Quality of venous thromboembolism prophylaxis in patients undergoing oncologic surgery

Jason D Wright, Sharyn N Lewin, Monjri Shah, William M Burke, Shing M Lee, Xuming Sun, Thomas J Herzog
Annals of Surgery 2011, 253 (6): 1140-6

OBJECTIVE: We analyzed use of venous thromboembolism (VTE) prophylaxis in patients undergoing oncologic surgery and examined the influence of surgeon and hospital characteristics on prophylaxis.

BACKGROUND: Cancer patients undergoing surgery are at high-risk for VTE. Despite the risk of VTE, the use of prophylaxis is variable. Little is known about the patient, surgeon, and hospital characteristics that influence the use of prophylaxis.

METHODS: Patients undergoing oncologic surgery from 2003 to 2007 and recorded in the Perspective database were analyzed. Surgeons and hospitals were stratified into volume-based tertiles for analysis. The effects of surgeon and hospital volume on use of any prophylaxis and pharmacologic prophylaxis were examined using generalized estimating equations adjusted for confounding variables.

RESULTS: In the cohort of 252,950 patients, some form of prophylaxis was given to 79% of patients whereas 46% received pharmacologic prophylaxis. The rate of VTE prophylaxis was 82.7% at high-volume hospitals compared with 75.6% at low-volume facilities (P < 0.0001). After adjustment for case mix and surgeon volume, the odds ratio for receipt of prophylaxis at high- versus low-volume hospitals was 1.40 (95% CI, 1.20-163). The odds ratio for prophylaxis for patients treated by high-volume surgeons was 1.35 (95% CI, 1.14-160) after adjusting for case mix and hospital volume. The rate of pharmacologic VTE prophylaxis was 53.1% in high-volume hospitals versus 38.8% in low-volume hospitals (P < 0.0001). Treatment at a high-volume hospital was associated with an odds ratio of 1.42 (95% CI, 1.22-1.66) for pharmacologic prophylaxis whereas the odds ratio for pharmacologic prophylaxis for patients treated by high-volume surgeons was 1.28 (95% CI, 1.08-1.51).

CONCLUSION: VTE prophylaxis is underutilized in patients undergoing oncologic surgery. Patients treated by high-volume surgeons and at high-volume hospitals are more likely to receive appropriate prophylaxis.

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