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Sustained Success of a Postoperative Venous Thromboembolism Prevention Protocol Over One Decade
Anna Kobzeva-Herzog*1, Jeffrey J. Siracuse2, Michael Cassidy3, Spencer Wilson1, Ryan Macht4, Stephanie Talutis5, Pamela Rosenkranz1, David McAneny1
1General Surgery, Boston Medical Center, Boston, MA; 2Vascular Surgery, Boston Medical Center, Boston, MA; 3Surgical Oncology, Boston Medical Center, Boston, MA; 4Minimally Invasive Surgery, University of California, San Francisco, San Francisco, CA; 5Vascular Surgery, University of California, Los Angeles, Los Angeles, CA


Objective: Sustaining a quality improvement initiative after initial success can be challenging. Our objective is to review the long-term efficacy of a post-operative venous thromboembolism (VTE) prevention program.
Design: A longitudinal review of National Surgical Quality Improvement Program (NSQIP) data from July 2008 to June 2022.
Setting: Tertiary-care, urban, academic, safety-net hospital.
Patients: Patients " 18-years-old who underwent general surgery operations.
Intervention(s): Implementation of a mandatory VTE risk assessment model and risk-commensurate prophylaxis protocol.
Main Outcome Measure: Risk-adjusted VTE outcomes.
Results: In 2009, a patient on the general surgery service at our institution was three times more likely to have a postoperative VTE event than predicted by NSQIP, based upon severity of illness (OR 3.02, 95% CI 1.99-4.40). That outcome corresponded to the 10th NSQIP decile (greatest opportunity to improve). After the implementation of a mandatory VTE risk assessment model within the electronic medical record in 2010, along with a risk-commensurate prophylaxis protocol, the odds ratio of a patient developing a postoperative VTE declined to 0.71 by 2013 (95% CI 0.41-1.23). This success persisted through 2022, and our institution was ranked in the first (most favorable) decile for VTE events during more than half (58%) of the reporting periods over the last decade.
Conclusions: Since our team presented the early success of a standardized postoperative VTE prevention program in 2013, we have sustained a desirably low likelihood of VTE events for the past decade. We continue to refine this protocol, including low molecular weight heparin dose escalation for patients at highest risk, to further reduce the likelihood of VTE events.


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