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Area of Science:

  • Oncology
  • Vascular Surgery
  • Surgical Quality Improvement

Background:

  • Venous thromboembolism (VTE) is a major complication after cancer surgery.
  • Current guidelines recommend VTE prophylaxis starting before surgery and continuing for 7-10 days postoperatively.
  • Adherence to these guidelines in abdominal cancer surgery is not well-understood.

Purpose of the Study:

  • To assess the variation in thromboprophylaxis practices for abdominal cancer surgery.
  • To evaluate the adherence to VTE prophylaxis guidelines in a regional surgical collaborative.
  • To identify potential barriers to prophylaxis administration.

Main Methods:

  • Retrospective study of 2967 patients undergoing abdominal cancer surgery across 52 hospitals (July 2012-September 2013).
  • Detailed collection of perioperative and postoperative pharmacologic and mechanical thromboprophylaxis data.
  • Hospital surveys to identify practice variations and barriers.

Main Results:

  • Only 40.4% of eligible patients received perioperative pharmacologic thromboprophylaxis.
  • 25.3% of high-risk patients received inadequate postoperative prophylaxis (dose or duration).
  • Significant hospital variation in perioperative thromboprophylaxis rates (0-96.1%) was observed.

Conclusions:

  • Less than half of patients undergoing abdominal cancer surgery receive perioperative thromboprophylaxis.
  • Wide variation in thromboprophylaxis utilization exists among hospitals.
  • Current practices fall short of evidence-based guidelines for VTE prevention.