Defects in Processes of Care for Pharmacologic Prophylaxis Are Common Among Neurosurgery Patients Who Develop In-Hospital Postoperative Venous Thromboembolism

• Published in: World neurosurgery Vol. 134; pp. e664 - e671
• Main Authors: Yun, Regina, Sciubba, Daniel M., Lewin, John J., Streiff, Michael B., Haut, Elliott R., Lau, Brandyn D., Shermock, Kenneth M., Kraus, Peggy S., Popoola, Victor O., Dalpoas, Stacy Elder
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2020
• Subjects: Aged; Algorithms; Anticoagulants - therapeutic use; Chemoprevention; Enoxaparin - therapeutic use; Female; Guideline Adherence; Heparin; Heparin - therapeutic use; Humans; Intensive Care Units; Length of Stay; Male; Middle Aged; Neurosurgery; Neurosurgical Procedures; Perioperative; Postoperative Complications - prevention & control; Practice Guidelines as Topic; Practice Patterns, Physicians; Process Assessment, Health Care; Pulmonary Embolism - prevention & control; Retrospective Studies; Risk Assessment; Time Factors; Venous thromboembolism; Venous Thromboembolism - prevention & control; Venous Thrombosis - prevention & control; VTE algorithm; VTE prophylaxis; Perioperative; DVT; VTE prophylaxis; UFH; VTE; VTE algorithm; Heparin; Neurosurgery; IQR; Venous thromboembolism
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.10.163

Venous thromboembolism (VTE) is a cause of considerable morbidity and mortality in hospitalized patients. An evidence-based algorithm was developed and implemented at our institution to guide perioperative VTE prophylaxis management.
We evaluated compliance with prescription of risk-appropriate VTE prophylaxis and administration of prescribed VTE prophylaxis in neurosurgery patients.
This was a retrospective analysis of postoperative neurosurgery patients at a single institution with subsequent diagnosis of acute VTE during their inpatient stay. Descriptive statistics were used to characterize pharmacologic VTE prophylaxis and prescribing patterns.
The incidence of VTE in our neurosurgery population was 248/13,913 (1.8%). Of the 123 patients, the median time to VTE diagnosis was 96 hours after surgery (interquartile range [IQR], 58–188 hours). A total of 108 patients (87.8%) were prescribed risk-appropriate VTE prophylaxis, among whom 61 (56.5%) received all doses as prescribed. Fifty-three patients (43.1%) missed ≥1 dose of prescribed prophylaxis and the median missed doses was 3 (IQR, 0–3). The median time to first dose of pharmacologic VTE prophylaxis was 42 hours (IQR, 28–51). More than half (n = 63, 51.2%) of the VTE risk assessments contained ≥1 error, of which 15 (23.8%) would have resulted in a change in recommendation.
Our evidence-based VTE prophylaxis algorithm was not accurately completed in more than half of patients. Many patients who developed VTE had a defect in their VTE prophylaxis management during their inpatient stay. Research to improve optimal VTE prevention practice in neurosurgery patients is needed.