Implementation of a Comprehensive Post-Discharge Venous Thromboembolism Prophylaxis Program for Abdominal and Pelvic Surgery Patients.
Prophylactic anticoagulation is routinely used in the inpatient setting; however, the risk of venous thromboembolism (VTE) remains elevated after discharge. Extensive evidence and clinical guidelines suggest post-discharge VTE prophylaxis is critical in at-risk populations, but it remains severely underused in practice.



We performed a single-institution retrospective, nonrandomized, pre- and post-intervention analysis of a systematic post-discharge pharmacologic prophylaxis program against the primary end point, which is post-discharge symptomatic VTE. An institutional American College of Surgeons NSQIP dataset was used to identify patients and outcomes. Patients undergoing major abdominal surgery for malignancy or inflammatory bowel disease were eligible for the post-discharge VTE prevention program.



Among 1,043 patients who underwent abdominal surgery for malignancy or inflammatory bowel disease, 800 (77%) were in the pre-intervention cohort and 243 (23%) patients were in the post-intervention cohort. Rates of inpatient VTE did not significantly differ between cohorts (0.7%, n = 6 pre-intervention vs 1.7%, n = 4 post-intervention; p = 0.25). However, compared with the pre-intervention cohort, patients in the post-intervention cohort demonstrated a significantly lower post-discharge VTE rate (2.5%, n = 20 pre-intervention vs 0.0%, n = 0 post-intervention; p < 0.01).



A systematic post-discharge VTE prophylaxis program including provider education, local guideline adaptation, bedside medication delivery, and education for at-risk patients, was associated with significantly fewer post-discharge VTE events.
Department of Surgery, Brigham and Women's Hospital, Boston, MA; Department of Quality and Safety, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, and Harvard TH Chan School of Public Health, Boston, MA. Electronic address: pnajjar@partners.org.
Peter A
PA
Najjar
Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Arin L
AL
Madenci
Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, and Harvard TH Chan School of Public Health, Boston, MA.
Cheryl K
CK
Zogg
Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, and Harvard TH Chan School of Public Health, Boston, MA.
Eric B
EB
Schneider
Department of Quality and Safety, Brigham and Women's Hospital, Boston, MA.
Christian A
CA
Dankers
Department of Quality and Safety, Brigham and Women's Hospital, Boston, MA.
Marc T
MT
Pimentel
Outpatient Pharmacy Division, Brigham and Women's Hospital, Boston, MA.
Amrita S
AS
Chabria
Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Joel E
JE
Goldberg
Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Gaurav
G
Sharma
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA.
Gregory
G
Piazza
Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Ronald
R
Bleday
Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Dennis P
DP
Orgill
Department of Quality and Safety, Brigham and Women's Hospital, Boston, MA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, and Harvard TH Chan School of Public Health, Boston, MA.
Allen
A
Kachalia
D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010388:Pelvis / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants
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