L. S. Anewenah1, A. Nadler1, K. Krauss1, R. Uzzo1, E. Sigurdson1, J. Farma1 1Fox Chase Cancer Center,Department Of Surgical Oncology,Philadelphia, PA, USA
Introduction:
The purpose of the study was to examine the administration and complications of pre-operative chemical VTE prophylaxis(pVTE) at an institutional level amongst complex surgical oncology patients to help inform policy creation.
Methods:
A retrospective study at a tertiary referral cancer center was performed. Data of all patients undergoing surgery in 2014 were analyzed for the use of preoperative chemical VTE prophylaxis. We did not include analysis of postoperative VTE prophylaxis in this study. Groups were subdivided by inpatient and outpatient status. Chi-square tests were performed.
Results:
Of the 4,954 procedures performed during 2014, 1,554 received chemical prophylaxis in the form of subcutaneous Heparin 5000 units prior to the start of the procedure. Overall administration rate in the institution was 31%. Inpatients had a significantly higher administration rate compared to outpatients (47% vs. 16%, OR 4.87, CI 4.26-5.57, p < 0.001). By service, pVTE prophylaxis administration was observed in 53.1%, 40.2%, 27.5%, 20.4%, 16.3%, 13.6% and 4.9% for Urologic Oncology, General Surgical Oncology, Gynecological Oncology, Head and Neck Oncology, Breast Oncology, Plastic and Reconstructive Surgery, and Thoracic Oncology, respectively. Of the 27 surgical patients who developed postoperative VTE, 10 had received pVTE prophylaxis and 17 had not (OR 1.29, CI 0.59-2.82, p=0.524). Return to the operating room for bleeding was observed in 0.8% of all surgical patients who had received pVTE prophylaxis compared to 0.2% of patients who had not (OR 3.77, CI 1.48-9.60, p = 0.003). For inpatient surgical patients, however, 0.9% who had received pVTE prophylaxis returned to the operating room for bleeding whereas 0.4% patients without prophylaxis did (OR 2.45, CI 0.65-7.06, p = 0.087).
Conclusion:
Given that less than a third of surgical patients received pVTE prophylaxis, further analysis of the data is needed to determine if other forms of VTE prophylaxis was used, and if not, factors associated with no administration. Such analysis will help develop an institutional and potentially nationwide policy change and quality improvement efforts to address pVTE for complex surgical oncology patients.
