Navigation Links
Surgeons report fewer postoperative blood clots using risk-based preventive measures
Date:6/2/2014

Chicago (June 2, 2014): Surgery patients are much less likely to get a blood clot in the lower extremities or lungs if they receive preventive treatment based on their individual clotting risk, in addition to walking soon after the operation. Results from a surgical quality improvement study, appearing in the June issue of the Journal of the American College of Surgeons, indicate that the odds of this common and potentially life-threatening postoperative complication steadily declined after the implementation of a multicomponent prevention program in a hospital's department of surgery.

Researchers at Boston Medical Center, Boston, Mass., reported that they lowered the frequency of deep venous thrombosesblood clots in a deep vein, usually in a lower extremityby 84 percent two years after the prevention efforts began, compared with the results two years before the program. The occurrence of pulmonary emboli, or blood clots that travel to the lungs, fell by 55 percent in the same period, according to study authors.

"We are encouraged by the success in reducing the frequency of these devastating events among our patients by implementing this prevention program," said co-investigator David McAneny, MD, FACS, vice chair of surgery at Boston Medical Center. Surgery patients have an increased risk of developing these blood clots, collectively known as venous thromboembolism (VTE). Pulmonary emboli can leave patients with pulmonary hypertension, which is high blood pressure in the arteries of the lungs. Deep venous thromboses can lead to debilitating swelling and chronic pain of the affected limb.

Before this study, Dr. McAneny and colleagues found that their large medical center had higher-than-expected rates of postoperative VTE, when their outcomes were compared with other hospitals while adjusting for severities of illness. They obtained their information through the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, the leading nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care in hospitals.

"ACS NSQIP was highly valuable in helping us realize the need for improvement in this area," Dr. McAneny said. "We then wanted to make sure the right patients were getting the right prophylaxispreventive treatmentespecially those at high risk for VTE." Among the many risk factors for VTE are older age, obesity, smoking, confinement to bed, a personal or family history of deep venous thromboses or pulmonary emboli, and a long operation.

Based on scientific evidence and national practice guidelines, the researchers developed a VTE prevention program that scored and totaled patients' individual risk factors. They then tested the program in all patients undergoing general surgery and vascular surgery procedures at their hospital.

Initially, there was an emphasis on early postoperative mobilizationgetting patients up and walking three times a day, starting on the day of the operation when possible. The program later included these additional components:

  • Standardized risk assessment using five categories of VTE risk based on scores of 0 (lowest risk) to more than 8 (highest risk)*

  • Individualized, risk-based prophylaxis involving inflatable pressure boots and/or low doses of anticoagulation medications, commonly called blood thinners

  • Electronic physician orders that specified early mobilization, the requirement to score the patient's VTE risk, and the score-based appropriate preventive treatment along with the suggested duration of prophylaxis in the hospital and, for high-risk patients, continuing at home

  • Patient education to explain the importance of preventing blood clots

Surgeons and their teams received mandatory electronic reminders regarding VTE prophylaxis before and after the operation and when the patient was discharged from the hospital. They could choose to opt out of the recommendation for preventive medication but needed to specify why. The researchers monitored the level of adherence to the automated recommendations.

Using the NSQIP database, the investigators tracked the occurrences of VTE in patients who underwent general surgery or vascular surgery procedures during the two calendar years before and then after implementing the electronic prevention program in February 2011.

Before the program was in place, the odds of a patient having a VTE after a general or vascular surgery procedure was 3.4 times greater than expected, when adjusted for patient risk, the authors reported. Two years after the program began, the risk of developing a VTE was less than one would expect (odds ratio of 0.94) according to Dr. McAneny. In that four-year period, the reported frequency of pulmonary emboli (lung clots) dropped from 1.1 percent of 1,569 patients to 0.5 percent of 1,323 patients. Meanwhile, the frequency of

DVT (limb clots) declined from 1.9 percent of 1,569 patients to 0.3 percent of 1,323 patients.

In addition, he said surgeons' adherence to ordering the recommended prophylaxis was high. Compliance rates ranged from 100 percent for patients at low or moderate risk for a VTE to 77 percent for patients in the highest risk category. Even when patients at highest risk did not receive prevention in accordance with the recommended measures, the electronic records contained an explanation for not using blood thinners (drug allergy, active bleeding, risk of hemorrhage outweighing risk of VTE, etc.).

Dr. McAneny attributed the success of their prevention efforts to the combination of early ambulation and individualized risk assessment and prophylaxis.

He said their VTE prevention program may serve as a model for other medical centers.


'/>"/>

Contact: Sally Garneski
pressinquiry@facs.org
312-202-5409
American College of Surgeons
Source:Eurekalert

Related medicine news :

1. Clinical news alert from the American Academy of Orthopaedic Surgeons
2. NYU Langone experts present research, clinical advances at neurosurgeons meeting
3. Slicing mitotic spindle with lasers, nanosurgeons unravel old pole-to-pole theory
4. Clinical news alert: Journal of the American Academy of Orthopaedic Surgeons May highlights
5. Surgeons Seek Repeal of Transplant Ban Between HIV-Positive People
6. Greater availability of neurosurgeons could reduce risk of death from motor vehicle accidents
7. Adding More Neurosurgeons Could Cut Traffic Deaths: Study
8. General surgeons identify postoperative complications posing strongest readmission risk
9. Young Surgeons May Be Easily Distracted
10. In US first, Johns Hopkins surgeons implant brain pacemaker for Alzheimers disease
11. General thoracic surgeons emerge as leading providers of complex, noncardiac thoracic surgery
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/19/2019)... ... February 19, 2019 , ... NCPDP announced ... advocate for patient engagement, will deliver the luncheon keynote on Tuesday, May ... of participatory medicine and empowering partnerships between patients and their medical providers to ...
(Date:2/19/2019)... ... February 18, 2019 , ... ... to test the PathO3Gen Solutions Footwear Sanitizing Stations to maximize infection control for ... to kill superbugs such as MRSA and C. difficile, which can be transmitted ...
(Date:2/19/2019)... ... February 19, 2019 , ... STAR Institute for Sensory ... occupational therapists beginning March 2019. The focus of the new program is to bring ... The new Group Supervision Programs will be held on Zoom for five weekly one-hour ...
(Date:2/16/2019)... ... , ... SilcSkin – silicone anti-wrinkle pad pioneer and creator of the original ... 2019 in the Neck and Decolleté category for the second time. The Decollette Pad ... the International Congress of Esthetics and Spa. Developed by two-time Emmy award winning make-up ...
(Date:2/14/2019)... ... February 14, 2019 , ... At ... launch of its Personal Cardiac Assistant (PCA 500), the only FDA-cleared, hospital quality, ... 4 can record single lead ECGs and identify arrhythmias, including atrial fibrillation or ...
Breaking Medicine News(10 mins):
(Date:2/16/2019)... ... February 15, 2019 , ... MDxHealth SA ... patient registries demonstrating the value of SelectMDx and ConfirmMDx for Prostate Cancer diagnosis, ... (ASCO GU), taking place in San Francisco, California from February 14-16, 2019. , ...
(Date:2/14/2019)... MISSION VIEJO, Calif. (PRWEB) , ... ... ... a privately-held spinal device company that focuses on developing and commercializing minimally-invasive, ... Amplify Surgical, Inc. , “The Amplify Surgical name better emphasizes our commitment ...
(Date:2/13/2019)... ... February 13, 2019 , ... ... opened their doors in November of 2013 and, to date, has been visited ... Peyronies Disease. With an over 90% success rate, The Louisville Men’s Clinic prides ...
Breaking Medicine Technology: