Risk assessment and compliance with hospital guidelines for venous thromboprophylaxis after gynecological surgeries

Abstract

Background and objective: Venous thromboembolism after gynecological surgery is a major cause of morbidity and mortality. This study aimed to determine the venous thromboembolism risk profile of women who underwent gynecological surgery at a tertiary hospital and review the prescribed venous thromboembolism prophylaxis. Methods: An audit review study was conducted on 490 women who underwent major and minor gynecological surgeries at the Maternity Teaching Hospital, Erbil city, Kurdistan Region, Iraq, from 1st December 2019 to 31st December 2020, regarding their risk of developing postoperative venous thromboembolism using the 2013 modified Caprini venous thromboembolism risk assessment model to determine their risk and the correct thromboprophylaxis prescription. Results: According to appropriate thromboprophylaxis administration of low molecular weight heparin, it was administered to two-thirds of the women. It was sufficient in 33.1% of the women, and only 8.2% of the women received it for the correct duration. The probability of incorrect decision was higher for the major surgeries than for minor surgeries [odds ratio (OR) = 15.5; 95% confidence interval (95% CI) =3.01–80.1]. Moderate risk carried a much higher probability of an incorrect decision than low risk (OR = 196.8; 95%CI = 30.4–1270.5), whereas the association with high risk was not significant. When low molecular weight heparin was administered, there was a higher probability of a wrong decision than when low molecular weight heparin was not administered (OR = 26.4; 95%CI = 7.1–97.6). Conclusion: The gynecologists' adherence to venous thromboembolism prophylaxis after major and minor gynecological surgeries at the hospital mandates more training for all healthcare providers. Keywords: Audit; Thromboprophylaxis; Caprini RAM 2013; Adherence to guidelines; Gynecological surgery.