Abstract
<h3>Objectives:</h3> To evaluate implementation of a venous thromboembolism (VTE) prophylaxis algorithm on adherence to evidence-based guidelines including the rate of administration of preoperative heparin and the overall VTE rate on the gynecologic-oncology service at a single institution. <h3>Methods:</h3> Prior to 2018, no consensus VTE prophylaxis protocol existed on the gynecologic oncology service at the authors' academic institution. ACOG and Chest guidelines were used to modify a published gynecology VTE risk algorithm. Interventions to improve preoperative heparin administration included: ID badge algorithm attachments, placards in operating rooms, integration of algorithm into the H&P template and order set in the electronic medical record. Surgical, anesthesia, and nursing teams were contacted to investigate cases in which pre-operative heparin was indicated but not administered. In 2020, three retrospective cohorts of 100 patients each (2016-2017, 2018, and 2019) spanning the pre-, intra- and post-QI implementation periods were consecutively identified using cancer and radical surgery-specific CPT codes to evaluate performance in these highest risk cases; cohorts were filled to 100 using randomly selected additional gynecologic oncology cases. Perioperative heparin administration and VTE rates were evaluated. Proportions were compared using chi-square tests; continuous factors were compared using ANOVA or Kruskal-Wallis tests. <h3>Results:</h3> A total of 3 retrospective surgical cohorts totaled 312 patients (2016-2017: 100, 2018: 110, 2019: 102); mean age was 60. Indications for surgery were ovarian (36.9%), endometrial (35.6%), and cervical cancer (11.9%), and benign (15.6%). Minimally invasive cases comprised 52% of the cohort in 2016-7, 42.7% in 2018, and 42.2% in 2019 (p=0.070). The mean (SD) number of risk factors for VTE was similar across cohorts (2016-2017: 3.7 (1.6), 2018: 3.6 (1.4), 2019: 3.5 (1.7); p=0.87). When retrospectively applied to all surgical cases reviewed, adherence to VTE algorithm improved from 31.0% in 2016-2017 to 69.1% in 2018 and 82.4% in 2019 (p<0.001). Appropriate administration of pre-operative heparin in high-risk patients improved over time with each cohort: 34.8% in 2016-2017, 83.3% in 2018, and 92.5% in 2019 (p<0.001). The VTE rate within 30 days of surgery was 5.0% in 2016-2017, 3.6% in 2018, and 1.0% in 2019; this was not statistically significant (p=0.25). Adverse event rates were not significantly different between cohorts; peri-operative blood transfusion was 17.0% in 2016-7, 16.4% in 2017, and 10.8% in 2019 (p=0.385). Superficial and subfascial surgical site infections, hematomas, and vaginal cuff dehiscence were rare across cohorts. <h3>Conclusions:</h3> Implementation of an individualized perioperative VTE prophylaxis algorithm has resulted in improved adherence to evidence-based prophylaxis guidelines and improvement in rates of preoperative heparin administration; observed trends in VTE rates have not achieved significance.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
