[Effect of the implementation of a guideline for venous thromboembolism prophylaxis in surgical patients].
BACKGROUND
Effective strategies for prevention of venous thromboembolism (VTE) are widely available, but still remain underused, mainly in our country.


OBJECTIVE
Our aim was to verify whether the implementation of a guideline for VTE prophylaxis for surgical patients influenced the prescription of prophylaxis by the medical staff.


METHODS
This was a retrospective preintervention-postintervention study. Charts of 150 patients before guideline implementation (BGI) and 150 after (AGI) were randomized among all patients admitted during one year in each period.


METHODS
>40 years-old, major abdominal or orthopedic surgeries.


METHODS
Incomplete files and use of anticoagulants for any reason at admission. Data registered: demographic data, reference to VTE risk factors, VTE prophylaxis prescription, diagnosis of deep venous thrombosis or pulmonary embolism during hospitalization. Results. The two groups, BGI and AGI were similar for demographic data and duration of prophylaxis (5.6 x 6.6 days). Frequency of prophylaxis in percentages was BGI x AGI respectively, before surgery: pharmacologic prophylaxis (PP), 6 x 9; graduated compression stockings (GCS), 4 x 3; intermittent pneumatic compression (IPC), 2 x 3. After surgery: PP, 53 x 53; GCS, 23 x 40 (P<0.05); IPC, 26 x 32. Including all patients, prophylaxis was prescribed for 60.5% BGI and 66.5% AGI, but was considered adequate only in 34% BGI and 32% AGI.


CONCLUSIONS
Adoption of a guideline, although increasing concern about prophylaxis, expressed by greater use of GCS, only minimally improved quality of prophylaxis , indicating that other active and continuous interventions are necessary to enforce compliance.
Maffei
Francisco Humberto de Abreu
FH
Faculdade de Medicina de Botucatu, UNESP. fhmaffei@uol.com.br
Sato
Ana Claudia
AC
Torggler Filho
Francisco
F
Silva
Sandra Cristina da
SC
Atallah
Alvaro
A
D000368:Aged; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic / Q000592:standards; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000145:classification; D054556:Venous Thromboembolism / Q000517:prevention & control*