Practices in the Prevention of Venous Thromboembolism

Objective: The objective of this study was to determine the proportion of Massachusetts Medicare patients who received prophylaxis for venous thromboembolism following colectomy, hysterectomy, or total hip arthroplasty. Sample frame: All 90 Massachusetts acute care hospitals. Time frame: 1 April through 30 September, 1994. Target population: Patients discharged with an International Classification of Disease (ICD-9-CM) discharge diagnostic code (recorded in the Massachusetts Medicare Claims Database) for colectomy, hysterectomy, or total hip arthroplasty were used to identify the target patient population. Sample population: 1,397 patients randomly selected from the target population, including 467 total hip arthroplasties, 474 colectomies, and 456 hysterectomies. Data extraction: Medical records were reviewed by trained nurse abstractors who collected information on the use of prophylaxis for venous thromboembolism. Results: Prophylaxis for venous thromboembolism was employed by surgeons practicing in Massachusetts hospitals in 93% of total hip arthroplasty cases (regional variation 85-98%), 84% of colectomies (regional variation 57-93%), 66% of hysterectomies (regional variation 35-71%), and in 87% of the subset of 111 hysterectomies with malignancy (regional variation 25-100%). Conclusions: The results of this statewide study demonstrated significant regional and hospital-to-hospital variation in the use of prophylaxis for venous thromboembolism following major surgery. A lower rate of prophylaxis use was observed in hospitals with fewer than 200 beds and in hospitals that did not have teaching programs. Hospitals with below-average rates of prophylaxis were targeted for intensive quality improvement interventions.