aged United States Surgery Case-Control Studies 030220 oncology & carcinogenesis Practice Guidelines as Topic Female Conditional logistic regression Guideline Adherence business Venous thromboembolism |
| Zdroj: | The American Journal of Surgery. 213:706-710 |
| ISSN: | 0002-9610 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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