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Objective: To implement and determine the efficacy of a suite of interventions in reducing postoperative venous thromboembolism (VTE) complications.
Design: A before-after trial, comparing National Surgical Quality Improvement Program (NSQIP) VTE outcomes (deep vein thromboses and pulmonary emboli) before and after implementing a standardized risk-stratified protocol combined with a postoperative mobilization program.
Setting: An urban, academic, safety net hospital.
Patients: All patients undergoing general or vascular surgery at our institution, both before and after the interventions.
Interventions: We developed a strategy to decrease VTE complications, based upon standardized electronic physician orders that specify early postoperative mobilization and mandatory VTE risk stratification for every patient using the “Caprini” grading system. The derived scores dictate the nature and duration of VTE prophylaxis, including on an outpatient basis. Electronic reminders about appropriate VTE prophylaxis are automatically generated before and after operations, and upon discharge. Both mechanical (pneumatic compression boots) and pharmacologic prophylaxis (fractionated or low molecular weight heparin) are employed, as indicated by risk level.
Main Outcome Measures: NSQIP-reported raw and risk-adjusted VTE outcomes during two years before and after implementing the VTE prevention program.
Results: The incidence of DVTs decreased by 84%, from 1.9% to 0.3% (p<0.01), with the implementation of VTE prevention efforts, while the PE incidence fell by 55%, from 1.1% to 0.5% (p<0.01). Risk-adjusted VTE outcomes steadily declined from an odds ratio (OR) of 3.41 to 0.94.
Conclusions: A patient care program, emphasizing early postoperative mobilization along with mandatory VTE risk stratification and corresponding prophylaxis recommendations, significantly reduced the risk-adjusted likelihood of VTE complications among our patients.