Rates of Guideline-Recommended Venous Thromboembolism Prophylaxis in Surgical Patients among US Hospitals: A Real-World Analysis.

Background: In spite of the wide availability of evidence-based guidelines for the thromboprophylaxis of venous thromboembolism (VTE), the burden of this syndrome in the US remains high. The improvement of VTE prophylaxis use is a major healthcare goal for the US Joint Commission. We therefore assessed the real-world rate of appropriate thromboprophylaxis in at-risk, hospitalized surgical patients, in accordance with the 7^th American College of Chest Physicians guidelines, in hospitals across the US.

Methods: Premier’s Perspective™ inpatient data were used to assess the rate of VTE prophylaxis in discharges undergoing surgical procedures. Discharges aged ≥ 40 years, with a length of stay ≥ 6 days, and without contraindications for anticoagulation were included in the analysis. Appropriate thromboprophylaxis was determined by comparing the daily use of anticoagulants and compression devices, dosage, and duration of prophylaxis with the 7^th ACCP recommendations for each surgical procedure. A number of other factors, including geographic region, hospital type and size, and admission source were also investigated for potential influence on the levels of appropriate thromboprophylaxis.

Results: A total of 116,915 surgical discharges from 1,574,320 discharges between January 2002 and December 2006 met the inclusion criteria and were included in this study. VTE prophylaxis rates varied among surgical groups, with an overall mean of only 14.4% of discharges receiving appropriate prophylaxis. Appropriate prophylaxis rates were 68.0% in orthopedic surgery (n = 2,404), 14.9% in vascular surgery (n = 54,170), 13.9% in general surgery (n = 39,072), 12.3% in laproscopic surgery (n = 14,905), 6.5% in gynecological surgery (n = 610), 5.2% in urological surgery (n = 2,640), and 4.0% in neurological surgery (n = 3,114).

Conclusion: There is a significant gap in adherence to the ACCP guidelines in surgical patients, with on average approximately 85% of surgical patients not receiving evidence-based VTE thromboprophylaxis. Although the rates of appropriate prophylaxis for orthopedic surgery patients were considerably higher than in other surgical categories, one-third of these patients still did not receive appropriate prophylaxis. As performance measures evaluating hospital’s VTE thromboprophylaxis use are rolled out across the US, it is important for individual hospitals to increase their awareness and use of the ACCP recommendations for VTE thromboprophylaxis.