Extended VTE Chemoprophylaxis in Cancer Patients Undergoing Abdominopelvic Surgery at Community Hospitals

Thursday, September 15, 2022

1:20 PM – 1:40 PM East Coast USA Time

Location: JW Grand Ballroom 5-6

CE: .25

Reference 1: Alhassan, N., Trepanier, M., Sabapathy, C., Chaudhury, P., Liberman, A. S., Charlebois, P., Stein, B. L., & Lee, L. (2018). Risk factors for post-discharge venous thromboembolism in patients undergoing colorectal resection: A NSQIP analysis. Techniques in Coloproctology, 22(12), 955–964. https://doi.org/10.1007/s10151-018-1909-8

Reference 2: Key, N. S., Khorana, A. A., Kuderer, N. M., Bohlke, K., Lee, A. Y. Y., Arcelus, J. I., Wong, S. L., Balaban, E. P., Flowers, C. R., Francis, C. W., Gates, L. E., Kakkar, A. K., Levine, M. N., Liebman, H. A., Tempero, M. A., Lyman, G. H., & Falanga, A. (2020). Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. Journal of Clinical Oncology, 38(5), 496–520. https://doi.org/10.1200/JCO.19.01461
Reference 3: Morris, Z. S., Wooding, S., & Grant, J. (2011). The answer is 17 years, what is the question: Understanding time lags in translational research. Journal of the Royal Society of Medicine, 104(12), 510–520. https://doi.org/10.1258/jrsm.2011.110180

Member Speaker(s)

OE

Omar EL-GHAZZAWY, DO

General Surgery Resident
South Pointe- Cleveland Clinic
Cleveland Clinic South Pointe

Disclosure(s): No financial relationships to disclose

Slides

Disclosure(s):

Omar EL-GHAZZAWY, DO: No financial relationships to disclose

Objectives: Extended venous thromboembolism prophylaxis (eVTEp) has been recommended by the American Society of Clinical Oncology since 2007 and endorsed by The American Society of Colon and Rectal Surgeons in 2018. A general surgery group at 3 community hospitals implemented this recommendation and tracked patients for three months regarding VTE events in cancer patients following surgery. The intervention aimed to change the group practice from no prescription for eVTEp to 100% discharge prescription for qualifying patients.

Methods :
We conducted an interrupted time series for patients undergoing abdominopelvic surgery at the three affiliated community hospitals on all patients over age eighteen. We used quality improvement methodology to educate the staff and resident surgeons to discharge patients with prophylactic dosing of either Lovenox or Heparin. Prescribing habits and VTE events were tracked over six-month intervals. August of 2020 to February of 2021 was the pre-intervention period, and April 2021 to October 2021 was the intervention period.

Results:
The mean age for the pre-intervention group (n=18) was 71 at the time of surgery and 64.7 for those in the intervention group (n=23). Three patients in the pre-intervention group had a VTE event during the hospitalization or within three months from surgery. There were no recorded VTE events in the intervention group. Three patients in the intervention group did not have eVTEp prescribed on discharge; one patient’s cancer was pathologically confirmed after discharge. Three additional patients had medical conditions that prohibited eVTEp on discharge.

Conclusion:
Education increased the number of patients discharged on eVTEp after major abdominopelvic surgery for cancer. No VTE events were documented in the intervention group and we demonstrated the safety of eVTEp on discharge. Additional evaluations are needed to evaluate compliance and barriers to patients completing the eVTEp treatment.
Learning Objectives:
Upon completion participants will be able to define extended chemoprophylaxis in surgical cancer patients.
Upon completion participants will be able to understand the elevated risk of VTE events in surgical cancer patients
Upon completion participants will be able to understand it takes time and education for new clinical guidelines to be implemented in practice