Quality of perioperative venous thromboembolism prophylaxis in gynecologic surgery

Jason D Wright, Dawn L Hershman, Monjri Shah, William M Burke, Xuming Sun, Alfred I Neugut, Sharyn N Lewin, Thomas J Herzog
Obstetrics and Gynecology 2011, 118 (5): 978-86

OBJECTIVE: To estimate the use of venous thromboembolism prophylaxis in women undergoing gynecologic surgery and to estimate the patient, physician, and hospital characteristics associated with guideline-based prophylaxis.

METHODS: A commercial database was used to examine women who underwent major gynecologic surgery from 2000 to 2010. Venous thromboembolism prophylaxis was classified as none, mechanical, pharmacologic, or a combination. Multivariable logistic regression models of factors associated with any prophylaxis and pharmacologic and combination prophylaxis were developed.

RESULTS: We identified a total of 738,150 women who underwent gynecologic surgery. No prophylaxis was given to 292,034 (39.6%) women, whereas 344,068 (46.6%) received mechanical prophylaxis, 40,268 (5.5%) pharmacologic prophylaxis, and 61,780 (8.4%) combination prophylaxis. Use of prophylaxis increased from 53.5% in 2000 to 67.5% in 2010. Prophylaxis was more commonly used in older women, those with Medicare, women with more comorbidities, white women, patients treated at rural hospitals, teaching facilities, and in patients treated by high-volume surgeons and at high-volume centers (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.23-1.27, P<.05 for all). Factors associated with use of pharmacologic prophylaxis included advanced age, white race, noncommercial insurance, later year of diagnosis, greater comorbidity, treatment at large hospitals and urban facilities, and treatment by a high-volume surgeon (OR 1.47, 95% CI 1.44-1.49).

CONCLUSION: Despite clear recommendations from evidence-based guidelines, venous thromboembolism prophylaxis is underused in women undergoing gynecologic surgery.

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