Original Communication| Volume 144, ISSUE 1, P3-11, July 2008

A 10-year analysis of venous thromboembolism on the surgical service: The effect of practice guidelines for prophylaxis


      There is a national effort to decrease the incidence of venous thromboembolism (VTE) in surgical patients by encouraging compliance with established guidelines for prophylaxis. Reported compliance with these guidelines has been poor. The outcome of noncompliance in terms of morbidity and mortality in surgical patients is unknown. We sought to determine if there has been a decrease in the incidence of symptomatic VTE since implementation of the guidelines and whether there has been compliance with the guidelines in individual patients; we also analyzed the outcome of a cohort with VTE.


      We reviewed the records of all patients with symptomatic VTE on 3 surgery services over the 10-year period since initial publication of the guidelines. We determined in each patient whether there was compliance with the guidelines. We weighted the morbidity of each episode of VTE based on the likelihood of short-term mortality and long-term morbidity to determine the disease burden.


      Of 37,615 patients, 172 developed a VTE (0.46%), and the incidence increased gradually over the years of the study. There was partial or complete compliance with the guidelines in 84% of the patients, but 37% of the VTEs were considered to be preventable. The disease burden was greatest in the higher-risk patients—there were 20 deaths (6%), 4 of which were caused by a pulmonary embolus.


      Despite one of the highest published rates of compliance with the guidelines for prophylaxis, the rate of symptomatic VTE is increasing.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Geerts W.H.
        • Pineo G.F.
        • Heit J.A.
        • et al.
        Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy.
        Chest. 2004; 126: 338-400
        • Clagett G.P.
        • Anderson Jr., F.A.
        • Heit J.
        • et al.
        Prevention of venous thromboembolism.
        Chest. 1998; 114: 531-560
        • Clagett G.P.
        • Anderson Jr., F.A.
        • Heit J.
        • Levine M.N.
        • Wheeler H.B.
        Prevention of venous thromboembolism.
        Chest. 1995; 108: 312-334
        • Geerts W.H.
        • Heit J.
        • Clagett G.P.
        • et al.
        Prevention of venous thromboembolism.
        Chest. 2001; 119: 132-175
        • Gangireddy C.
        • Rectenwald J.R.
        • Upchurch G.R.
        • et al.
        Risk factors and clinical impact of postoperative symptomatic venous thromboembolism.
        J Vasc Surg. 2007; 45: 335-342
        • Tooher R.
        • Middleton P.
        • Pham C.
        • et al.
        A systematic review of strategies to improve prophylaxis for venous thromboembolism in hospitals.
        Ann Surg. 2005; 241: 397-415
        • Kucher N.
        • Koo S.
        • Quiroz R.
        • et al.
        Electronic alerts to prevent venous thromboembolism among hospitalized patients.
        N Engl J Med. 2005; 352: 969-977
        • Rogers F.B.
        Venous thromboembolism in trauma patients: a review.
        Surgery. 2001; 130: 1-12
        • Rogers F.B.
        • Shackford S.R.
        • Ricci M.A.
        • Wilson J.T.
        • Parsons S.
        Routine prophylactic vena cava filter insertion in severely injured trauma patients decreases the incidence of pulmonary embolism.
        J Am Coll Surg. 1995; 180: 641-647
        • Rogers F.B.
        • Cipolle M.D.
        • Velmahos G.
        • Rozycki G.
        • Luchette F.A.
        Practice management guidelines for the prevention of venous thromboembolism in trauma patients: The EAST practice management guidelines work group.
        J Trauma. 2002; 53: 142-164
        • Shackford S.R.
        • Moser K.M.
        Deep venous thrombosis and pulmonary embolism in trauma patients.
        J Intensive Care Med. 1988; 3: 87-98
        • Healey M.A.
        • Shackford S.R.
        • Osler T.
        • Rogers F.B.
        • Burns E.
        Complications in surgical patients.
        Arch Surg. 2002; 137: 611-618
        • Bertges D.J.
        • Shackford S.R.
        • Cloud A.K.
        • et al.
        Toward optimal recording of surgical complications: concurrent tracking compared to the discharge data set.
        Surgery. 2007; 141: 19-31
        • Caprini J.A.
        Thrombosis risk assessment as a guide to patient care.
        Dis Mon. 2005; 51: 70-78
        • Lonner J.H.
        • Frank J.J.
        • McGuire K.
        • Lotke P.A.
        Post-thrombotic syndrome after a symptomatic deep vein thrombosis following total knee and hip arthroplasty.
        Am J Orthop. 2006; 35: 469-477
        • Moser K.M.
        • LeMoine J.R.
        Is embolic risk conditioned by the location of deep vein thrombosis?.
        Ann Intern Med. 1981; 94: 439-446
        • Cushman M.
        Epidemiology of risk factors for venous thromboembolism.
        Semin Hematology. 2007; 44: 62-69
        • Shackford S.R.
        • Davis J.W.
        • Hollinsworth-Fridlund P.
        • Brewer N.S.
        • Hoyt D.B.
        • Mackersie R.C.
        Venous thromboembolism in patients with major trauma.
        Amer J Surg. 1990; 159: 365-369
        • Haut E.R.
        • Noll K.
        • Efron D.T.
        • et al.
        Can increased incidence of deep vein thrombosis (DVT) be used as a marker of quality of care in the absence of standardized screening? The potential effect of surveillance bias on reported DVT rates after trauma.
        J Trauma. 2007; 63: 1131-1135
        • Velmahos G.
        • Kern J.
        • Chan L.S.
        • Oder D.
        • Murray J.
        • Shekelle P.
        Prevention of venous thromboembolism after injury: an evidence-based report—part I: analysis of risk factors and evaluation of the role of vena caval filters.
        J Trauma. 2000; 49: 132-139
        • Altpeter T.
        • Luckhardt K.
        • Lewis J.N.
        • Harken A.H.
        • Polk Jr., H.C.
        Expanded surgical time out: a key to real-time data collection and quality improvement.
        J Am Coll Surg. 2007; 204: 527-534
        • Iezzoni L.I.
        Risk and outcomes.
        in: Iezzoni L.I. Risk adjustment for measuring healthcare outcomes. 2nd ed. Health Administration Press, Chicago1997 (1-41)
        • Arnold D.M.
        • Kahn S.R.
        • Shrier I.
        Missed opportunities for prevention of venous thromboembolism: an evaluation of the use of thromboprophylaxis guidelines.
        Chest. 2001; 120: 1964-1971
        • Muntz J.
        • Scott D.A.
        • Lloyd A.
        • Egger M.
        Major bleeding rates after prophylaxis against venous thromboembolism: systematic review, meta-analysis, and cost implications.
        Int J Technol Assess Health Care. 2004; 20: 405-414

      Linked Article