Evaluation of Perioperative Venous Thromboembolism Prophylaxis after Minimally Invasive Hysterectomy

Abstract

Study Objective Evaluate appropriate utilization of postoperative venous thromboembolism prophylaxis using recommendations from the Modified Caprini Risk model. Design We performed an IRB-approved retrospective cohort study. Setting Academic medical institution. Patients or Participants Patients who underwent a robotic -assisted total laparoscopic hysterectomy and were admitted for postoperative care with the gynecologic oncology service from January 2019 to May 2020. Interventions Patients were stratified into VTE risk categories using the Modified Caprini Risk model. We analyzed VTE prophylaxis received and trends in following recommendations. Measurements and Main Results A total of 171 patients met inclusion criteria and were stratified into risk categories – 2 low risk, 42 moderate risk, 45 high risk, 82 high risk with cancer. Intermittent pneumatic compression (IPC) devices were used in 50%, 85.7%, 88.9%, and 90.2% of patients in the low, moderate, high, and high risk with cancer categories. Immediate chemoprophylaxis was used in 45.2%, 40%, and 63.4% of patients in the moderate, high, and high risk with cancer categories. Extended chemoprophylaxis was used in 2.4%, 8.9%, and 9.8% of patients in the moderate, high, and high risk with cancer categories. Patients were more likely to receive immediate and extended chemoprophylaxis with increasing risk (P=.001 and P=.02). Conclusion Our analyses indicate we appropriately utilize IPC devices with the majority of minimally invasive hysterectomies on the gynecologic oncology service. However, identification of high-risk patients and use of pharmacologic interventions to prevent VTE are lacking. These findings highlight an opportunity for a quality improvement initiative on perioperative VTE prophylaxis. Evaluate appropriate utilization of postoperative venous thromboembolism prophylaxis using recommendations from the Modified Caprini Risk model. We performed an IRB-approved retrospective cohort study. Academic medical institution. Patients who underwent a robotic -assisted total laparoscopic hysterectomy and were admitted for postoperative care with the gynecologic oncology service from January 2019 to May 2020. Patients were stratified into VTE risk categories using the Modified Caprini Risk model. We analyzed VTE prophylaxis received and trends in following recommendations. A total of 171 patients met inclusion criteria and were stratified into risk categories – 2 low risk, 42 moderate risk, 45 high risk, 82 high risk with cancer. Intermittent pneumatic compression (IPC) devices were used in 50%, 85.7%, 88.9%, and 90.2% of patients in the low, moderate, high, and high risk with cancer categories. Immediate chemoprophylaxis was used in 45.2%, 40%, and 63.4% of patients in the moderate, high, and high risk with cancer categories. Extended chemoprophylaxis was used in 2.4%, 8.9%, and 9.8% of patients in the moderate, high, and high risk with cancer categories. Patients were more likely to receive immediate and extended chemoprophylaxis with increasing risk (P=.001 and P=.02). Our analyses indicate we appropriately utilize IPC devices with the majority of minimally invasive hysterectomies on the gynecologic oncology service. However, identification of high-risk patients and use of pharmacologic interventions to prevent VTE are lacking. These findings highlight an opportunity for a quality improvement initiative on perioperative VTE prophylaxis.