BACKGROUND: Prevention of venous thromboembolism after colorectal surgery remains challenging. National guidelines

 

Abstract

BACKGROUND: Prevention of venous thromboembolism after colorectal surgery remains challenging. National guidelines endorse thromboembolism prophylaxis for 4 weeks after colorectal cancer resection. Expert consensus favors extended prophylaxis after inflammatory bowel disease surgery. Actual frequency of prescription after resection remains unknown.

OBJECTIVE: To assess prescription of extended, post-discharge venous thromboembolism prophylaxis after resection in Michigan.

DESIGN: Retrospective review of elective colorectal resections within a statewide collaborative receiving post-discharge, extended duration prophylaxis.

SETTING: This study was conducted between October 2015 and February 2018 at an academic center.

PATIENTS: A total of 5722 patients (2171 with colorectal cancer, 266 with inflammatory bowel disease, 3285 with other).

MAIN OUTCOME MEASURES: We compared prescription of extended, post-discharge prophylaxis over time, between hospitals, and by indication.

RESULTS: Of 5722 patients, 373 (6.5%) received extended duration prophylaxis after discharge. Use was similar between patients undergoing surgery for cancer (282/2171, 13.0%) or inflammatory bowel disease (31/266, 11.7%, p=0.54), but was significantly more common for both compared with patients with other indications (60/3285, 1.8%, p<0.001).<0.001))<0.05)300 beds) were significantly more likely to prescribe extended duration prophylaxis for all conditions (both p<0.001),

LIMITATIONS: This study was limited by lack of assessment of actual adherence, small number of observed venous thromboembolism events, small sample of inflammatory bowel disease patients, and restriction to state of Michigan.

CONCLUSIONS: Use of extended duration venous thromboembolism prophylaxis after discharge is increasing, but remains uncommon in most hospitals. Efforts to improve adherence may require quality implementation initiatives or targeted payment incentives. See Video Abstract at http://links.lww.com/DCR/B193.

PMID: 32109912 [PubMed - as supplied by publisher]

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