Presentation Authors: Rikin Patel*, Hugh Fisher, Barry Kogan, Albany, NY
Introduction: Venous thromboembolism (VTE) is a common cause of morbidity and mortality in urologic surgery. Appropriate risk stratification and administration of prophylaxis can help reduce VTE-related complications. Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) we discovered a high VTE rate and investigated why.
Methods: We retrospectively reviewed data from the NSQIP database from January 1, 2015 to December 31, 2016, including 202 urology operations at Albany Medical Center. Eight patients were identified to have a VTE occurrence within 30 days of urologic surgery. We identified that although pharmacological VTE prophylaxis was ordered to be administered on the day of surgery, actual administration was being postponed to the next post-operative day by a computer decision support system. This system was put into place due to the perceived risk of increased bleeding. We revised this policy as a quality improvement initiative in January 2017. Subsequently, 238 additional cases were reviewed from January 1, 2017 through June 30, 2018. Analysis included demographic and lifestyle information, medical comorbidities, procedure performed, operative time, VTE risk, prophylaxis administered, and significant postoperative events.
Results: Ten patients with a mean age of 61.5 years (range 50-79) had VTEs. All ten were undergoing surgery for cancer. Our institution's postoperative VTE rate was 3.96% compared to 0.5% nationally from 2015 to 2016. Following revision of the prophylaxis administration policy in January 2017, our incidence of VTE has been only two events in 238 cases, or 0.8%. There has been no increased risk of bleeding complications.
Conclusions: We believe that many VTEs are preventable when prophylaxis is given per guidelines. In quality review, it is important to consider all possible sources of error. Although prophylaxis was ordered per guidelines, a decision support system we were not aware of delayed the ordered administration. After our quality improvement initiative, we have documented a reduction in our VTE rate.