Population-Based Analysis of Adherence to Postdischarge Extended Venous Thromboembolism Prophylaxis After Colorectal Resection.

Background Prevention of venous thromboembolism after colorectal surgery remains challenging. National guidelines endorse thromboembolism prophylaxis for 4 weeks after colorectal cancer resection. Expert consensus favors extended prophylaxis after IBD surgery. The actual frequency of prescription after resection remains unknown. Objective This study aimed to assess prescription of extended, postdischarge venous thromboembolism prophylaxis after resection in Michigan. Design This is a retrospective review of elective colorectal resections within a statewide collaborative receiving postdischarge, extended-duration prophylaxis. Setting This study was conducted between October 2015 and February 2018 at an academic center. Patients A total of 5722 patients (2171 with colorectal cancer, 266 with IBD, and 3285 with other). Main outcome measures We compared the prescription of extended, postdischarge prophylaxis over time, between hospitals and by indication. Results Of 5722 patients, 373 (6.5%) received extended-duration prophylaxis after discharge. Use was similar between patients undergoing surgery for cancer (282/2171, 13.0%) or IBD (31/266, 11.7%, p = 0.54), but was significantly more common for both patients undergoing surgery for cancer or IBD in comparison with patients with other indications (60/3285, 1.8%, p 300 beds) were significantly more likely to prescribe extended-duration prophylaxis for all conditions (both p Limitations This study was limited by the lack of assessment of actual adherence, small number of observed venous thromboembolism events, small sample of patients with IBD, and restriction to the state of Michigan. Conclusions The use of extended-duration venous thromboembolism prophylaxis after discharge is increasing, but remains uncommon in most hospitals. Efforts to improve adherence may require quality implementation initiatives or targeted payment incentives. See Video Abstract at http://links.lww.com/DCR/B193. ANALISIS POBLACIONAL DE LA ADHERENCIA A LA PROFILAXIS ANTI-TROMBOTICA EXTENDIDA (TEV) EN PACIENTES DE ALTA LUEGO DE UNA RESECCION COLORECTAL.: La prevencion del tromboembolismo venoso despues de cirugia colorrectal sigue siendo un desafio. Las guias nacionales han aprobado la profilaxia del tromboembolismo durante cuatro semanas luego de una reseccion de cancer colorrectal. El consenso de expertos favorece la profilaxia extendida solamente despues de la cirugia por enfermedad inflamatoria intestinal. La frecuencia real de prescripcion despues de la reseccion colorrectal sigue siendo desconocida.Evaluar la prescripcion de profilaxia prolongada de tromboembolismo venoso despues del alta luego de una reseccion colorrectal en Michigan.Revision retrospectiva de las resecciones colorrectales electivas seguidas de una profilaxia de larga duracion con el apoyo de todo el estado (MI).Este estudio se realizo entre octubre de 2015 y febrero de 2018 en un solo centro academico.Un universo de 5722 pacientes operados (2171 por cancer colorrectal, 266 por enfermedad inflamatoria intestinal, 3285 por otros diagnosticos).Se comparo la prescripcion de profilaxia prolongada despues del alta segun la duracion, los hospitales y la indicacion.De 5722 pacientes, 373 (6.5%) recibieron profilaxia de duracion prolongada despues del alta. El uso fue similar entre pacientes sometidos a cirugia por cancer (282/2171, 13.0%) o enfermedad inflamatoria intestinal (31/266, 11.7%, p = 0.54), pero fue significativamente mas comun para ambos en comparacion con pacientes con otras indicaciones (60/3285, 1.8%, p 300 camas) tenian mayor probabilidad de prescribir la profilaxia de duracion extendida en todas las afecciones (ambas p