Electronic health record risk-stratification tool reduces venous thromboembolism events in surgical patients

Radhika Rastogi, MD; Courtney M. Lattimore, MD; J. Hunter Mehaffey, MD, MSc; Florence E. Turrentine, PhD, RN; Hillary S. Maitland, MD, MS; Victor M. Zaydfudim, MD, MPH

Surgery Open Science (Jul 2022)

Electronic health record risk-stratification tool reduces venous thromboembolism events in surgical patients

Radhika Rastogi, MD,
Courtney M. Lattimore, MD,
J. Hunter Mehaffey, MD, MSc,
Florence E. Turrentine, PhD, RN,
Hillary S. Maitland, MD, MS,
Victor M. Zaydfudim, MD, MPH

Affiliations

Radhika Rastogi, MD: Department of Surgery, University of Virginia, Charlottesville, VA 22908
Courtney M. Lattimore, MD: Department of Surgery, University of Virginia, Charlottesville, VA 22908; Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA 22908
J. Hunter Mehaffey, MD, MSc: Department of Surgery, University of Virginia, Charlottesville, VA 22908
Florence E. Turrentine, PhD, RN: Department of Surgery, University of Virginia, Charlottesville, VA 22908; Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA 22908
Hillary S. Maitland, MD, MS: Department of Medicine, Hematology/Oncology, University of Virginia, Charlottesville, VA 22908
Victor M. Zaydfudim, MD, MPH: Department of Surgery, University of Virginia, Charlottesville, VA 22908; Surgical Outcomes Research Center, University of Virginia, Charlottesville, VA 22908; Corresponding author at: Division of Surgical Oncology, Department of Surgery, PO Box 800709, Charlottesville, VA, 22908-0709. Tel.: +1-434-924-2839; fax: +1 434-982-4778.

Journal volume & issue: Vol. 9
pp. 34 – 40

Abstract

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Background: Venous thromboembolism is a preventable cause of morbidity and mortality after surgery. To ensure that patients receive appropriate venous thromboembolism chemoprophylaxis, a nonmandatory risk-stratification tool based on patient clinical condition was implemented through the electronic health record to stratify patient risk and recommend chemoprophylaxis. We hypothesized that implementing this tool would reduce postoperative venous thromboembolism events in general surgery as well as across all surgical services. Methods: All adult patients undergoing inpatient surgical operations (January 2012–December 2019) at a single quaternary care center and Level 1 trauma center were abstracted from institutional electronic health record database and stratified into patients admitted before and after venous thromboembolism risk-stratification tool implementation. Bivariable analyses compared venous thromboembolism chemoprophylaxis prescription and venous thromboembolism events with implementation and screening among all surgical patients as well as in general surgery patient subset. Results: A total of 64,377 adults underwent operations: 27,819 preimplementation and 36,558 postimplementation. A significant reduction in venous thromboembolism events occurred from pre- to post-tool implementation for all cases (0.77% vs 0.47%, P < .001). General surgery patients (n = 15,723) had a significant increase in chemoprophylaxis prescription (81.9% vs 86.0%, P < .001) and a significant reduction in venous thromboembolism events (1.41% vs 0.59%, P < .001). After tool implementation, use of extended postdischarge chemoprophylaxis was greater among general surgery patient subset than the entire patient cohort (46.7% vs 29.6%, P < .001). Conclusion: The integration of a nonmandatory electronic health record risk-stratification tool was associated with a significant reduction in venous thromboembolism events. Extended chemoprophylaxis was prescribed in nearly half of general surgery patients at very high risk for postdischarge events.

Published in Surgery Open Science

ISSN: 2589-8450 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://www.journals.elsevier.com/surgery-open-science/

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