title: Prevention of Postoperative Venous Thromboembolism in Thoracic Surgical Patients: Implementation and Evaluation of a Caprini Risk Assessment Protocol.
abstract: Venous thromboembolism (VTE) can be a devastating postoperative complication, with about one-third of VTEs occurring post-discharge. We previously retrospectively evaluated the Caprini VTE risk assessment model (RAM) in postoperative lung and esophageal cancer patients, demonstrating that "high risk" patients were more likely to have a postoperative VTE. In this study, we sought to implement the RAM protocol in thoracic surgical patients to evaluate adherence, safety, and VTE outcomes.
  
  
  
  This prospective cohort study at a large safety net hospital included all surgically treated patients within the thoracic surgery division beginning in July 2014. Per RAM protocol, patients with high risk scores were prescribed a total of 30 days of postoperative daily enoxaparin prophylaxis, and moderate risk patients received a total of 10 postoperative days. Adherence and outcome audits were conducted.
  
  
  
  A total of 126 patients were included for analysis. Provider adherence to RAM score calculation was 99.2% (125 of 126), with appropriate post-discharge prophylaxis prescribed in 96.0% of cases. Twenty-four patients scored high risk (19.2%), 60 were moderate risk (48.0%), and 41 scored low risk (32.8%). Patient adherence to post-discharge enoxaparin prophylaxis was 97.2%. The overall VTE rate was 2.3%, with no post-discharge VTEs or adverse bleeding events.
  
  
  
  Implementation of a VTE risk assessment protocol with extended course prophylaxis in high risk patients is safe and feasible for providers and thoracic surgical patients at a large safety net institution with a diverse patient population. Follow-up studies are needed to assess efficacy of the RAM in this surgical population.
authors.affiliation: Department of Surgery, Boston University, Boston, MA.
authors.forename: Krista J
authors.initials: KJ
authors.lastname: Hachey
authors.affiliation: School of Medicine, Boston University, Boston, MA.
authors.forename: Helene
authors.initials: H
authors.lastname: Sterbling
authors.affiliation: School of Medicine, Boston University, Boston, MA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Choi
authors.affiliation: Department of Surgery, Boston University, Boston, MA.
authors.forename: Emma
authors.initials: E
authors.lastname: Pinjic
authors.affiliation: School of Medicine, Boston University, Boston, MA.
authors.forename: Philip D
authors.initials: PD
authors.lastname: Hewes
authors.affiliation: Division of Thoracic Surgery, Boston University, Boston, MA.
authors.forename: Juan
authors.initials: J
authors.lastname: Munoz
authors.affiliation: Department of Surgery, Boston University, Boston, MA.
authors.forename: David
authors.initials: D
authors.lastname: McAneny
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, MA.
authors.forename: Yorghos
authors.initials: Y
authors.lastname: Tripodis
authors.affiliation: Division of Thoracic Surgery, Boston University, Boston, MA.
authors.forename: Hiran C
authors.initials: HC
authors.lastname: Fernando
authors.affiliation: Division of Thoracic Surgery, Boston University, Boston, MA. Electronic address: Virginia.litle@bmc.org.
authors.forename: Virginia R
authors.initials: VR
authors.lastname: Litle
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D054869:Clinical Audit; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D017984:Enoxaparin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods* / Q000592:standards; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D019616:Thoracic Surgical Procedures; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016903:Drug Monitoring
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin