Surgical Thrombo-Embolism Prevention: Implementation and impact of a risk-stratified thromboprophylaxis model on postoperative thromboembolism in cancer surgery patients

Blood clots (thromboembolisms) are a leading cause of preventable death after surgery. Preventing blood clots is a "patient safety priority", however drugs used to prevent blood clots after surgery can result in increased risk of bleeding. We designed the surgical thromboembolism prevention quality improvement program (STEP-QIP), which aimed to reduce the incidence of blood clots after surgery using a protocol - the surgical thromboembolism prevention (STEP) protocol. The program was implemented over four stages. 24,952 surgical admissions were assessed between June 2013 and March 2018. Compliance with the surgical thromboembolism prevention protocol increased to 91% by the final implementation stage. Before implementing the STEP-QIP, the rates of blood clots after surgery were 3.1 per 1,000 surgical admissions. By the end of the study, the rate of blood clots after surgery reduced by 79%, or 0.6 per 1,000 surgical admissions. Bleeding rates after surgery also reduced by 15%, but this was not statistically significant. The STEP-QIP showed a reduction in thromboembolism events after surgery without increasing bleeding rates in a high-risk cancer population. This flexible approach demonstrated significant effectiveness that can be translated to surgical populations at other institutions.