• World Neurosurg · Feb 2020

    Observational Study

    Defects in processes of care for pharmacologic prophylaxis are common among neurosurgery patients who develop in-hospital, post-operative venous thromboembolism (VTE).

    • Regina Yun, Daniel M Sciubba, John J Lewin, Michael B Streiff, Elliott R Haut, Brandyn D Lau, Kenneth M Shermock, Peggy S Kraus, Victor O Popoola, and Stacy Elder Dalpoas.
    • Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
    • World Neurosurg. 2020 Feb 1; 134: e664-e671.

    BackgroundVenous thromboembolism (VTE) is a cause of considerable morbidity and mortality in hospitalized patients. An evidence-based algorithm was developed and implemented at our institution to guide perioperative VTE prophylaxis management.ObjectiveWe evaluated compliance with prescription of risk-appropriate VTE prophylaxis and administration of prescribed VTE prophylaxis in neurosurgery patients.MethodsThis was a retrospective analysis of postoperative neurosurgery patients at a single institution with subsequent diagnosis of acute VTE during their inpatient stay. Descriptive statistics were used to characterize pharmacologic VTE prophylaxis and prescribing patterns.ResultsThe incidence of VTE in our neurosurgery population was 248/13,913 (1.8%). Of the 123 patients, the median time to VTE diagnosis was 96 hours after surgery (interquartile range [IQR], 58-188 hours). A total of 108 patients (87.8%) were prescribed risk-appropriate VTE prophylaxis, among whom 61 (56.5%) received all doses as prescribed. Fifty-three patients (43.1%) missed ≥1 dose of prescribed prophylaxis and the median missed doses was 3 (IQR, 0-3). The median time to first dose of pharmacologic VTE prophylaxis was 42 hours (IQR, 28-51). More than half (n = 63, 51.2%) of the VTE risk assessments contained ≥1 error, of which 15 (23.8%) would have resulted in a change in recommendation.ConclusionsOur evidence-based VTE prophylaxis algorithm was not accurately completed in more than half of patients. Many patients who developed VTE had a defect in their VTE prophylaxis management during their inpatient stay. Research to improve optimal VTE prevention practice in neurosurgery patients is needed.Copyright © 2019 Elsevier Inc. All rights reserved.

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