Initial evaluation of deep venous thrombosis / pulmonary embolism [DVT/PE] risk in hospitalized surgical patients has become the standard of care. As the patient is hospitalized, the DVT/PE risk changes. This change in risk and the appropriateness of changing therapy against the new risk is an area where data is sparse. We hypothesize that in the absence of changing level of care that DVT/PE risk does increase in surgical patients.
We performed a retrospective data analysis on 96 adult patients admitted to a 350 bed community hospital located in Brooklyn, NY. Re-evaluation of all surgical patients’ DVT/PE risk during a 1 month period resulted in variable re-assessment time intervals. The risk assessment was performed using an established scoring system [1=low risk, 2=moderate risk, 3=high risk, 4=very high risk]. Demographic data as well as initial risk assessment data and therapy information was collected. Patients with DVT or PE were excluded from analysis.
We analyzed the data on 53 men and 43 women, mean age 60 years. Gender did not correlate with DVT/PE risk. Our hospital instituted a policy of initial risk assessment performance for all admitted patients. We found that appropriateness of DVT/PE prophylaxis was significantly lower in the very high risk group as compared to the other 3 groups despite intensive education of our staff. The second assessment was performed on patients ranging from 1 day post admission to 78 days post admission. The risk change by category was noted to be no change in 20 patients, 1 category in 33 patients, 2 categories in 19 patients and 3 categories in 24 patients. The appropriateness of DVT/PE prophylaxis after re-assessment was significantly reduced in 3 of the 4 risk groups.
DVT/PE risk should be reassessed on a regular basis in hospitalized patients as the risk categorization changes significantly during the course of a hospital stay.
The prophylaxis of very high risk patients should be closely monitored for appropriateness as many may be under treated.
Radhika Malhotra, No Financial Disclosure Information; No Product/Research Disclosure Information