P. E. Serrano1,3,4, C. Griffiths1, A. Gafni3, S. Parpia2,3,4, L. Linkins5, M. Simunovic1,2,3 1McMaster University,Surgery,Hamilton, ONTARIO, Canada 2McMaster University,Oncology,Hamilton, ONTARIO, Canada 3McMaster University,Department Of Health Research Methods, Evidence, And Impact,Hamilton, ONTARIO, Canada 4Ontario Clinical Oncology Group,Hamilton, ONTARIO, Canada 5McMaster University,Medicine,Hamilton, ONTARIO, Canada
Introduction:
Venous thromboembolism (VTE) occurs in approximately 10% of patients following major abdominal cancer surgery. Recent practice guidelines recommend the routine use of VTE prophylaxis for 28 days following surgery, typically extending prophylaxis beyond hospital discharge. We sought to characterize and compare awareness, agreement, adoption, and adherence to these guidelines among colorectal and hepatobiliary surgeons.
Methods:
We electronically surveyed Canadian hepatobiliary surgeons registered with the Canadian Hepatopancreatobiliary Association, and, general surgeons and colorectal surgeons registered with the College of Physicians and Surgeons of Ontario and the Canadian Society of Colorectal Surgeons, respectively, who provide care for patients with colorectal cancer with a pilot-tested questionnaire. Attitudes to relevant guideline recommendations and perceived barriers to post-discharge VTE prophylaxis were assessed on a 5-point Likert scale. Comparisons between specialties and attitudes towards guidelines were performed using 1-way ANOVA and Kruskal-Wallis tests.
Results:
There were 128 responses (response rate 60%, 128/213), including 60 general/colorectal and 68 hepatobiliary surgeons. Most surgeons (122 /128, 95%) were aware, agreed (101/122, 83%), adopted (78/101, 77%) and adhered (74/78, 95%) with post-discharge VTE prophylaxis guidelines[MOU1] [CG2] . Hepatobiliary surgeons, compared to surgeons performing colorectal cancer surgery were more likely to agree (94% vs. 69%), adopt (88% vs. 59%) and adhere (98% vs. 86%) with these guidelines. Insufficient evidence (median Likert: 4, IQR 3-5) and low incidence of VTE (median Likert: 4, IQR 3-4) were cited as the strongest barriers among respondents that did not agree with post-discharge VTE prophylaxis. Surgeons that agreed but did not adopt post-discharge VTE prophylaxis programs reported that the most significant barriers were cost (median Likert: 4, IQR 3-4), low support from surgical colleagues (median Likert: 4, IQR 4-4) and difficulty of subcutaneous injections (median Likert: 4, IQR 3-4), whereas surgeons that adhered additionally reported “logistical challenges of prescribing” as one of the greatest barriers to implementation.
Conclusion:
There remains apprehension regarding implementation of post-discharge VTE prophylaxis following abdominal cancer surgery among non-hepatobiliary surgeons, citing poor evidence and cost of the medication as the major barriers. Uptake among hepatobiliary surgeons versus surgeons performing colorectal cancer surgery was higher.