An assessment of surgical thromboprophylaxis in a tertiary care center

Venous thromboembolism (VTE) is a frequent surgical complication. The American College of Chest Physicians (ACCP) recommends implementation of pharmacologic thromboprophylaxis according to surgery type and VTE risk factors. We conducted a retrospective cohort study of surgical admissions to determine the rate and predictors of use and appropriate use of thromboprophylaxis as defined by the 2004 ACCP guidelines and to determine the risk of postoperative VTE.

Using data from an administrative health care database of the Centre Hospitalier Universitaire de Sherbrooke in the province of Quebec, we assembled a cohort of all consecutive surgical admissions in 2006 that met ACCP criteria for pharmacologic thromboprophylaxis and assessed rates of thromboprophylaxis presence and appropriateness. Multiple logistic regression was used to determine characteristics associated with thromboprophylaxis prescription. The incidence of postoperative VTE was assessed at 3 months.

Of 2286 surgical admissions that met criteria for pharmacologic thromboprophylaxis, 81% received thromboprophylaxis and, of these, 31% received appropriate thromboprophylaxis as per ACCP guidelines. Male sex, age below 40 years, and short-duration hospitalization were significantly associated with absent and inappropriate thromboprophylaxis. Cancer diagnosis and heart failure within 3 months preceding surgery were protective against inappropriate thromboprophylaxis (OR 0.43, 95% CI [0.33-0.57] and 0.43 [0.26-0.70], respectively). At 3 months following surgery, 27 patients (1.2%) developed VTE. Patients who developed VTE were more likely to have had a previous VTE than patients who did not develop a VTE (P < .0001).

Targeted recommendations, in particular concerning male patients with short duration hospitalization, may improve thromboprophylaxis compliance and appropriateness rates.