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P U L M O N A R Y E M B O L I S M FACS, RVT, RPVI, a vascular surgeon from decisions to start cases that don't include some type of prophylaxis against deep venous thrombosis. "The culture here is such that if a patient is not being prophylaxed for DVT, we want to know why," says Carl R. Boyd, MD, FACS, Memorial's medical director of Fast Facts About Pulmonary Embolism • Remains the most common preventable cause of death in hospitals. • 80% of PE occurs without symptoms. • Two-thirds of deaths occur within 30 minutes. — Dan O'Connor Medicare is now linking hospital reimbursements to how well faciliPREVENTABLE CAUSE OF DEATH Venous thromboembolism occurs when a blood clot forms in deep veins in the legs, travels to another part of the body and blocks blood flow to vital organs such as the lungs. ties ensure recommended venous thromboembolism prophylaxis is administered. Memorial wasn't always so vigilant Staying Vigilant Against about preventing blood clots from Deep Vein Thrombosis forming after surgery. It wasn't until Prophylaxis should be the rule for most every patient, not the exception. the hospital began participating in the Dan O'Connor | Editor-in-Chief Improvement Program a few years C National Surgical Quality oncern spreads through the staff at ago that it made DVT prevention a top priori- Memorial University Medical ty for performance improvement. Hospitals Center in Savannah, Ga., if a participating in NSQIP, a national bench- patient doesn't get a sequential compres- marking program administered by the sion device or subcutaneous heparin American College of Surgeons, report on 9 before a case starts. Surgeons and staff categories of surgical complications, includ- have been conditioned to second-guess ing pulmonary embolism and venous throm- 4 2 SUPPLEMENT TO O U T PAT I E N T S U R G E R Y M A G A Z I N E | J A N U A R Y 2013 that will alert you to a patient who's at risk for clotting. • Patient history. Screen patients based on age (risk rises steadily from age 40), obesity, malignancy, history of DVT or PE, immobilization (bed rest, paralysis of legs, plaster casts), pregnancy and puerperium, perioperative services. That bodes well for Memorial, because St. Petersburg, Fla., of the several factors and oral contraceptive use. "Patients with PREVENTION At least 90% of pulmonary emboli are thought to originate in major leg veins. Intermittent pneumatic leg compression enhances blood flow in the deep veins. acquired (cancer) or inherited (lupus) hypercoaguable states are at risk, says Dr. Mackay. "When the blood's not flowing well, clots can form," he says. Patients with inflammatory bowel disease (IBD) bosis. NSQIP reports back to hospitals how they're doing compared to national benchmarks. undergoing surgery are at increased risk for developing DVT or PE. The risk appears to be even higher for patients with IBD who are having non-intestinal surgery, 'Heparin or hose' There's nothing complicated about DVT prevention. An injectable anticoagulant, compression boots or elastic stockings alone or in combination are effective at keeping blood flowing and decreasing DVT risk. "You have to have an index of suspicion according to a study in the February 2012 Archives of Surgery. • Type of surgery. Hip and knee surgery, venous procedures, abdominal surgery, gynecological surgery (particularly in older women) and major surgery lasting longer than 30 minutes are associated with significant risk. to prevent DVT," says Edward Mackay, MD, J A N U A R Y 2013 | S U P P L E M E N T • Type of anesthesia. Recent studies have TO O U T PAT I E N T S U R G E R Y M A G A Z I N E 4 3