Use of Computerized Clinical Decision Support Systems to Prevent Venous Thromboembolism in Surgical Patients

Borab, Zachary; Lanni, Michael A.; Tecce, Michael G.; Pannucci, Christopher J.; Fischer, John P.

doi:10.1001/jamasurg.2017.0131

Cited by 58 publications

(51 citation statements)

References 47 publications

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“…These clinical decision support tools have been shown to significantly increase the appropriate ordering of VTE prophylaxis and to significantly decrease the rate of VTE. 15 This review provides evidence-based recommendations on the prevention of VTE in OHNS, weighing the risks and benefits of alternative and overlapping prevention strategies with a focus on the unique risks in the OHNS population. Owing to the paucity of specialty-specific evidence, these should not be considered clinical practice guidelines, nor are they meant to supplant personalized assessment in the context of the doctor-patient relationship.…”

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confidence: 99%

Antithrombotic Therapy for Venous Thromboembolism and Prevention of Thrombosis in Otolaryngology–Head and Neck Surgery: State of the Art Review

Cramer

Shuman

Brenner

2018

Otolaryngol.--head neck surg.

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Objective The aim of this report is to present a cohesive evidence-based approach to reducing venous thromboembolism (VTE) in otolaryngology-head and neck surgery. VTE prevention includes deep venous thrombosis and pulmonary embolism. Despite national efforts in VTE prevention, guidelines do not exist for otolaryngology-head and neck surgery in the United States. Data Sources PubMed/MEDLINE. Review Methods A comprehensive review of literature pertaining to VTE in otolaryngology-head and neck surgery was performed, identifying data on incidence of thrombotic complications and the outcomes of regimens for thromboprophylaxis. Data were then synthesized and compared with other surgical specialties. Conclusions We identified 29 articles: 1 prospective cohort study and 28 retrospective studies. The overall prevalence of VTE in otolaryngology appears lower than that of most other surgical specialties. The Caprini system allows effective individualized risk stratification for VTE prevention in otolaryngology. Mechanical and chemoprophylaxis ("dual thromboprophylaxis") is recommended for patients with a Caprini score ≥7 or patients with a Caprini score of 5 or 6 who undergo major head and neck surgery, when prolonged hospital stay is anticipated or mobility is limited. For patients with a Caprini score of 5 or 6, we recommend dual thromboprophylaxis or mechanical prophylaxis alone. Patients with a Caprini score ≤4 should receive mechanical prophylaxis alone. Implications for Practice Otolaryngologists should consider an individualized and risk-stratified plan for perioperative thromboprophylaxis in every patient. The risk of bleeding must be weighed against the risk of VTE when deciding on chemoprophylaxis.

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confidence: 99%

Antithrombotic Therapy for Venous Thromboembolism and Prevention of Thrombosis in Otolaryngology–Head and Neck Surgery: State of the Art Review

Cramer

Shuman

Brenner

2018

Otolaryngol.--head neck surg.

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“…In our previous review, multifaceted interventions were found to be the most effective system-wide intervention in observational studies 35. In the most recent systematic review and meta-analysis, the use of computer-based clinical decision support system in observational studies was associated with an increased rate of ordering appropriate thromboprophylaxis and a reduced rate of VTE in hospitalised surgical patients 57. The additional findings from our updated review compared with other reviews are most likely due to the inclusion of the largest number of RCTs involving a large number of hospitalised medical and surgical patients at risk of VTE.…”

Section: Discussionmentioning

confidence: 98%

Effectiveness of interventions for the implementation of thromboprophylaxis in hospitalised patients at risk of venous thromboembolism: an updated abridged Cochrane systematic review and meta-analysis of randomised controlled trials

