Zachary M Borab1, Michael A Lanni2, Michael G Tecce2, Christopher J Pannucci3, John P Fischer2. 1. Wyss Department of Plastic and Reconstructive Surgery, New York University School of Medicine, New York. 2. Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia. 3. Division of Plastic Surgery, School of Medicine, University of Utah, Salt Lake City.
Abstract
Importance: Health care professionals do not adequately stratify risk or provide prophylaxis for venous thromboembolism (VTE) among surgical patients. Computerized clinical decision support systems (CCDSSs) have been implemented to assist clinicians and improve prophylaxis for VTE. Objective: To evaluate the effect of implementing CCDSSs on the ordering of VTE prophylaxis and the rates of VTE. Data Sources: PubMed, MEDLINE via OVID, EMBASE via OVID, Scopus, Cochrane CENTRAL Register of Controlled Trials, and clinicaltrials.gov were searched in June 2016 for articles published in English from October 15, 1991, to February 16, 2016. A manual search of references from relevant articles was also performed. Study Selection: Clinical trials and observational studies among surgical patients comparing CCDSSs with VTE risk stratification and assistance in ordering prophylaxis vs routine care without decision support were included. Of the 188 articles screened, 11 (5.9%) were eligible for meta-analysis. Data Extraction and Synthesis: Meta-analysis of Observational Studies in Epidemiology guidelines were followed. Two reviewers extracted data and assessed quality independently. Main Outcomes and Measures: Rates of prophylaxis for VTE and VTE events. Random- and fixed-effects models were used to summarize odds ratios and risk ratios. Results: Eleven articles (9 prospective cohort trials and 2 retrospective cohort trials) comprising 156 366 individuals (104 241 in the intervention group and 52 125 in the control group) were included. The use of CCDSSs was associated with a significant increase in the rate of appropriate ordering of prophylaxis for VTE (odds ratio, 2.35; 95% CI, 1.78-3.10; P < .001) and a significant decrease in the risk of VTE events (risk ratio, 0.78; 95% CI, 0.72-0.85; P < .001). Conclusions and Relevance: Use of CCDSSs increases the proportion of surgical patients who were prescribed adequate prophylaxis for VTE and correlates with a reduction in VTE events.
Importance: Health care professionals do not adequately stratify risk or provide prophylaxis for venous thromboembolism (VTE) among surgical patients. Computerized clinical decision support systems (CCDSSs) have been implemented to assist clinicians and improve prophylaxis for VTE. Objective: To evaluate the effect of implementing CCDSSs on the ordering of VTE prophylaxis and the rates of VTE. Data Sources: PubMed, MEDLINE via OVID, EMBASE via OVID, Scopus, Cochrane CENTRAL Register of Controlled Trials, and clinicaltrials.gov were searched in June 2016 for articles published in English from October 15, 1991, to February 16, 2016. A manual search of references from relevant articles was also performed. Study Selection: Clinical trials and observational studies among surgical patients comparing CCDSSs with VTE risk stratification and assistance in ordering prophylaxis vs routine care without decision support were included. Of the 188 articles screened, 11 (5.9%) were eligible for meta-analysis. Data Extraction and Synthesis: Meta-analysis of Observational Studies in Epidemiology guidelines were followed. Two reviewers extracted data and assessed quality independently. Main Outcomes and Measures: Rates of prophylaxis for VTE and VTE events. Random- and fixed-effects models were used to summarize odds ratios and risk ratios. Results: Eleven articles (9 prospective cohort trials and 2 retrospective cohort trials) comprising 156 366 individuals (104 241 in the intervention group and 52 125 in the control group) were included. The use of CCDSSs was associated with a significant increase in the rate of appropriate ordering of prophylaxis for VTE (odds ratio, 2.35; 95% CI, 1.78-3.10; P < .001) and a significant decrease in the risk of VTE events (risk ratio, 0.78; 95% CI, 0.72-0.85; P < .001). Conclusions and Relevance: Use of CCDSSs increases the proportion of surgical patients who were prescribed adequate prophylaxis for VTE and correlates with a reduction in VTE events.
Authors: Lorenzo Moja; Koren H Kwag; Theodore Lytras; Lorenzo Bertizzolo; Linn Brandt; Valentina Pecoraro; Giulio Rigon; Alberto Vaona; Francesca Ruggiero; Massimo Mangia; Alfonso Iorio; Ilkka Kunnamo; Stefanos Bonovas Journal: Am J Public Health Date: 2014-10-16 Impact factor: 9.308
Authors: Nils Kucher; Sophia Koo; Rene Quiroz; Joshua M Cooper; Marilyn D Paterno; Boris Soukonnikov; Samuel Z Goldhaber Journal: N Engl J Med Date: 2005-03-10 Impact factor: 91.245
Authors: Susan R Kahn; David R Morrison; Jacqueline M Cohen; Jessica Emed; Vicky Tagalakis; Andre Roussin; William Geerts Journal: Cochrane Database Syst Rev Date: 2013-07-16
Authors: William H Geerts; David Bergqvist; Graham F Pineo; John A Heit; Charles M Samama; Michael R Lassen; Clifford W Colwell Journal: Chest Date: 2008-06 Impact factor: 9.410
Authors: Craig A Umscheid; Asaf Hanish; Jesse Chittams; Mark G Weiner; Todd E H Hecht Journal: BMC Med Inform Decis Mak Date: 2012-08-31 Impact factor: 2.796
Authors: Fernanda Fuzinatto; Fernando Starosta de Waldemar; André Wajner; Cesar Al Alam Elias; Juliana Fernándes Fernandez; João Luiz de Souza Hopf; Sergio Saldanha Menna Barreto Journal: J Bras Pneumol Date: 2013 Mar-Apr Impact factor: 2.624
Authors: Samuel W Ross; Kali M Kuhlenschmidt; John C Kubasiak; Lindsey E Mossler; Luis R Taveras; Thomas H Shoultz; Herbert A Phelan; Caroline E Reinke; Michael W Cripps Journal: JAMA Surg Date: 2020-06-01 Impact factor: 14.766
Authors: Radhika Rastogi; Courtney M Lattimore; J Hunter Mehaffey; Florence E Turrentine; Hillary S Maitland; Victor M Zaydfudim Journal: Surg Open Sci Date: 2022-04-26
Authors: Brian C Stagg; Joshua D Stein; Felipe A Medeiros; Barbara Wirostko; Alan Crandall; M Elizabeth Hartnett; Mollie Cummins; Alan Morris; Rachel Hess; Kensaku Kawamoto Journal: Ophthalmol Glaucoma Date: 2020-08-15
Authors: Susan R Kahn; David R Morrison; Gisèle Diendéré; Alexandre Piché; Kristian B Filion; Adi J Klil-Drori; James D Douketis; Jessica Emed; André Roussin; Vicky Tagalakis; Martin Morris; William Geerts Journal: Cochrane Database Syst Rev Date: 2018-04-24
Authors: Elisa G Liberati; Francesca Ruggiero; Laura Galuppo; Mara Gorli; Marien González-Lorenzo; Marco Maraldi; Pietro Ruggieri; Hernan Polo Friz; Giuseppe Scaratti; Koren H Kwag; Roberto Vespignani; Lorenzo Moja Journal: Implement Sci Date: 2017-09-15 Impact factor: 7.327
Authors: Susan R Kahn; Gisele Diendéré; David R Morrison; Alexandre Piché; Kristian B Filion; Adi J Klil-Drori; James Douketis; Jessica Emed; André Roussin; Vicky Tagalakis; Martin Morris; William Geerts Journal: BMJ Open Date: 2019-05-24 Impact factor: 2.692