GS19 - Implementation and Evaluation of Extended VTE Chemoprophylaxis in Cancer Patients Undergoing Abdominopelvic Surgery at Community Hospitals

Introduction/Purpose: Patients undergoing major abdominopelvic surgery in the setting of malignancy are at increased risk of venous thromboembolic events. These complications are due to culmination of factors including hypercoagulability due to cancer, venous stasis during operation, and endothelial injury of vessels during surgery. Guidelines for extended venous thromboembolic chemoprophylaxis has been endorsed by American Society of Clinical Oncology since 2007 and recently further endorsed by the American Society of Colon and Rectal Surgeons in 2018, yet it is not commonly prescribed for post-operative patients after discharge. This study aimed to show that education on updated guidelines can lead to improved adherence to these guidelines.

Methods or Case Description: The quality improvement study took place in Cleveland, Ohio at three different community hospitals. This was accomplished with an interrupted time series of two six-month intervals for patients undergoing major abdominal or pelvic surgery. First six months generated the pre-intervention group to determine how many people were diagnosed with cancer and had surgeries during that time. After this the general surgery attendings and residents were emailed with education materials regarding the new guidelines and then their prescribing habits were studied.

Outcomes: During the pre-intervention time frame August 2020 to February 2021, 24 patients were diagnosed with cancer and 19 of them underwent surgery, and two were prescribed venous thromboembolic chemoprophylaxis on discharge. During the intervention time frame April 2021 to October 2021, 23 underwent surgery and 16 were discharged with venous thromboembolic chemoprophylaxis of either Heparin or Lovenox.

Conclusion: Although the study was able to demonstrate an increase in prescribing extended chemoprophylaxis, it was not able to show a 100% increase. This was due to unforeseen circumstances such as miscommunication with primary team at time of discharge or if they were on already on anticoagulation prior to surgery. Additional follow up studies s are needed to track patient compliance, barriers to treatment completion, and other methods of education that may increase prescribing habits even more.
No VTE events such as DVT, PE, or portal vein thrombus were documented in the intervention group three months after their surgery and there was no associated bleeding risk thus demonstrating the safety of eVTEp was on discharge. Providing education to staff did improve prescribing habits of the surgery team for extended chemoprophylaxis, but the small sample size limits generalizability. A larger sample size could be used to test the education methods and determine the best way to increase the number of patients going home with an extended course of chemoprophylaxis after surgery.