Venous thromboembolism prophylaxis in surgical patients: identifying a patient group to maximize performance improvement.

Background: Venous thromboembolism (VTE) in surgical patients is a cause of increased morbidity, mortality, and cost of care. Deep vein thrombosis (DVT) prophylaxis reduces the risk of DVT or pulmonary embolism (PE), but not to zero, which is concerning because DVT/PE is being considered a serious reportable event. A study was conducted in January-June 2009 to test the hypothesis that most surgical VTEs occur despite the patient's receiving appropriate prophylaxis.

Methods: All patients with a surgical diagnosis-related group (DRG) who had a documented DVT/PE in 2008 were retrospectively reviewed. Each VTE episode was characterized as occurring during the index admission for surgery or being present on admission (POA). DVT prophylaxis compliance was measured in all patients who had a procedure at the institution, a 454-bed university teaching hospital, and those patients were classified in terms of compliance with our VTE protocols. Class 1 patients had VTE protocols followed; Class 2 patients had contraindications to VTE protocols documented; Class 3 patients should have received VTE prophylaxis but did not; and Class 4 patients had contraindications to VTE prophylaxis that were not documented.

Results: Some 156 (6.3%) of 2,474 surgical patients had a DVT/PE in 2008; for the 144 patients with complete records for review, 89 were candidates for VTE prophylaxis. Some 77 of the 89 patients had received appropriate VTE prophylaxis or had documented contraindications to prophylaxis. Eleven (12.4%) patients who should have received VTE prophylaxis did not.

Conclusions: Compliance with VTE protocols continues to be less than 100%, and even when patients adhere to existing protocols VTE events continue to occur.