title: Timing of preoperative pharmacoprophylaxis for pancreatic surgery patients: a venous thromboembolism reduction initiative.
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.
authors: Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA. caroline.reinke@uphs.upenn.edu
authors: Caroline E
authors: CE
authors: Reinke
authors: Jeffrey A
authors: JA
authors: Drebin
authors: Susan
authors: S
authors: Kreider
authors: Craig
authors: C
authors: Kean
authors: Andrew
authors: A
authors: Resnick
authors: Steven
authors: S
authors: Raper
authors: Rachel R
authors: RR
authors: Kelz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; C006871:calcium heparin; D006493:Heparin