Variations in practice of thromboprophylaxis across general surgical subspecialties: a multicentre (PROTECTinG) study of elective major surgeries
Corresponding Author
David S. Liu PhD, FRACS
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Department of Surgery, Northern Health, Melbourne, Victoria, Australia
Department of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
Correspondence
Dr David S. Liu, Department of Surgery and Perioperative Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042, Australia. Email: [email protected]
Contribution: Conceptualization, Methodology, Formal analysis, Project administration, Supervision, Validation, Writing - original draft, Writing - review & editing
Search for more papers by this authorSean Stevens MSurgEd, FRACS
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Austin Precinct, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
Contribution: Conceptualization, Methodology, Project administration, Supervision, Validation, Writing - review & editing
Search for more papers by this authorEnoch Wong MBBS, FRACS
Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
Contribution: Conceptualization, Methodology, Supervision, Project administration, Validation, Writing - review & editing
Search for more papers by this authorJonathan Fong MBBS, FRACS
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Contribution: Conceptualization, Methodology, Project administration, Supervision, Validation, Writing - review & editing
Search for more papers by this authorKrinal Mori MS, FRACS
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Department of Surgery, Northern Health, Melbourne, Victoria, Australia
Northern Precinct, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
Contribution: Conceptualization, Methodology, Project administration, Supervision, Validation, Writing - review & editing
Search for more papers by this authorNicola Fleming MD
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorPith Soh Beh MBBS
Department of Surgery, Northern Health, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorAmy Crowe MBBS
Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorTess Howard MD
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorMaeve Slevin MBChB
Department of Surgery, Northern Health, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorAnshini Jain MBBS, FRACS
Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorAnna Sonia Gill MBBS
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorSharon Lee BBioMed, MD
Department of Surgery, Northern Health, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorWael Jamel MBChB
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorSimon Bennet MBBS
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorChi Chung MBBS
Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
Search for more papers by this authorSalena Ward MS, FRACS
Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
Monash University Eastern Health Clinical School, Melbourne, Victoria, Australia
Contribution: Investigation, Methodology, Writing - review & editing
Search for more papers by this authorVijayaragavan Muralidharan PhD, FRACS
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Austin Precinct, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
Contribution: Investigation, Methodology, Supervision, Writing - review & editing
Search for more papers by this authorVERITAS collaborative
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Search for more papers by this authorCorresponding Author
David S. Liu PhD, FRACS
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Department of Surgery, Northern Health, Melbourne, Victoria, Australia
Department of Surgery and Perioperative Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
Correspondence
Dr David S. Liu, Department of Surgery and Perioperative Medicine, Flinders Medical Centre, Flinders Drive, Bedford Park, SA 5042, Australia. Email: [email protected]
Contribution: Conceptualization, Methodology, Formal analysis, Project administration, Supervision, Validation, Writing - original draft, Writing - review & editing
Search for more papers by this authorSean Stevens MSurgEd, FRACS
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Austin Precinct, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
Contribution: Conceptualization, Methodology, Project administration, Supervision, Validation, Writing - review & editing
Search for more papers by this authorEnoch Wong MBBS, FRACS
Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
Contribution: Conceptualization, Methodology, Supervision, Project administration, Validation, Writing - review & editing
Search for more papers by this authorJonathan Fong MBBS, FRACS
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Contribution: Conceptualization, Methodology, Project administration, Supervision, Validation, Writing - review & editing
Search for more papers by this authorKrinal Mori MS, FRACS
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Department of Surgery, Northern Health, Melbourne, Victoria, Australia
Northern Precinct, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
Contribution: Conceptualization, Methodology, Project administration, Supervision, Validation, Writing - review & editing
Search for more papers by this authorNicola Fleming MD
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorPith Soh Beh MBBS
Department of Surgery, Northern Health, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorAmy Crowe MBBS
Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorTess Howard MD
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorMaeve Slevin MBChB
Department of Surgery, Northern Health, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorAnshini Jain MBBS, FRACS
Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorAnna Sonia Gill MBBS
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorSharon Lee BBioMed, MD
Department of Surgery, Northern Health, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorWael Jamel MBChB
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorSimon Bennet MBBS
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Contribution: Data curation, Investigation, Methodology, Writing - review & editing
Search for more papers by this authorChi Chung MBBS
Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
Search for more papers by this authorSalena Ward MS, FRACS
Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
Monash University Eastern Health Clinical School, Melbourne, Victoria, Australia
Contribution: Investigation, Methodology, Writing - review & editing
Search for more papers by this authorVijayaragavan Muralidharan PhD, FRACS
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Austin Precinct, Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
Contribution: Investigation, Methodology, Supervision, Writing - review & editing
Search for more papers by this authorVERITAS collaborative
Department of Surgery, Austin Health, Melbourne, Victoria, Australia
Search for more papers by this authorAbstract
Background
Despite guidelines recommending perioperative thromboprophylaxis for patients undergoing general surgery, we have observed significant variations in its practice. This may compromise patient safety. Here, we quantify the heterogeneity of perioperative thromboprophylaxis across all major general surgical operations, and place them in relation to their risk of bleeding and venous thromboembolism.
Methods
Retrospective review of all elective major general surgeries performed between 1 January 2018 and 30 June 2019 across seven Victorian hospitals was conducted.
Results
A total of 5912 patients who underwent 6628 procedures were reviewed. Significant heterogeneity was found in the use of chemoprophylaxis, timing of its initiation, type of anticoagulant administered and application of extended chemoprophylaxis. These variations were observed within the same procedure, and between different surgeries and subspecialties. Contrastingly, there was minimal heterogeneity with the use of mechanical thromboprophylaxis. Oesophago-gastric, liver and colorectal cancer resections had the highest thromboembolic risk. Breast, oesophago-gastric, liver, pancreas and colon cancer resections had the highest bleeding risk.
Conclusion
Perioperative chemoprophylaxis across general surgery is highly variable. This study has highlighted key areas of variance. Our findings also enable surgeons to compare their practices, and provide baseline data to inform future efforts towards optimizing thromboprophylaxis for general surgical patients.
Conflicts of interest
None declared.
Supporting Information
| Filename | Description |
|---|---|
| ans16374-sup-0001-Tables.docxWord 2007 document , 34.9 KB | Table S1. Australian Classification for Health Intervention codes for general surgery and its subspecialties. Table S2. International Classification of Diseases 10 codes for surgical complications. Table S3. Thromboprophylaxis in general surgery. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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