Risk assessment and compliance with hospital guidelines for venous thromboprophylaxis after gynecological surgeries
Keywords:Audit, Thromboprophylaxis, Caprini RAM 2013, Adherence to guidelines, Gynecological surgery
Background and objective: Venous thromboembolism after gynecological surgery is a major cause of morbidity and mortality. This study aimed to determine the venous thromboembolism risk profile of women who underwent gynecological surgery at a tertiary hospital and review the prescribed venous thromboembolism prophylaxis.
Methods: An audit review study was conducted on 490 women who underwent major and minor gynecological surgeries at the Maternity Teaching Hospital, Erbil city, Kurdistan Region, Iraq, from 1st December 2019 to 31st December 2020, regarding their risk of developing postoperative venous thromboembolism using the 2013 modified Caprini venous thromboembolism risk assessment model to determine their risk and the correct thromboprophylaxis prescription.
Results: According to appropriate thromboprophylaxis administration of low molecular weight heparin, it was administered to two-thirds of the women. It was sufficient in 33.1% of the women, and only 8.2% of the women received it for the correct duration. The probability of incorrect decision was higher for the major surgeries than for minor surgeries [odds ratio (OR) = 15.5; 95% confidence interval (95% CI) =3.01–80.1]. Moderate risk carried a much higher probability of an incorrect decision than low risk (OR = 196.8; 95%CI = 30.4–1270.5), whereas the association with high risk was not significant. When low molecular weight heparin was administered, there was a higher probability of a wrong decision than when low molecular weight heparin was not administered (OR = 26.4; 95%CI = 7.1–97.6).
Conclusion: The gynecologists' adherence to venous thromboembolism prophylaxis after major and minor gynecological surgeries at the hospital mandates more training for all healthcare providers.
Snyman LC, Potgieter J. Venous thromboembolism: Risk profile and management of prophylaxis in gynaecological surgery patients. S Afr J Obstet Gynaecol. 2014;20(3):76–9. https://doi.org/10.7196/SAJOG.490
Shi J, Ye J, Zhuang X, Cheng X, FuR, Zhao A. Application value of Caprini risk assessment model and elevated tumor-specific D-dimer level in predicting postoperative venous thromboembolism for patients undergoing surgery of gynecologic malignancies. J Obstet Gynaecol Res. 2019;45(3):657–64. https://doi.org/10.1111/jog.13832
Shapiro R, Vogel JD, Kiran RP. Risk of postoperative venous thromboembolism after laparoscopic and open colorectal surgery: an additional benefit of the minimally invasive approach? Dis Colon Rectum. 2011;54:1496–502.
Sud S, Mittmann N, Cook DJ, Geerts W, Chan B, Dodek P, et al. Screening and prevention of venous thromboembolism in critically ill patients: A decision analysis and economic evaluation. Am J Respir Crit Care Med. 2011;184(11):1289–98. https://doi.org/10.1164/rccm.201106-1059OC
Pannucci CJ, Laird S, Dimick JB, Campbell DA, Henke PK. A validated risk model to predict 90-day VTE events in postsurgical patients. Chest. 2014;145(3):567–73.
Cronin M, Dengler N, Krauss ES, Segal A, Wei N, Daly M, et al. Completion of the updated Caprini risk assessment model (2013 version). Clin Appl Thromb Hemost. 2019;25:1–10. https://doi.org/10.1177/1076029619838052
Lyman GH, Khorana AA, Kuderer NM, Lee AY, Arcelus JI, Balaban EP, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31:2189–204.
Wang X, Huang J, Bingbing Zh, Li S, Li L. Risk factors, risk assessment, and prognosis in patients with gynecological cancer and thromboembolism. J Int Med Res. 2020;48(4):0300060519893173. https://doi.org/10.1177/0300060519893173
Stroud W, Whitworth JM, Miklic M, Schneider KE, Finan MA, Scalici J, et al. Validation of a venous thromboembolism risk assessment model in gynecologic oncology. Gynecol Oncol. 2014;134(1):160–3. https://doi.org/10.1016/j.ygyno.2014.04.051
Sturlese E, Triolo O, Grasso R, Laganà AS, Retto A, Rossetti D, et al. Thromboembolism prophylaxis in laparoscopic surgery for gynecologic benign diseases. Results of a single center experience in 922 procedures. Ann Ital Chir. 2017;88:342–7.
Krauss ES, Segal A, Cronin M, Dengler N, Lesser ML, Ahn S, et al. Implementation and validation of the 2013 Caprini score for risk stratification of arthroplasty patients in the prevention of venous thrombosis. Clin Appl Thromb Hemost. 2019;25:1076029619838066. https://doi.org/10.1177/1076029619838066
Sterbling HM, Rosen AK, Hachey KJ, Vellanki NS, Hewes Ph, Rao SR, et al. Caprini Risk Model Decreases Venous Thromboembolism Rates in Thoracic Surgery Cancer Patients. Ann Thorac Surg. 2018;105:879–85. https://doi.org/10.1016/j.athoracsur.2017.10.013
World Health Organization. Body mass index–BMI. (Accessed April 24, 2021, at https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi).
Illinois Medical Society. Are you at risk for DVT? (Accessed April 23, 2021, at https://www.venousdisease.com/caprini-dvt-risk-assessment.pdf).
Kahn S, Lim W, Dunn A, Cushman M, Dentali F, Akl E, et al. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2):e195S–226. https://doi.org/10.1378/chest.11-2296
Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic therapy for VTE disease. CHEST guideline and expert panel report. Chest. 2016;149(2):315–52.
Piróg MM, Jach R, Undas A. Thromboprophylaxis in women undergoing gynecological surgery or assisted reproductive techniques: new advances and challenges. Ginekol Pol. 2016;87(11):773–9. https://doi.org/10.5603/GP.2016.0086
Gao Y, Long A, Xie Z, Meng Y, Tan J, Lv H, et al. The compliance of thromboprophylaxis affects the risk of venous thromboembolism in patients undergoing hip fracture surgery. Springerplus. 2016;5(1):1362. https://doi.org/10.1186/s40064-016-2724-1
Zipple M, Itenberg E. Improving adherence to recommended venous thromboembolic prophylaxis in abdominal and pelvic oncologic surgery. Surgery. 2018;164(4):900–4. https://doi.org/10.1016/j.surg.2018.06.023
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