BACKGROUND: Venous thromboembolism (VTE) can be a devastating postoperative complication, with about one-third of VTEs occurring post-discharge. We previously retrospectively evaluated the Caprini VTE risk assessment model (RAM) in postoperative lung and esophageal cancer patients, demonstrating that "high risk" patients were more likely to have a postoperative VTE. In this study, we sought to implement the RAM protocol in thoracic surgical patients to evaluate adherence, safety, and VTE outcomes. STUDY DESIGN: This prospective cohort study at a large safety net hospital included all surgically treated patients within the thoracic surgery division beginning in July 2014. Per RAM protocol, patients with high risk scores were prescribed a total of 30 days of postoperative daily enoxaparin prophylaxis, and moderate risk patients received a total of 10 postoperative days. Adherence and outcome audits were conducted. RESULTS: A total of 126 patients were included for analysis. Provider adherence to RAM score calculation was 99.2% (125 of 126), with appropriate post-discharge prophylaxis prescribed in 96.0% of cases. Twenty-four patients scored high risk (19.2%), 60 were moderate risk (48.0%), and 41 scored low risk (32.8%). Patient adherence to post-discharge enoxaparin prophylaxis was 97.2%. The overall VTE rate was 2.3%, with no post-discharge VTEs or adverse bleeding events. CONCLUSIONS: Implementation of a VTE risk assessment protocol with extended course prophylaxis in high risk patients is safe and feasible for providers and thoracic surgical patients at a large safety net institution with a diverse patient population. Follow-up studies are needed to assess efficacy of the RAM in this surgical population.
BACKGROUND:Venous thromboembolism (VTE) can be a devastating postoperative complication, with about one-third of VTEs occurring post-discharge. We previously retrospectively evaluated the Caprini VTE risk assessment model (RAM) in postoperative lung and esophageal cancerpatients, demonstrating that "high risk" patients were more likely to have a postoperative VTE. In this study, we sought to implement the RAM protocol in thoracic surgical patients to evaluate adherence, safety, and VTE outcomes. STUDY DESIGN: This prospective cohort study at a large safety net hospital included all surgically treated patients within the thoracic surgery division beginning in July 2014. Per RAM protocol, patients with high risk scores were prescribed a total of 30 days of postoperative daily enoxaparin prophylaxis, and moderate risk patients received a total of 10 postoperative days. Adherence and outcome audits were conducted. RESULTS: A total of 126 patients were included for analysis. Provider adherence to RAM score calculation was 99.2% (125 of 126), with appropriate post-discharge prophylaxis prescribed in 96.0% of cases. Twenty-four patients scored high risk (19.2%), 60 were moderate risk (48.0%), and 41 scored low risk (32.8%). Patient adherence to post-discharge enoxaparin prophylaxis was 97.2%. The overall VTE rate was 2.3%, with no post-discharge VTEs or adverse bleeding events. CONCLUSIONS: Implementation of a VTE risk assessment protocol with extended course prophylaxis in high risk patients is safe and feasible for providers and thoracic surgical patients at a large safety net institution with a diverse patient population. Follow-up studies are needed to assess efficacy of the RAM in this surgical population.
Authors: Michelle B Mulder; Kenneth G Proctor; Evan J Valle; Alan S Livingstone; Dao M Nguyen; Robert M Van Haren Journal: World J Surg Date: 2019-12 Impact factor: 3.352
Authors: Peter A Gold; Terence Y Ng; Josephine R Coury; Luke J Garbarino; Nipun Sodhi; Michael A Mont; Giles R Scuderi Journal: J Orthop Date: 2020-07-23
Authors: Gu-Ha A-Lai; Yun-Ke Zhu; Gang Li; Me-Wu-Jia Mai-Ji; Han-Yu Deng; Jun Luo; Ze-Guo Zhuo; Xu Shen; Yi-Dan Lin Journal: Ann Transl Med Date: 2019-03