PURPOSE:The surgical care improvement project (SCIP) has identified the prevention of venous thromboembolism (VTE) as a key improvement area to reduce preventable surgical complications in the United States. One key performance area focuses on the use of VTE prophylaxis in postoperative patients. We use a national hospital database to assess the proportion of at-risk surgical patients that were administered SCIP-required VTE prophylaxis (SCIP VTE-2).
METHODS:Premier Perspective database discharges (January 2004–December 2006) aged ≥18 years, at risk of VTE due to a surgical condition (gynecological, orthopedic, urological, general, or neurosurgery), with no contraindication to anticoagulation, and with complete hospital stay records were included. Exclusion criteria were applied according to the CMS SCIP algorithm to identify the final study population, and the rate of SCIP VTE-2. We evaluated the proportion of at-risk surgery discharges receiving either a recommended type of prophylaxis, or both recommended and timely prophylaxis, as defined by SCIP VTE-2. Dose of prophylaxis was not captured. Temporal trends during the study period and the impact of hospital characteristics on SCIP VTE-2 rates were also collected.
RESULTS:A total of 149,785 surgical discharges were included in the analysis. Of these, 84,137 (56.2%) received a recommended prophylaxis type and 78,994 (52.7%) received recommended and timely prophylaxis. Of the discharges receiving recommended and timely prophylaxis, 51.6% received pharmacological prophylaxis, 25.5% mechanical prophylaxis, and 22.9% received both. Urban hospitals and non-teaching hospitals appeared to have a higher proportion of timely prophylaxis than rural hospitals and teaching hospitals (53.3% and 54.1% vs 47.1% and 51.1%, respectively). Rates of appropriate (range 54.8–58.0%) or timely prophylaxis (range 51.1–55.2%) showed a small and slightly upward trend during the study period.
CONCLUSION:Nearly one half of all surgical patients at risk of VTE did not receive recommended and timely prophylaxis as specified by the SCIP performance measures.
CLINICAL IMPLICATIONS:An improvement in VTE prophylaxis will reduce the level of preventable VTE in surgical patients, and thus reduce the disease burden.
DISCLOSURE:Steven Deitelzweig, Grant monies (from industry related sources) Mohamed Hussein, David Battleman - employees at IMS Health which received funding to perform the analysis from sanofi-aventisSteven Deitelzweig - research funding from sanofi-aventis, Bristol Myers Squibb, Scios; Employee Jay Lin - employee at sanofi-aventis US, Inc.; Consultant fee, speaker bureau, advisory committee, etc. Steven Deitelzweig - speakers bureau, advisory board from sanofi-aventis, Bristol Myers Squibb, Scios, Pfizer; Other Financial and editorial support for this publication was provided by sanofi-aventis US, Inc.; No Product/Research Disclosure Information