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Journal of the American College of Surgeons
08 01, 2022;235 (2): 306-314.

Optimizing Perioperative Venous Thromboembolism Chemoprophylaxis on a Gynecologic Oncology Service.

Melissa H Lippitt, Emily S Johnson, Anja S Frost, Sharon D Thompson, Payam K Kashi, Anna L Beavis, Amanda N Fader, J Stuart Ferriss, Rebecca L Stone, Stephanie L Wethington
Author Information
  1. Melissa H Lippitt: From the Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Lippitt, Johnson, Frost, Thompson, Kashi, Beavis, Fader, Ferriss, Stone, Wethington).
  2. Emily S Johnson: From the Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Lippitt, Johnson, Frost, Thompson, Kashi, Beavis, Fader, Ferriss, Stone, Wethington).
  3. Anja S Frost: From the Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Lippitt, Johnson, Frost, Thompson, Kashi, Beavis, Fader, Ferriss, Stone, Wethington).
  4. Sharon D Thompson: From the Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Lippitt, Johnson, Frost, Thompson, Kashi, Beavis, Fader, Ferriss, Stone, Wethington).
  5. Payam K Kashi: From the Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Lippitt, Johnson, Frost, Thompson, Kashi, Beavis, Fader, Ferriss, Stone, Wethington).
  6. Anna L Beavis: From the Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Lippitt, Johnson, Frost, Thompson, Kashi, Beavis, Fader, Ferriss, Stone, Wethington).
  7. Amanda N Fader: From the Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Lippitt, Johnson, Frost, Thompson, Kashi, Beavis, Fader, Ferriss, Stone, Wethington).
  8. J Stuart Ferriss: From the Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Lippitt, Johnson, Frost, Thompson, Kashi, Beavis, Fader, Ferriss, Stone, Wethington).
  9. Rebecca L Stone: From the Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Lippitt, Johnson, Frost, Thompson, Kashi, Beavis, Fader, Ferriss, Stone, Wethington).
  10. Stephanie L Wethington: From the Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD (Lippitt, Johnson, Frost, Thompson, Kashi, Beavis, Fader, Ferriss, Stone, Wethington).
PMID: 35839408 DOI: 10.1097/XCS.0000000000000253

Abstract

BACKGROUND: Perioperative venous thromboembolism (VTE) is a significant cause of morbidity and mortality after gynecologic cancer surgery. Here we report a quality improvement intervention to increase perioperative VTE chemoprophylaxis compliance.
STUDY DESIGN: All operations performed by a gynecologic oncologist at a tertiary urban university medical center admitted to the hospital for at least one midnight were included. Using a pre/post design with a washout period, we sought to increase perioperative VTE chemoprophylaxis compliance from 22% in the historical control (HC) cohort to 90% in the quality improvement (QI) cohort. The perioperative VTE chemoprophylaxis process was standardized by addressing four domains: preoperative VTE chemoprophylaxis, surgical time-out, postoperative VTE chemoprophylaxis, and intervention education and compliance tracking. Pearson's chi-square test was used to compare HC vs QI cohort compliance.
RESULTS: There were 130 surgical cases in the HC cohort and 131 in the QI cohort. Forty-two percent underwent laparotomy, and 57% had cancer at the time of operation. VTE chemoprophylaxis compliance improved from 22% in the HC cohort to 82% in the QI cohort (p < 0.001). Preoperative VTE chemoprophylaxis compliance improved from 76% in the HC cohort to 94% in the QI cohort (p < 0.001), and postoperative VTE chemoprophylaxis compliance improved from 27% to 87% (p < 0.001). Thirty-day postoperative VTE occurred in three patients (2%) in the HC cohort and none in the QI cohort (p = 0.08).
CONCLUSIONS: A low-cost and low-technology QI initiative intervention improved perioperative compliance with VTE chemoprophylaxis.

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MeSH Term

Anticoagulants
Chemoprevention
Cohort Studies
Female
Genital Neoplasms, Female
Humans
Postoperative Complications
Quality Improvement
Retrospective Studies
Venous Thromboembolism

Chemicals

Anticoagulants
Journal Article

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