Underuse of venous thromboembolism prophylaxis for general surgery patients: physician practices in the community hospital setting.
BACKGROUND
Venous thromboembolism is a common complication of surgery. Although surveys of physician self-reported practices have suggested near universal support for routine use of measures to prevent venous thromboembolism, medical record auditing has demonstrated underuse.


OBJECTIVE
To assess physician practices of venous thromboembolism prophylaxis in the community hospital setting.


METHODS
Retrospective review of the medical records from 20 hospitals in Oklahoma of 419 Medicare patients aged 65 years or older undergoing major abdominothoracic surgery between April 1 and December 31, 1995. Utilization rates of prophylaxis stratified according to patient risk for venous thromboembolism were measured.


RESULTS
Prophylaxis measures were implemented for only 160 (38%) of 419 patients studied (95% confidence interval, 33%-43%). There was little variation in the use of prophylaxis based on the risk for venous thromboembolism. Only 97 (39%) of 250 patients (95% confidence interval, 33%-45%) at very high risk received any form of prophylaxis and of these 97, only 64 patients (66%) received appropriate measures (95% confidence interval, 56%-75%).


CONCLUSIONS
Despite widely disseminated, evidence-based recommendations, venous thromboembolism prophylaxis is underused in Medicare patients undergoing major abdominothoracic surgery in community hospitals in Oklahoma.
Bratzler
D W
DW
Oklahoma Foundation for Medical Quality Inc., Clinical Epidemiology Unit, Veterans Administration Medical Center, Oklahoma City 73118-7472, USA. okpro.dbratzler@sdps.org.
Raskob
G E
GE
Murray
C K
CK
Bumpus
L J
LJ
Piatt
D S
DS
D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008499:Medical Records; D006278:Medicare; D009825:Oklahoma; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012306:Risk; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D014481:United States
D000925:Anticoagulants