Inappropriate Venous Thromboembolism Prophylaxis in a General Surgery Department: Risk Factors and Improvement with a Si
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ORIGINAL ARTICLE
Inappropriate Venous Thromboembolism Prophylaxis in a General Surgery Department: Risk Factors and Improvement with a Simple Educational Program Oscar Cano-Valderrama 1,2,3 & Yolanda Cuñarro-López 4 & Beatriz Laiz 5 & Montiel Jiménez-Fuertes 5 & Antonio J. Torres 1,2,3 & Manuel Duran-Poveda 5,6 Received: 30 August 2019 / Accepted: 24 March 2020 # Association of Surgeons of India 2020
Abstract The aim of this study was to describe the rate of patients with an inappropriate venous thromboembolism (VTE) prophylaxis in a Department of Surgery, study the risk factors associated with an inappropriate VTE prophylaxis, and analyze the effect of a simple educational program to improve these results. A quasi-experimental study was performed. VTE prophylaxis was studied in a Department of Surgery. The results of this analysis were presented to the Staff of the Department. Then, prophylaxis was again studied to analyze if this simple educational program improved these results. Inappropriate prophylaxis was seen in nearly 40% of the patients, mainly due to a lack of prescription. Inappropriate prophylaxis was associated with advanced age, ASA, surgical patient, no same-day surgery, no discharged patients, and high VTE risk. In the multivariate analysis, only no same-day surgery was related to inappropriate prophylaxis. The educational program achieved a non-significant reduction of inappropriate prophylaxis (31.7% vs. 40.5%, p = 0.070). A high percentage of patients in the Department of Surgery had an inappropriate VTE prophylaxis, mainly due to the lack of prescription. A simple educational program improved VTE prophylaxis prescription, although this improvement was not statistically significant. Keywords Venous thromboembolism . Prophylaxis . Deep vein thrombosis . Pulmonary embolism . Surgery . Patient safety . Quality control
Introduction Every year, 465,000 patients are diagnosed with deep vein thrombosis (DVT) and 370,000 patients die because of venous
* Oscar Cano-Valderrama [email protected] 1
Department of Surgery, Hospital Clínico San Carlos, C/ Profesor Martín Lagos SN, 28040 Madrid, Spain
2
Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
3
Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
4
Department of Gynecology and Obstetrics, Hospital Gregorio Marañón, Madrid, Spain
5
Department of Surgery, Hospital Rey Juan Carlos, Móstoles, Madrid, Spain
6
Department of Medicine and Surgery, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
thromboembolism (VTE) in Europe [1]. It is important to know about VTE not only because of the short-term morbidity and mortality that it provokes but also because of the longterm complications that can be seen after VTE, such as VTE recurrence or postthrombotic syndrome [2, 3]. More than 100 years ago, Virchow described the three main factors that are associated with VTE: venous stasis, hypercoagulable state, and endothelial damage [4]. These factors are nearly always seen in surgical patients; therefor
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