Current Practice Patterns of Venothromboembolism Prophylaxis in Advanced Minimally Invasive Surgery

E Gilbert, MD, A Lamoshi, MD, S Markwardt, MPH, T Deloughery, MD, B Sheppard, MD. Oregon Health & Science University

Introduction:
Postoperative venothromboembolism (VTE) is a well known complication of surgery. Although there are guidelines for the use of prolonged (28 day) VTE prophylaxis following open surgery, indications for prolonged VTE prophylaxis in high risk patients following advanced minimally invasive surgery (MIS) are less clear. The purpose of this cross-sectional study was to determine the current clinical practice patterns of VTE prophylaxis in advanced MIS.

Methods:
An 11-point survey was sent to a sample population of members of the Society of Alimentary and Gastrointestinal Surgeons in three rounds 6 weeks apart from November 2010 – March 2011. The questionnaire was designed to obtain basic demographic information and practice patterns of VTE prophylaxis of the respondents. All means, standard deviations, percentages and 95% confidence intervals were calculated using survey analysis techniques.
 

Results:
The response rate was 34.2% (315/920). Mean number of years in practice was 10.7 (± 7.24) and mean number of operations performed was 387 (± 185.56). Ninety-two percent (± 28%) reported that more than 25% of their practice was MIS. Participants were equally likely to be affiliated with a teaching hospital as with a non-teaching hospital (52% vs. 47%). Preoperative VTE prophylaxis was used in >75% of case by 67% of surgeons who were more likely to have been in practice greater than 10yrs [29.3 (24.6, 34.4) vs. 38.1 (33.0, 43.4); α = 0.10]. Twelve percent (± 33%) reported using prolonged prophylaxis in >5% of cases, 82% (± 38%) reported they would provide prolonged VTE prophylaxis following MIS in certain clinical scenarios and only 17% (±38%) reported they would not use prolonged VTE prophylaxis following MIS. The most common indications indicated by respondents for prolonged VTE prophylaxis were hypercoagulability (n=224), previous deep vein thrombosis (n=204), immobilization (n=132) and malignancy (n=72).

Conclusions:
Although a minority of surgeons use prolonged VTE prophylaxis in >5% of their MIS cases, a majority report using prolonged VTE prophylaxis in a number of specific clinical indications. This variation in national practice patterns likely reflects an absence of specific guidelines for prolonged VTE prophylaxis utilization following advanced minimally invasive surgery.
 

View Poster