Title : Outcome of the Venous Thromboembolism (VTE) prevention protocol combined with Enhanced Recovery After Surgery (ERAS) for acute care surgery patients: A retrospective study of tertiary center
Abstract:
Introduction
An emergency general surgery has limitation for the VTE risk assessment and prophylaxis. The significanlimitation is when pharmacological VTE prophylaxis cannot given. The ERAS protocol is encouraged for all type of surgery but still no best protocol for emergency surgery, but an early ambulation is the key success of both VTE prophylaxis and ERAS. So, if we combine some elements of ERAS and VTE risk assessment and prophylaxis may decrease risk and improve outcomes of VTE events in emergency general surgery patients.
Methodology
We retrospective comparison between before and after implement of VTE prophylaxis protocol to emergency general patients. All demographic data and risk factor were collected and compared. The primary outcome were incidence of VTE event and dead from VTE event. A secondary outcome is compliance to protocol in emergency surgery.
Results
In total of 246 patients, an average age was 57(+20) years. Compliance to VTE prophylaxis protocol from multidisciplinary team is 99%. Postoperative prophylaxis by pharmacological is 2 (1%), mechanical 66 (27%), and early ambulation of ERAS 159 (65%). Application of VTE protocol is significant lower dead rate in univariable analysis of emergency surgical patients, OR 0.18 (0.05-0.65), p-value = 0.009, but no statistical different in multivariable by adjust OR 0.84 (0.12-5.82), p-value = 0.862. The VTE event is significant lower when apply VTE protocol in both univariable and multivariable, OR 0.01 (0.00-0.11), p-value <0.001 and adjust OR 0.04 (0.00-0.40), p-value = 0.006.
Conclusion
VTE prophylaxis protocol is lower postoperative VTE event, pulmonary embolism rate, and dead in emergency general surgery patients. When pharmacological prophylaxis for VTE cannot provide. Early ambulation according to ERAS protocol is better than nothing to reduce VTE events and dead.
Audience Take Away Notes:
- Audience will be able to use the information and hopefully incorporate VTE prophylaxis protocol and Early ambulation of ERAS to prevent the VTE incidence and dead rate in emergency general surgery patients.
- This will help Quality improvement in patient care and reduce VTE and dead rate.