et al. 2019

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ObjectiveTo assess the effectiveness of system-wide interventions designed to increase the implementation of thromboprophylaxis and decrease the incidence of venous thromboembolism (VTE) in hospitalised medical and surgical patients at risk of VTE.DesignSystematic review and meta-analysis of randomised controlled trials (RCTs).Data sourcesMedline, PubMed, Embase, BIOSIS, CINAHL, Web of Science, CENTRAL, DARE, EED, LILACS and clinicaltrials.gov without language restrictions from inception to 7 January 2017, as well as the reference lists of relevant review articles.Eligibility criteria for selecting studiesRCTs that evaluated the effectiveness of system-wide interventions such as alerts, multifaceted, education, and preprinted orders when compared with no intervention, existing policy or another intervention.ResultsWe included 13 RCTs involving 35 997 participants. Eleven RCTs had data available for meta-analysis. Compared with control, we found absolute increase in the prescription of prophylaxis associated with alerts (21% increase, 95% CI [15% to 275%]) and multifaceted interventions (4% increase, 95% CI [3% to 11%]), absolute increase in the prescription of appropriate prophylaxis associated with alerts (16% increase, 95% CI [12% to 20%]) and relative risk reductions (risk ratio 64%, 95% CI [47% to 86%]) in the incidence of symptomatic VTE associated with alerts. Computer alerts were found to be more effective than human alerts, and multifaceted interventions with an alert component appeared to be more effective than multifaceted interventions without, although comparative pooled analyses were not feasible. The quality of evidence for improvement in outcomes was judged to be low to moderate certainty.ConclusionsAlerts increased the proportion of patients who received prophylaxis and appropriate prophylaxis, and decreased the incidence of symptomatic VTE. Multifaceted interventions increased the proportion of patients who received prophylaxis but were found to be less effective than alerts interventions.Trial registration numberCD008201.

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“…Routine screening for all possible risk factors may be difficult and may not be cost-effective. Previous studies have suggested that the use of computerized clinical decision support systems may contribute to a more systematic screening of patients for risk factors and select appropriate patients for chemoprophylaxis to prevent VTE in surgical patients [34],…”

Section: Discussionmentioning

confidence: 99%

Risk factors for symptomatic venous thromboembolism following surgery for closed ankle fractures: A case-control study

Stavem

Skjaker

Hoel

et al. 2020

Foot and Ankle Surgery

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Background: We analyzed risk factors for venous thromboembolism (VTE) within 6 months after surgery for closed ankle fractures Methods: This was a case-control study based on data from chart review in a cohort of patients having open reduction and internal fixation (ORIF) for closed ankle fractures in two large general hospitals 2009-2011. Cases with symptomatic VTE (pulmonary embolism or deep venous thrombosis) were identified in the cohort, and additional cases of VTE were identified by computerized search of discharge diagnoses in the same hospitals in 2004-2008 and 2012-2016. In total, we identified 60 cases with VTE and compared with 240 randomly selected controls among 998 patients without VTE in the cohort. Risk factors were assessed using logistic regression analysis. Results: Among cases, 27 (45%) had pulmonary embolism, 33 (55%) deep venous thrombosis. Those with VTE were older, had higher BMI, had more often a family history of VTE, and more often had antibiotic prophylaxis during surgery than controls. In multivariable logistic regression analysis age/10 (OR 25.75, 95%CI 3,52 to 188.44, p=0.001), (age/10) 2 (OR 0.77, 95%CI 0.65 to 0.93, p=0.005), BMI (1.15 per kg/m 2 , 95%CI 1.07 to 1.24, p<0.001) and Charlson comorbidity index ≥2 vs.0 (OR 0.27, 95%CI 0.08 to 0.92, p=0.036) and 1 vs. 0 (OR 0.27, 95%CI 0.09 to 0.86, p=0.026) were associated with VTE within 6 months of surgery. Conclusions: The odds of symptomatic VTE within 6 months of ORIF increased with increasing age and BMI, but were lower with increasing comorbidity.

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Use of Computerized Clinical Decision Support Systems to Prevent Venous Thromboembolism in Surgical Patients

Abstract: Use of CCDSSs increases the proportion of surgical patients who were prescribed adequate prophylaxis for VTE and correlates with a reduction in VTE events.

Cited by 58 publications

References 47 publications

Antithrombotic Therapy for Venous Thromboembolism and Prevention of Thrombosis in Otolaryngology–Head and Neck Surgery: State of the Art Review

Antithrombotic Therapy for Venous Thromboembolism and Prevention of Thrombosis in Otolaryngology–Head and Neck Surgery: State of the Art Review

Effectiveness of interventions for the implementation of thromboprophylaxis in hospitalised patients at risk of venous thromboembolism: an updated abridged Cochrane systematic review and meta-analysis of randomised controlled trials

Risk factors for symptomatic venous thromboembolism following surgery for closed ankle fractures: A case-control study

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