Association Between Surgeon Practice Knowledge and Venous Thromboembolism
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ORIGINAL CONTRIBUTIONS
Association Between Surgeon Practice Knowledge and Venous Thromboembolism Alirio de Meireles 1 & Arthur M. Carlin 2 & Anne Cain-Nielsen 3 & Amanda Stricklen 3 & Rachel Ross 3 & Jonathan F. Finks 1,3 & Oliver A. Varban 1,3 & Amir A. Ghaferi 1,3,4
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The most common cause of mortality following bariatric surgery is venous thromboembolism. Our study aimed to (1) determine the practice patterns of venous thromboembolism (VTE) chemoprophylaxis among bariatric surgeons participating in a large statewide quality collaborative and (2) compare the results of surgeon self-reported chemoprophylaxis practices to actual practices from abstracted chart data. Methods We administered a 13-question survey to 66 surgeons across a statewide collaborative aimed at revealing VTE practice patterns such as medication type, dosage, timing, duration, and level of trainee involvement (response rate 93%). We conducted on-site data audits to examine the charts of all patients that had developed VTE during the study period and 15 other randomly selected patient charts per site. We then evaluated both the ordered perioperative chemoprophylaxis and the actual administered chemoprophylaxis from nursing and electronic records. Results There was 31% overall discordance between self-reported and abstracted chart data for pre-operative VTE dosing regimens. Among patients who had a VTE, 39% of administered chemoprophylaxis did not match surgeon responses. Conversely, among patients who did not have a VTE, only 29% were discordant (p = 0.03). In contrast, for post-operative VTE dosing, there was no significant difference in the rate of discordance in patients with and without a VTE (47% discordance vs 38%, p = 0.0552, respectively). Conclusions Greater discordance between surgeon self-reported and actual perioperative VTE chemoprophylaxis is associated with significantly increased risk of VTE. Further understanding of the system characteristics associated with these practices may yield insights into how best to improve appropriate VTE chemoprophylaxis. Keywords Venous thromboembolism . VTE . Bariatric surgery . Metabolic surgery . Health services research . VTE prophylaxis
Introduction Venous thromboembolism (VTE) is the most common cause of mortality following bariatric surgery. Rates of deep vein * Amir A. Ghaferi [email protected] 1
Department of Surgery, University of Michigan, Ann Arbor, MI, USA
2
Department of Surgery, Henry Ford Health System, Detroit, MI, USA
3
Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
4
Institute for Healthcare Policy & Innovation, University of Michigan, 2800 Plymouth Avenue Building 16, Rm 140-E, Ann Arbor, MI 48109–2800, USA
thrombosis (DVT) and pulmonary embolism (PE) in the post-surgical setting may be as high as 5.4% and 6.4%, respectively [1–4]. Given these risks, VTE chemoprophylaxis is routinely recommended in the form of unfractionated heparin (UFH) or low molecular weight hepar
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