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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2012

01-01-2012 | Healthcare Policy and Outcomes

Timing of Preoperative Pharmacoprophylaxis for Pancreatic Surgery Patients: A Venous Thromboembolism Reduction Initiative

Authors: Caroline E. Reinke, MD, MSPH, Jeffrey A. Drebin, MD, PhD, Susan Kreider, RN, MS, Craig Kean, MS, Andrew Resnick, MD, MBA, Steven Raper, MD, Rachel R. Kelz, MD, MSCE

Published in: Annals of Surgical Oncology | Issue 1/2012

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Abstract

Background

Venous thromboembolism (VTE) remains a clinical problem in surgical oncology. We report the impact of preoperative initiation of subcutaneous heparin on VTE events after pancreatic surgery.

Methods

A retrospective cohort study of patients undergoing pancreatic surgery by a single surgeon and enrolled in the American College of Surgeons National Surgery Quality Improvement Program database (FY09/10) was performed. In FY10, a protocol was developed to encourage the use of preoperative pharmacoprophylaxis for high-risk patients. We compared patient characteristics before and after implementation of the protocol. Our primary outcome was 30-day VTE rate and secondary outcomes were bleeding events and 30-day mortality. Outcomes were compared by Student’s t-test and Fisher’s exact test.

Results

Seventy-three patients were studied, 34 patients underwent surgery before and 39 had surgery after implementation of the protocol. All patients received intra-operative intermittent compression boots (ICB) and postoperative pharmacoprophylaxis. Patients in the two groups were statistically equivalent with respect to age, body mass index, procedure length, and VTE risk factors. The percentage of patients with a VTE event decreased significantly after the protocol (17.6% vs. 2.6%, P = 0.035). The mean number of units of red blood cells transfused in the OR was not statistically different (0.4 vs. 0.7, P = 0.43.) Two patients returned to the operating room for bleeding after the implementation of the protocol. There were no deaths.

Conclusions

Intraoperative ICBs with postoperative initiation of subcutaneous heparin pharmacoprophylaxis may be inadequate for VTE prophylaxis for high risk patients. The use of a preoperative dose of subcutaneous heparin in high-risk pancreatic surgery patients resulted in a statistically significant reduction of VTE events.
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Metadata
Title
Timing of Preoperative Pharmacoprophylaxis for Pancreatic Surgery Patients: A Venous Thromboembolism Reduction Initiative
Authors
Caroline E. Reinke, MD, MSPH
Jeffrey A. Drebin, MD, PhD
Susan Kreider, RN, MS
Craig Kean, MS
Andrew Resnick, MD, MBA
Steven Raper, MD
Rachel R. Kelz, MD, MSCE
Publication date
01-01-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 1/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1858-1

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