title: Familiarity and self-reported compliance with American Urological Association best practice recommendations for use of thromboembolic prophylaxis among American Urological Association members.
abstract: OBJECTIVE
  Thromboprophylaxis with subcutaneous heparin or low molecular weight heparin is now an integral part of national surgical quality and safety assessment efforts, and has been incorporated into the current AUA Best Practice Statement. We evaluated familiarity and compliance with the AUA Best Practice Statement, assessed practice patterns in terms of perioperative thromboprophylaxis and specifically examined self-reported compliance in high risk patients undergoing radical cystectomy.
  
  
  METHODS
  An electronic survey was sent to AUA members with valid e-mail addresses (10,966). Associations between AUA Best Practice Statement adherence and factors such as urological specialty, graduation year and guideline familiarity were assessed using chi-square analyses and generalized estimating equations.
  
  
  RESULTS
  With 1,210 survey responses the largest group of respondents was urological oncologists and/or laparoscopic/robotic specialists (26.0%). This group was more likely to use thromboprophylaxis than nonurological oncologists and/or laparoscopic/robotic specialists in high risk patients (OR 1.3, CI 1.1-1.5). Respondents aware of the AUA Best Practice Statement guidelines (50.7%) were more likely to use thromboprophylaxis (OR 1.4, CI 1.2-1.6). Although 18.1% of urological oncologists and/or laparoscopic/robotic specialists and 34.2% of nonurological oncologists and/or laparoscopic/robotic specialists avoided routine thromboprophylaxis in patients undergoing radical cystectomy, the former were more likely to use thromboprophylaxis (p <0.0001) than other respondents. Urologists graduating after the year 2000 used thromboprophylaxis in high risk patients undergoing radical cystectomy more often than did earlier graduates (79.2% vs 63.4%, p <0.0001).
  
  
  CONCLUSIONS
  Although younger age and self-reported urological oncologist and/or laparoscopic/robotic specialist status correlated strongly with thromboprophylaxis use, self-reported adherence to AUA Best Practice Statement was low, even in high risk cases with clear AUA Best Practice Statement recommendations such as radical cystectomy. These data identify opportunities for quality improvement in patients undergoing major urological surgery.
authors.affiliation: Division of Urologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Temple University School of Medicine, Philadelphia, Pennsylvania 19111, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Sterious
authors.forename: Jay
authors.initials: J
authors.lastname: Simhan
authors.forename: Robert G
authors.initials: RG
authors.lastname: Uzzo
authors.forename: Boris
authors.initials: B
authors.lastname: Gershman
authors.forename: Tianyu
authors.initials: T
authors.lastname: Li
authors.forename: Karthik
authors.initials: K
authors.lastname: Devarajan
authors.forename: Daniel
authors.initials: D
authors.lastname: Canter
authors.forename: John
authors.initials: J
authors.lastname: Walton
authors.forename: Ryan
authors.initials: R
authors.lastname: Fogg
authors.forename: Serge
authors.initials: S
authors.lastname: Ginzburg
authors.forename: Anthony
authors.initials: A
authors.lastname: Corcoran
authors.forename: Marc C
authors.initials: MC
authors.lastname: Smaldone
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutikov
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000592:standards; D006801:Humans; D007279:Injections, Subcutaneous; D020407:Internet; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000639:trends; D057566:Self Report; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D014481:United States; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D006495:Heparin, Low-Molecular-Weight
keywords: AUA; American Urological Association; BPS; Best Practice Statement; DVT; LMWH; PTE; RC; SQH; TP; UOLRS; VTE; deep vein thrombosis; heparin; low molecular weight heparin; practice guidelines as topic; prevention and control; pulmonary thromboembolism; radical cystectomy; societies, medical; subcutaneous heparin; thromboembolism; thromboprophylaxis; urological oncologists and/or laparoscopic/robotic specialists; venous thromboembolism