Evaluation of a Standardized Risk-Based Venous Thromboembolism Prophylaxis Protocol in the Setting of Thyroid and Parathyroid Surgery.
BACKGROUND
An elevated odds ratio for venous thromboembolism (VTE) prompted development of a Caprini risk assessment and risk-based prophylaxis protocol for all general surgery patients. This system includes pre- and postoperative prophylactic heparin as well as extended courses of low molecular weight heparin for high-risk patients. This study evaluated the safety of this chemoprophylaxis program in thyroid and parathyroid surgery.


METHODS
A retrospective review was conducted of all general surgery patients undergoing thyroid or parathyroid operations after implementation of the Caprini prophylaxis protocol. Descriptive statistics were performed to evaluate bleeding complications, risk score categories, and chemoprophylaxis.


RESULTS
Of 1,012 consecutive patients, 72% were determined to be at low/moderate risk for VTE, 26% were high risk, and 2% were highest risk. Only 29% of eligible high/highest-risk patients actually received extended prophylaxis after discharge. Fifteen patients (1.5%) developed wound hematomas that required evacuations, 12 of them within 24 hours of the index operation. Among patients who developed bleeding complications, 5 (33%) had Caprini scores indicating low/moderate-risk for VTE, and 10 (67%) were in the high/highest-risk categories. Only 1 patient developed a delayed hematoma that required a return to the hospital for evacuation. One patient developed a VTE complication.


CONCLUSIONS
Although the incidence of VTE is quite low for patients undergoing thyroid and parathyroid operations, the Caprini prophylaxis protocol identifies a subset of high-risk patients who may benefit from extended VTE prophylaxis without the likelihood of added harm. Conversely, Caprini scores might also select low-risk patients who require no chemoprophylaxis, possibly reducing risks of hemorrhage.
Department of Surgery, Boston Medical Center, Boston, MA. Electronic address: ryan.macht@bmc.org.
Ryan
R
Macht
Department of Surgery, Oregon Health and Science University, Portland, OR.
Ivy
I
Gardner
Department of Surgery, Boston Medical Center, Boston, MA.
Stephanie
S
Talutis
Department of Surgery, Boston Medical Center, Boston, MA.
Pamela
P
Rosenkranz
Department of Surgery, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA.
Gerard
G
Doherty
Department of Surgery, Boston Medical Center, Boston, MA.
David
D
McAneny
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D002985:Clinical Protocols; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures; D010280:Parathyroid Glands / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D013961:Thyroid Gland / Q000601:surgery*; D054556:Venous Thromboembolism / Q000517:prevention & control*
D000925:Anticoagulants; D006493:Heparin