VTE Incidence Low, Largely Unchanged Despite Increase in Surgical Prophylaxis
13 Jun 2015
The incidence of venous thromboembolism (blood clot) complications after colorectal surgery was low and remained largely unchanged despite increased use of pre- and post-surgical prevention (prophylaxis) therapies, according to a report published online by JAMA Surgery. 1
Preventing venous thromboembolism (VTE) in hospitalized patients has been promoted as a patient safety priority by a multitude of agencies.
The Colorectal Writing Group for the Surgical Care and Outcomes Assessment Program-Comparative Effectiveness Research Translation Network (SCOAP-CERTAIN) Collaborative analyzed data for 16,120 patients who had colorectal surgery between 2006 and 2011 at 52 hospitals in Washington state to determine whether the incidence of VTE had changed along with evolving prophylaxis treatment patterns.
The study found the incidence of any VTE up to 90-days after surgery was 2.2 percent (360 of 16,120 patients) and 61 percent of those patients (218 of 360) had VTE complications during the hospital stay for their surgery.
The use of VTE prevention therapies grew during the study period from 31.6 percent (323 of 1,021 patients) to 86.4 percent (3,007 of 3,480 patients) for pre-surgery use and from 59.6 percent (603 of 1,012 patients) to 91.4 percent (3,223 of 3,527 patients) for in-hospital use. Overall, 10.6 percent of patients (1,399 of 13,230) were discharged on a blood clot prevention regimen.
The authors also observed that patients having abdominal operations had higher rates of 90-day VTE compared with patients who had pelvic operations (2.5 percent vs. 1.8 percent) and those patients having cancer operations had a similar incidence of VTE as those patients having noncancer operations (2.1 percent vs. 2.3 percent).
“Venous thromboembolism remains an infrequent but important complication, and rates are largely unchanged despite increasing chemoprophylaxis use. Although most patients receive perioperative and in-hospital VTE chemoprophylaxis, extended prophylaxis rates lag behind. With almost 40 percent of VTE events occurring after discharge, this may represent an area for quality improvement implementation. However, it must be carefully balanced against the potential for increased complications and higher costs at no additional benefit. These findings should influence future studies looking specifically at extended prophylaxis and prophylaxis guidelines,” the study concludes.
In a related commentary2, Christian de Virgilio, M.D., and Jerry J. Kim, M.D., of Harbor-UCLA Medical Center, Torrance, Calif., write: “Linking VTE rates to reimbursement has the potential to negatively influence patient care. Extended prophylaxis may lead to bleeding complications. Physicians and hospitals may become more reluctant to perform needed imaging procedures when the indications are questionable. Paradoxically, this PSI (patient safety indicator) may ultimately prove to be detrimental to patient care. In an era where quality measures and outcomes are increasingly being linked to reimbursement and economic burden, thoughtful consideration should be given to ensure that truly modifiable and well-understood outcomes are the driving force for health policy.”
1. JAMA Surgery. Published online June 10, 2015. doi:10.1001/jamasurg.2015.1057.
2. JAMA Surgery. Published online June 10, 2015. doi:10.1001/jamasurg.2015.1065