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Multicenter Study
. 2020 Dec;90(12):2441-2448.
doi: 10.1111/ans.16374. Epub 2020 Oct 30.

Variations in practice of thromboprophylaxis across general surgical subspecialties: a multicentre (PROTECTinG) study of elective major surgeries

David S Liu  1   2   3 , Sean Stevens  1   4 , Enoch Wong  5 , Jonathan Fong  1 , Krinal Mori  1   2   6 , Nicola Fleming  1 , Pith Soh Beh  2 , Amy Crowe  5 , Tess Howard  1 , Maeve Slevin  2 , Anshini Jain  5 , Anna Sonia Gill  1 , Sharon Lee  2 , Wael Jamel  1 , Simon Bennet  1 , Chi Chung  5 , Salena Ward  5   7 , Vijayaragavan Muralidharan  1   4 ; VERITAS collaborative  1
Affiliations
Multicenter Study

Variations in practice of thromboprophylaxis across general surgical subspecialties: a multicentre (PROTECTinG) study of elective major surgeries

David S Liu et al. ANZ J Surg. 2020 Dec.

Abstract

Background: Despite guidelines recommending perioperative thromboprophylaxis for patients undergoing general surgery, we have observed significant variations in its practice. This may compromise patient safety. Here, we quantify the heterogeneity of perioperative thromboprophylaxis across all major general surgical operations, and place them in relation to their risk of bleeding and venous thromboembolism.

Methods: Retrospective review of all elective major general surgeries performed between 1 January 2018 and 30 June 2019 across seven Victorian hospitals was conducted.

Results: A total of 5912 patients who underwent 6628 procedures were reviewed. Significant heterogeneity was found in the use of chemoprophylaxis, timing of its initiation, type of anticoagulant administered and application of extended chemoprophylaxis. These variations were observed within the same procedure, and between different surgeries and subspecialties. Contrastingly, there was minimal heterogeneity with the use of mechanical thromboprophylaxis. Oesophago-gastric, liver and colorectal cancer resections had the highest thromboembolic risk. Breast, oesophago-gastric, liver, pancreas and colon cancer resections had the highest bleeding risk.

Conclusion: Perioperative chemoprophylaxis across general surgery is highly variable. This study has highlighted key areas of variance. Our findings also enable surgeons to compare their practices, and provide baseline data to inform future efforts towards optimizing thromboprophylaxis for general surgical patients.

Keywords: bleeding; general surgery; thromboembolism; thromboprophylaxis.

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References

    1. Australian Commission on Safety and Quality in Health Care. Venous thromboembolism prevention clinical care standard. 2020. [Cited 25 June 2020.] Available from URL: https://www.safetyandquality.gov.au/publications-and-resources/resource-...
    1. The Australian and New Zealand Working Party on the Management and Prevention of Venous Thromboembolism. Prevention of venous thromboembolism, best practice guidelines for Australia and New Zealand, 4th edn. 2007. [Cited 28 Mar 2020.] Available from URL: https://umbraco.surgeons.org/media/1621/vte_guidelines.pdf
    1. Liu DS, Wong E, Fong J et al. Perioperative thromboprophylaxis is highly variable in general surgery: results from a multicentre survey. ANZ J. Surg. 2020. https://doi.org/10.1111/ans.16223.
    1. Liu DS, Stevens S, Wong E et al. Pre-operative and intra-operative chemical thromboprophylaxis increases bleeding risk following elective cholecystectomy: a multicentre (PROTECTinG) study. ANZ J. Surg. 2020. https://doi.org/10.1111/ans.15998.
    1. Pannucci CJ, Basta MN, Fischer JP, Kovach SJ. Creation and validation of a condition-specific venous thromboembolism risk assessment tool for ventral hernia repair. Surgery 2015; 158: 1304-13.

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