Prevention of venous thromboembolism after elective surgery is better influenced by judgement than by protocols

Prophylaxis of venous thromboembolism in general surgery: guidelines differ and we still need local policies

INTRODUCTION

Venous thromboembolism (VTE) prophylaxis has become a major issue for surgeons both in the UK and worldwide. Several different sources of guidance on VTE prophylaxis are available but these differ in design and detail.

METHODS

Two similar audits were performed, one year apart, on the VTE prophylaxis prescribed for all general surgical inpatients during a single week (90 patients and 101 patients). Classification of patients into different risk groups and compliance in prescribing prophylaxis were examined using different international, national and local guidelines.

RESULTS

There were significant differences between the numbers of patients in high, moderate and low-risk groups according to the different guidelines. When groups were combined to indicate simply 'at risk' or 'not at risk' (in the manner of one of the guidelines), then differences were not significant. Our compliance improved from the first audit to the second. Patients at high risk received VTE prophylaxis according to guidance more consistently than those at low risk.

CONCLUSIONS

Differences in guidance on VTE prophylaxis can affect compliance significantly when auditing practice, depending on the choice of 'gold standard'. National guidance does not remove the need for clear and detailed local policies. Making decisions about policies for lower-risk patients can be more difficult than for those at high risk.