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Association Between Surgeon Practice Knowledge and Venous Thromboembolism

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Abstract

Background

The most common cause of mortality following bariatric surgery is venous thromboembolism. Our study aimed to (1) determine the practice patterns of venous thromboembolism (VTE) chemoprophylaxis among bariatric surgeons participating in a large statewide quality collaborative and (2) compare the results of surgeon self-reported chemoprophylaxis practices to actual practices from abstracted chart data.

Methods

We administered a 13-question survey to 66 surgeons across a statewide collaborative aimed at revealing VTE practice patterns such as medication type, dosage, timing, duration, and level of trainee involvement (response rate 93%). We conducted on-site data audits to examine the charts of all patients that had developed VTE during the study period and 15 other randomly selected patient charts per site. We then evaluated both the ordered perioperative chemoprophylaxis and the actual administered chemoprophylaxis from nursing and electronic records.

Results

There was 31% overall discordance between self-reported and abstracted chart data for pre-operative VTE dosing regimens. Among patients who had a VTE, 39% of administered chemoprophylaxis did not match surgeon responses. Conversely, among patients who did not have a VTE, only 29% were discordant (p = 0.03). In contrast, for post-operative VTE dosing, there was no significant difference in the rate of discordance in patients with and without a VTE (47% discordance vs 38%, p = 0.0552, respectively).

Conclusions

Greater discordance between surgeon self-reported and actual perioperative VTE chemoprophylaxis is associated with significantly increased risk of VTE. Further understanding of the system characteristics associated with these practices may yield insights into how best to improve appropriate VTE chemoprophylaxis.

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Authors and Affiliations

  1. Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Alirio de Meireles, Jonathan F. Finks, Oliver A. Varban & Amir A. Ghaferi

  2. Department of Surgery, Henry Ford Health System, Detroit, MI, USA

    Arthur M. Carlin

  3. Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA

    Anne Cain-Nielsen, Amanda Stricklen, Rachel Ross, Jonathan F. Finks, Oliver A. Varban & Amir A. Ghaferi

  4. Institute for Healthcare Policy & Innovation, University of Michigan, 2800 Plymouth Avenue Building 16, Rm 140-E, Ann Arbor, MI, 48109–2800, USA

    Amir A. Ghaferi

Authors
  1. Alirio de Meireles
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  2. Arthur M. Carlin
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  3. Anne Cain-Nielsen
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  4. Amanda Stricklen
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  5. Rachel Ross
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  6. Jonathan F. Finks
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  7. Oliver A. Varban
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  8. Amir A. Ghaferi
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Corresponding author

Correspondence to Amir A. Ghaferi.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

Dr. Ghaferi is supported through grants from the Agency for Healthcare Research and Quality (Grant Nos.: 5K08HS02362 and P30HS024403) and a Patient Centered Outcomes Research Institute Award (CE-1304-6596). Dr. Ghaferi receives salary support from Blue Cross Blue Shield of Michigan as the Director of the Michigan Bariatric Surgery Collaborative.

Drs. Finks and Varban receive salary support from Blue Cross Blue Shield of Michigan in association with their participation in the Michigan Bariatric Surgery Collaborative.

The remaining authors have no conflicts of interest nor sources of outside funding to declare.

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Appendix. Survey question sent to participating MBSC surgeons

Appendix. Survey question sent to participating MBSC surgeons

  • Q1: Do you use MBSC’s Risk Calculator for VTE – (Y/N)

  • Q2: Do you follow the MBSC guidelines for VTE prophylaxis – (Y/N)

  • Q3: Do you use sequential compression devices (SCDs) for your patients – (Y/N)

  • Q4: What do you give patients for VTE prophylaxis PRE-operatively? (LMWH, 5000U Sub-Q Heparin, No Pharmacologic Prophylaxis, Other)

  • Q5: What dose of LMWH do you give PRE-operatively? – (30mg, 40mg, weight-based prophylactic dose)

  • Q6: What do you give patients for VTE prophylaxis POST-operatively? – (LMWH Injection, Sub-Q Heparin)

  • Q7: What dose of SubQ heparin do you use POST-operatively – (500U q8hrs, 500U q12hrs)

  • Q8: What dose of LMWH do you use POST-operatively – (30mg once daily, 30mg twice daily, 40mg once daily, 40mg twice daily, weight-based prophylactic LMWH and if so please specify)

  • Q9: When is the first POST-operative dose of VTE prophylaxis given? – (day after surgery, night of surgery, other please specify)

  • Q10: Do you give POST-DISCHARGE VTE prophylaxis? – (Yes, always; Yes, if the MBSC guidelines for risk recommend it; Yes, but I don’t use the MBSC risk parameters; No)

  • Q11: What do you give patients for VTE prophylaxis POST-DISCHARGE? – (LMWH 30mg twice daily, LMWH 40mg once daily, LMWH 40mg twice daily, LMWH Weight Based, Other)

  • Q12: What duration of days do you give VTE prophylaxis POST-DISCHARGE? – (1–7, 8–14, 15–21, 22–28, 29–35)

  • Q13: Do you work with residents in your daily practice? – (Never, Sometimes/Always)

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de Meireles, A., Carlin, A.M., Cain-Nielsen, A. et al. Association Between Surgeon Practice Knowledge and Venous Thromboembolism. OBES SURG 30, 2274–2279 (2020). https://doi.org/10.1007/s11695-020-04468-6

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  • DOI: https://doi.org/10.1007/s11695-020-04468-6

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