@article{b5e71fafc6e249ce903bda99f30dacb8,
title = "Defects in Processes of Care for Pharmacologic Prophylaxis Are Common Among Neurosurgery Patients Who Develop In-Hospital Postoperative Venous Thromboembolism",
abstract = "Background: Venous thromboembolism (VTE) is a cause of considerable morbidity and mortality in hospitalized patients. An evidence-based algorithm was developed and implemented at our institution to guide perioperative VTE prophylaxis management. Objective: We evaluated compliance with prescription of risk-appropriate VTE prophylaxis and administration of prescribed VTE prophylaxis in neurosurgery patients. Methods: This was a retrospective analysis of postoperative neurosurgery patients at a single institution with subsequent diagnosis of acute VTE during their inpatient stay. Descriptive statistics were used to characterize pharmacologic VTE prophylaxis and prescribing patterns. Results: The incidence of VTE in our neurosurgery population was 248/13,913 (1.8%). Of the 123 patients, the median time to VTE diagnosis was 96 hours after surgery (interquartile range [IQR], 58–188 hours). A total of 108 patients (87.8%) were prescribed risk-appropriate VTE prophylaxis, among whom 61 (56.5%) received all doses as prescribed. Fifty-three patients (43.1%) missed ≥1 dose of prescribed prophylaxis and the median missed doses was 3 (IQR, 0–3). The median time to first dose of pharmacologic VTE prophylaxis was 42 hours (IQR, 28–51). More than half (n = 63, 51.2%) of the VTE risk assessments contained ≥1 error, of which 15 (23.8%) would have resulted in a change in recommendation. Conclusions: Our evidence-based VTE prophylaxis algorithm was not accurately completed in more than half of patients. Many patients who developed VTE had a defect in their VTE prophylaxis management during their inpatient stay. Research to improve optimal VTE prevention practice in neurosurgery patients is needed.",
keywords = "Heparin, Neurosurgery, Perioperative, VTE algorithm, VTE prophylaxis, Venous thromboembolism",
author = "Regina Yun and Sciubba, {Daniel M.} and Lewin, {John J.} and Streiff, {Michael B.} and Haut, {Elliott R.} and Lau, {Brandyn D.} and Shermock, {Kenneth M.} and Kraus, {Peggy S.} and Popoola, {Victor O.} and Dalpoas, {Stacy Elder}",
note = "Funding Information: Conflict of interest statement: E.R.H is/was primary investigator of contracts from Patient-Centered Outcomes Research Institute entitled ?Preventing Venous Thromboembolism: Empowering Patients and Enabling Patient-Centered Care via Health Information Technology? (CE-12-11-4489) and ?Preventing Venous Thromboembolism (VTE): Engaging Patients to Reduce Preventable Harm from Missed/Refused Doses of VTE Prophylaxis? (DI-1603-34596); primary investigator of a grant from the Agency for Healthcare Research and Quality (1R01HS024547) entitled ?Individualized Performance Feedback on Venous Thromboembolism Prevention Practice?; co-investigator on a grant from the National Institutes of Health National Heart, Lung, and Blood Institute (R21HL129028) entitled ?Analysis of the Impact of Missed Doses of Venous Thromboembolism Prophylaxis?; he is supported by a contract from The Patient-Centered Outcomes Research Institute ?A Randomized Pragmatic Trial Comparing the Complications and Safety of Blood Clot Prevention Medicines Used in Orthopedic Trauma Patients? (PCS-1511-32745); he receives royalties from Lippincott Williams & Wilkins for the book Avoiding Common ICU Errors. He was the paid author of a paper commissioned by the National Academies of Medicine entitled ?Military Trauma Care's Learning Health System: The Importance of Data Driven Decision Making,? which was used to support the report titled ?A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury.? Publisher Copyright: {\textcopyright} 2019 Elsevier Inc. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",
year = "2020",
month = feb,
doi = "10.1016/j.wneu.2019.10.163",
language = "English (US)",
volume = "134",
pages = "e664--e671",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",
}