Low agreement for assessing the risk of postoperative deep venous thrombosis when deciding prophylaxis strategies: a study using clinical vignettes

O’Flaherty, Martin; Lerum, Kaja; Martin, Paula; Grassi, Daniel

doi:10.1186/1472-6963-2-16

Cited by 10 publications

(4 citation statements)

References 4 publications

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“…31-33 Furthermore, there likely are interclinician differences in application of clinical decision rules for when to suspect a DVT or PE and thresholds for further testing that also could affect facility-level rates of VTE diagnosis. 34 The conclusion that surveillance bias is present from the studies reviewed is an assumption. Beyond surveying sites/providers with respect to VTE screening practices, definitive proof of surveillance bias would require different data collection methods that are less feasible for assessing facility-level rates, such as by medical record review for VTE or direct observation in order to better assess the indication for and appropriateness of testing in the case of VTE, and of adherence to CDC definitions for HAIs.…”

Section: Discussionmentioning

confidence: 99%

Does Surveillance Bias Influence the Validity of Measures of Inpatient Complications? A Systematic Review

et al. 2017

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Surveillance bias may threaten the accuracy of inpatient complication measures. A systematic literature review was conducted to examine whether surveillance bias influences the validity of selected Patient Safety Indicator- and health care associated infection-related measures. Ten venous thromboembolism (VTE) articles were identified: 7 trauma related, 3 postoperative, and 1 central line-associated bloodstream infection (CLABSI) article. Nine VTE articles found positive associations between deep vein thrombosis imaging and VTE diagnoses. Because imaging also may be symptom driven, most studies performed additional analyses to corroborate findings. Six trauma-related and 2 postoperative VTE studies concluded that surveillance bias was present, the latter based on circumstantial evidence. The non-VTE study found a significant positive correlation between surveillance aggressiveness and intensive care unit CLABSI rates. Even considering VTE, relatively little is known about the impact of surveillance bias on inpatient complication measures. Given the implications of misclassifying hospitals on quality, this issue requires further investigation using more direct measurement methods.

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Section: Discussionmentioning

confidence: 99%

Does Surveillance Bias Influence the Validity of Measures of Inpatient Complications? A Systematic Review

et al. 2017

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“…Some of these factors include the need to become more aware or familiar with current guidelines, the lack of consensus between expert guidelines, concerns about possible bleeding complications, and a general underestimation of the risk of VTE. 19,23 It is crucial to implement measures to remove barriers related to medical providers. Educational programs play a vital role in improving the implementation of prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…Among these barriers, factors related to medical providers play a significant role in appropriately implementing VTE prophylaxis. Some of these factors include the need to become more aware or familiar with current guidelines, the lack of consensus between expert guidelines, concerns about possible bleeding complications, and a general underestimation of the risk of VTE 19,23 . It is crucial to implement measures to remove barriers related to medical providers.…”

Section: Discussionmentioning

confidence: 99%

Enhancing thromboprophylaxis after colorectal cancer surgery in China: Bridging the gap between evidence and implementation through pathway optimization

Gu,

Dai,

Wei

et al. 2024

Pharmacotherapy

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BackgroundThe CRC‐VTE trial conducted in China revealed a significant occurrence of venous thromboembolism (VTE) in patients following colorectal cancer (CRC) surgery, raising concerns about implementing thromboprophylaxis measures. The present study aimed to identify and analyze inappropriate aspects of current thromboprophylaxis practices.MethodsThis study performed an analysis of the CRC‐VTE trial, a prospective multicenter study that enrolled 1836 patients who underwent CRC surgery. The primary objective was to identify independent risk factors for VTE after CRC surgery using multivariate logistic regression analysis. Furthermore, among the cases in which VTE occurred, the appropriateness of thromboprophylaxis was assessed based on several factors, including pharmacologic prophylaxis, time to initiate prophylaxis, drug selection, drug dosage, and duration of pharmacologic prophylaxis. Based on the analysis of the current state of thromboprophylaxis and relevant clinical guidelines, a modified Delphi method was used to develop a clinical pathway for VTE prophylaxis after CRC surgery.ResultsIn this analysis of 1836 patients, 205 (11.2%) were diagnosed with VTE during follow‐up. The multifactorial analysis identified several independent risk factors for VTE, including age (≥70 years), female sex, varicose veins in the lower extremities, intraoperative blood transfusion, and the duration of immobilization exceeding 24 h. None of the patients diagnosed with VTE in the CRC trial received adequate thromboprophylaxis. The main reasons for this inappropriate practice were the omission of thromboprophylaxis, delayed initiation, and insufficient duration of thromboprophylaxis. We developed a specialized clinical pathway for thromboprophylaxis after CRC surgery to address these issues.ConclusionsThis study offers a comprehensive nationwide evaluation of existing thromboprophylaxis practices in patients after CRC surgery in China. A specialized clinical pathway was developed to address the identified gaps and improve the quality of care. This clinical pathway incorporates explicit, tailored, detailed recommendations for thromboprophylaxis after CRC surgery.

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“…Physician‐related barriers towards implementation of appropriate VTE prophylaxis include the lack of awareness or insufficient familiarity with current guidelines, lack of agreement between expert guidelines, lack of belief it may impact outcomes, fear of bleeding complications and a general underestimation of the risk of VTE [52], particularly in medical patients [51]. As a result of the number of predisposing and triggering thrombotic risk factors present in hospitalized patients, the perception of patient risk may vary between physicians [52]. In this regard, the use of objective individualized VTE risk‐assessment models [17,53] or computerized decision‐support software can improve the accuracy of prophylaxis prescribing [54].…”

Section: Barriers To Compliance With Thromboprophylaxis Guidelinesmentioning

confidence: 99%

Prophylaxis of venous thromboembolism in the US: improving hospital performance

Cohn

2009

Journal of Thrombosis and Haemostasis

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Summary. Venous thromboembolism (VTE) prevention has been recognized as the most important practice for improving patient safety in hospitals. To be effective, VTE prophylaxis must be appropriately prescribed with respect to type, dose and duration. Large-scale studies of medical discharge records have highlighted low rates of appropriate thromboprophylaxis in hospitalized medical patients, especially those with cancer or severe lung disease. Lack of prophylaxis and an insufficient duration are the most common forms of inappropriate prophylaxis. Multifaceted, active, quality improvement initiatives have been developed and shown to successfully increase the appropriate prescribing of VTE prophylaxis in patients at risk. By increasing the use of appropriate VTE prophylaxis in at-risk patients, the disease burden of hospital-acquired VTE and its resulting complications can be reduced.

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Low agreement for assessing the risk of postoperative deep venous thrombosis when deciding prophylaxis strategies: a study using clinical vignettes

Cited by 10 publications

References 4 publications

Does Surveillance Bias Influence the Validity of Measures of Inpatient Complications? A Systematic Review

Does Surveillance Bias Influence the Validity of Measures of Inpatient Complications? A Systematic Review

Enhancing thromboprophylaxis after colorectal cancer surgery in China: Bridging the gap between evidence and implementation through pathway optimization

Prophylaxis of venous thromboembolism in the US: improving hospital performance

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