Caprini guideline indicated venous thromboembolism (VTE) prophylaxis among inpatient surgical patients: are there racial/ethnic differences in practice patterns and outcomes? - 07/06/24

Doi : 10.1016/j.amjsurg.2024.115785

Michael A. Edwards ^a,^⁎ , Mark Falstin ^a, Akash Uddandam ^b, Emily Brennan ^c, Aaron Spaulding ^c
^a Mayo Clinic, Department of Surgery, Division of Advanced GI and Bariatric Surgery, Jacksonville, FL, 32224, USA
^b McMaster University, Department of Health Sciences, Hamilton, Ontario, L8S 4L8, Canada
^c Mayo Clinic, Robert D. and Patricia E. Kern Center, Division of Health Care Delivery Research, Jacksonville, FL, 32224, USA

^⁎Corresponding author. Mayo Clinic Alix School of Medicine, Department of Surgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.Mayo Clinic Alix School of MedicineDepartment of SurgeryMayo Clinic4500 San Pablo Rd SJacksonvilleFL32224USA

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Abstract

Background

While racial disparity in surgical mortality due to venous thromboembolism (VTE) has improved, a gap persists. Our study aim was to determine differences in VTE prevention practices and their impact on outcomes among racial surgical cohorts.

Methods

Elective surgeries performed between 1.1.2016 and 5.31.2021 were included. Racial/ethnic cohorts were propensity-matched 1:1 to non-Hispanic White (NHW) patients, and outcomes were compared using unadjusted logistic regression. Match cohort balance was assessed using absolute standardized mean differences and linear model analysis of variance (ANOVA). Pearson's Chi-square tests evaluated bi-variate associations. Conditional logistic regression to compare outcomes between matched groups. Odds ratios, 95 % confidence intervals, and p-values are reported. Analyses were performed using R version 4.1.2 and the R package Matchit.

Results

Non-Hispanic other race (NHOR) (vs. NHW) patients were less likely to receive inpatient prophylaxis (OR 0.86, CI:0.76–0.98). Appropriate prophylaxis resulted in similar VTE for NHB (p = 0.71) and Hispanic (p = 0.06), compared to NHW patients. Inpatient bleeding was higher in Hispanic patients with a higher likelihood of receiving appropriate prophylaxis (OR 1.94, CI:1.16–3.32) and NHOR patients with a lower likelihood (OR 1.90, CI:1.10–3.36)

Conclusion

Postoperative VTE was similar for minority patients receiving appropriate prophylaxis, compared to NHW patients. Inpatient bleeding was more likely in Hispanic and NHOR patients but may not be related to receiving appropriate prophylaxis. NHOR patients were less likely to receive inpatient thromboprophylaxis.

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Highlights

•	Receipt of Caprini guideline indicated VTE prophylaxis varied by race/ethnicity.
•	VTE outcomes were similar when racial/ethnic cohorts received apppropriate risk-based prophylaxis.
•	Bleeding was higher in Hispanic and NHOR patients.
•	Postoperative bleeding is likely multifactorial, and may be independent of VTE prophylaxis.

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Keywords : Venous thromboembolism, Caprini score, Prophylaxis, Race/ethnic, Disparity