title: Improving adherence rate of extended prophylaxis for venous thromboembolic disease after abdominal and pelvic oncologic surgery: a pilot educational study.
abstract: BACKGROUND
  Venous thromboembolic disease (VTE) is higher among patients with cancer. For those undergoing abdominal or pelvic surgery for cancer, it is suggested to extend thromboprophylaxis during 4 weeks with low-molecular-weight heparin over limited-duration of 7 days. There is no published local data from our country about compliance with recommended guidelines of extended prophylaxis (EP) in patients with cancer undergoing surgical procedures. Our aim was to evaluate the adherence rate to extended pharmacological thromboprophylaxis after abdominal-pelvic surgery for cancer, before and after an educational intervention program (EIP) geared toward surgeons.
  
  
  METHODS
  Prospective cross-sectional study before and after an EIP aimed for surgeons. All consecutive patients older than 65 years who underwent surgery for abdominal-pelvic neoplasm, at the Hospital Italiano de Buenos Aires, Argentina, between September 2013 and May 2014, were evaluated for inclusion.
  
  
  RESULTS
  A total of 120 patients were included, 60 before and 60 after the EIP aimed for surgeons. None of the initial 60 patients received EP, while 13 (21.6%) of 60 patients received prophylaxis for 28 days (all with colon or rectal cancer) after the intervention. There were no bleeding or death during 90 days of follow-up, and there were 7 of 120 VTE events, none in the group receiving extended thromboprophylaxis.
  
  
  CONCLUSIONS
  The EIP for the surgical team significantly improved their adherence but only in the colon-rectal surgeries. The adherence to the recommended guidelines is still low. Reasons could be the subjective perception of elevated bleeding risk and the variable grade of recommendation in different guidelines.
authors.affiliation: Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina fernando.vazquez@hospitalitaliano.org.ar.
authors.forename: Fernando Javier
authors.initials: FJ
authors.lastname: Vázquez
authors.affiliation: Surgery Department, Colorectal cancer Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: María Soledad
authors.initials: MS
authors.lastname: Bilbao
authors.affiliation: Home Care Medicine Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Javier
authors.initials: J
authors.lastname: Saimovici
authors.affiliation: Surgery Department, Colorectal cancer Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Carlos
authors.initials: C
authors.lastname: Vaccaro
mesh_terms: D000008:Abdominal Neoplasms / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001118:Argentina; D003110:Colonic Neoplasms / Q000601:surgery*; D003430:Cross-Sectional Studies; D004502:Education, Medical, Continuing; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D010386:Pelvic Neoplasms / Q000601:surgery*; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D006495:Heparin, Low-Molecular-Weight
keywords: cancer; deep vein thrombosis; enoxaparin; neoplasm; pulmonary embolism; surgery; thromboprophylaxis; venous thrombosis