title: Effectiveness and safety of expanded perioperative thromboprophylaxis in complex gynecologic surgery.
abstract: OBJECTIVE
  To determine the effectiveness and safety of an expanded perioperative venous thromboembolism (VTE) prophylaxis strategy in women undergoing complex gynecologic surgery.
  
  
  METHODS
  We performed a cohort study of 527 patients undergoing major surgery at a single institution over a thirty-month interval during which the gynecologic oncology service implemented an expanded approach to VTE prophylaxis. We compared rates of VTE pre- and post-intervention as well as bleeding and infectious complications.
  
  
  RESULTS
  Prior to the intervention, there were 23 VTE events in 345 patients (rate of 6.67%): 8 deep vein thromboses (DVTs) and 15 pulmonary emboli (PEs). Post-intervention, there were 5 VTE events in 182 patients (2.7%): 3 DVTs and 2 PEs (RR=0.4, p=0.056). Time-to-event analysis showed a significantly higher incidence of VTE events in the pre-intervention time frame compared to the post-intervention period (p=0.049). There were no significant differences in bleeding or infection complications between groups.
  
  
  CONCLUSIONS
  Implementation of a perioperative VTE prophylaxis protocol was safe, feasible and resulted in a clinically significant reduction in symptomatic VTE. Preoperative single-dose unfractionated heparin for all patients, combined with two weeks of thromboprophylaxis in gynecologic cancer patients, may decrease VTE events without increasing bleeding or infection.
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado, United States.
authors.forename: Bradley R
authors.initials: BR
authors.lastname: Corr
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, United States.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Winter
authors.affiliation: Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, United States.
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
authors.affiliation: Division of Gynecologic Oncology, Fox Chase Cancer Center, United States.
authors.forename: Christina S
authors.initials: CS
authors.lastname: Chu
authors.affiliation: Department of General Medical Sciences, Washington University School of Medicine, United States.
authors.forename: Brian F
authors.initials: BF
authors.lastname: Gage
authors.affiliation: Department of Obstetrics and Gynecology, Washington University School of Medicine, United States. Electronic address: hagemanna@wudosis.wustl.edu.
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Hagemann
mesh_terms: D015331:Cohort Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008875:Middle Aged; D059035:Perioperative Period / Q000379:methods; D011446:Prospective Studies; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control*
chemical_list: D006493:Heparin
keywords: Extended prophylaxis; Gynecologic surgery; Perioperative outcomes; Venous thromboembolism