Title : Re audit of extended thromboprophylaxis following abdominal and pelvic cancer surgery: Closing the gap in compliance
Abstract:
Background: Extended venous thromboembolism (VTE) prophylaxis — typically low molecular weight heparin (LMWH) for up to 4 weeks after major abdominal or pelvic cancer surgery — is supported by randomized controlled trials showing reduced postoperative VTE rates without a significant increase in bleeding risk [1,2]. Major guidelines, including NICE and ASCO, recommend extended prophylaxis for high-risk cancer surgery patients [3,4]. Despite this, realworld audits have demonstrated variable compliance across institutions [5]. This re-audit aimed to assess current adherence to NHS Tayside guidelines following implementation of targeted quality improvement measures.
Methods: A retrospective review was conducted of all patients undergoing major abdominal or pelvic cancer surgery between January and March 2024. Data were extracted from electronic patient records regarding prescription and administration of extended VTE prophylaxis. Compliance was assessed against NHS Tayside guidelines and compared with the previous audit cycle. The first audit cycle highlighted gaps in prescribing extended prophylaxis at discharge. In response, a series of targeted interventions were implemented, including delivering educational lectures during junior doctor induction, placing posters in the prescribing room to highlight protocol requirements, adding electronic prescribing reminders, and holding multidisciplinary meetings with pharmacists to reinforce discharge prescription checks
Results: Eighty-two patients were included. • Compliance rate: 66/82 patients (80.5%) received extended VTE prophylaxis. • Non-compliance: 16/82 patients (19.5%) did not receive the recommended prophylaxis. This represents an improvement from the prior audit but full adherence was not achieved. Barriers included omission at discharge prescribing, patient refusal, and clinical contraindications.
Conclusions: Implementation of targeted recommendations has improved compliance with extended VTE prophylaxis in abdominal and pelvic cancer surgery, but gaps remain. Strategies such as electronic prescribing prompts, discharge checklist integration, and staff education may further improve adherence. Continued monitoring is necessary to maintain progress.
Keywords: VTE prophylaxis, abdominal surgery, pelvic surgery, cancer, audit, quality improvement, reaudit
