Resident Knowledge on Venous Thromboembolism
*Matthew Fleming, *James Farrelly, *Erin White, Linda Maerz, *Robert Becher
Yale School of Medicine, Department of Surgery, New Haven, CT
Objective: To determine surgical trainee knowledge-gaps that may drive suboptimal venous thromboembolism (VTE) prophylaxis practices for surgical and trauma patients.
Design: IRB-approved survey of general surgery residents at a single training program.
Setting: Large, tertiary, academic medical center in New England.
Participants: General surgery resident-physicians across all training levels.
Interventions: Online survey with seven knowledge- and case-based questions related to VTE prophylaxis.
Main Outcome Measures: Response rate; percent of questions correctly answered.
Results: Response rate was 81.3% (61/75). 29.8% (17) of residents correctly identified the four procedure types for which holding VTE-chemoprophylaxis (VTE-CP) is indicated. 77.0% (47) chose the appropriate VTE-CP indicated for polytrauma patients, while 19.7% (n=12) chose insufficient VTE-CP, and 3.3% (2) chose none. 29.5% (18) of residents did not know that a missed dose of VTE-CP is associated with increased risk of VTE; 37.7% (23) did not feel a missed VTE-CP dose was a major concern. Answers regarding when it is safe to initiate postoperative VTE-CP were varied: recovery room (23.0%; 14), 4 hours post-operatively (34.4%; 21), 8 hours post-operatively, (16.4%; 10), and according to attending-specific instruction (16.4%; 10). Most residents correctly identified the initial steps when suspecting heparin-induced thrombocytopenia (78.7%; 48) though were unfamiliar with the mechanism of action for sequential compression devices (31.7%; 19).
Conclusions: Surgical trainee knowledge-gaps exist about the mechanisms, indications, and management of VTE prophylaxis in surgical and trauma patients. Our data show wide variability regarding when to hold preoperative and start postoperative VTE-CP. Results from this survey can guide VTE education of surgery trainees and attendings across disciplines, and inform the creation and implementation of guidelines to standardize VTE-CP administration in specific surgical patient-populations.
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