Venous Thromboembolism (VTE) Prophylaxis on Discharge Following Major Cancer Surgery in the Abdomen: Improving Compliance With National Guidelines

Abstract

Background Venous thromboembolism (VTE) prophylaxis in hospitalized patients, particularly those undergoing abdominal surgery for cancer, is critical to reducing the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE). Despite increased awareness, ensuring appropriate VTE prophylaxis post-discharge remains challenging. The National Institute for Health and Care Excellence (NICE) guidelines recommend prolonged prophylaxis in specific cases, yet compliance on discharge often falls short. Method A retrospective audit was conducted on 60 patients admitted for elective abdominal cancer surgery in a District General Hospital (DGH) from January to December 2023. This assessed compliance with VTE prophylaxis guidelines, both during admission and post-discharge. Following the first audit cycle, educational interventions for junior doctors, posters in relevant departments, and reminders in electronic patient records were implemented to enhance compliance. A second audit cycle was conducted over four months with 30 patients to evaluate the effectiveness of these interventions. Results Initial results showed 100% compliance with VTE assessments and inpatient prophylaxis but only 49.1% compliance with full 28-day post-discharge prophylaxis. Around 24.5% of patients received no further prophylaxis after discharge, while 20.8% exceeded the recommended duration. After the intervention, compliance with recommended VTE prophylaxis improved significantly, with 81.25% of patients completing the prescribed course and only 14.8% receiving inpatient-only prophylaxis. The number of patients exceeding 28 days of prophylaxis decreased from 20.8% to 3.7%. Overall, non-compliance fell from 50.9% to 18.5%. Conclusion Simple, targeted interventions, including education and reminders within electronic records, led to significant improvements in VTE prophylaxis compliance post-abdominal cancer surgery. Continued adherence to these strategies, alongside system-embedded reminders, is expected to sustain these improvements and further reduce VTE-related morbidity and mortality.

Keywords: colon resection; colorectal cancer; deep vein thrombosis (dvt); general surgery and colorectal surgery; postop complication; postoperative thromboprophylaxis; surgical practice; venous thromboembolism (vte).

Figure 1. Flow chart of patient inclusion and exclusion based on study criteria and prophylaxis administration, in the first cycle.

Figure 2. Flow chart of patient inclusion and exclusion based on study criteria and prophylaxis administration, in the second cycle.

Figure 3. VTE prophylaxis post-abdominal cancer surgery, comparing cycle 1 and cycle 2.

VTE: venous thromboembolism