The prevention of venous thromboembolism: a statewide evaluation of practices in Massachusetts

The objective of this study was to determine the proportion of Massachusett s Medicare patients who received prophylaxis for venous thromboembolism fol lowing colectomy, hysterectomy or total hip arthroplasty. The sample frame was all 90 Massachusetts acute care hospitals, and the time frame was 1 Apr il to 30 September 1994. The patients discharged with an International Clas sification of Disease (ICD-9-CM) discharge diagnostic code (recorded in the Massachusetts Medicare Claims Database) for colectomy, hysterectomy or tot al hip arthroplasty were used to Identify the larger patient population. Th e sample population comprised 1397 patients randomly selected from the targ et population, including 467 total hip arthroplasties, 474 colectomies, and 456 hysterectomies. Medical records were reviewed by trained nurse abstrac tors who collected information on the use of prophylaxis for venous thrombo embolism. Prophylaxis for venous thromboembolism was employed by surgeons p ractising in Massachusetts hospitals in 93 per cent of total hip arthroplas ty cases (regional variation 85-98 per cent), 84 per cent of colectomies (r egional variation 57-93 per cent), 66 per cent of hysterectomies (regional variation 35-71 per cent), and in 87 per cent of the subset of 111 hysterec tomies with malignancy (regional variation 25-100 per cent). The results of this statewide study demonstrated significant regional and hospital-to-hos pital variation in use of prophylaxis for venous thromboembolism following major surgery. A lower rare of prophylaxis use was observed in hospitals wi th fewer than 200 beds and in hospitals that did not have teaching programm es. Hospitals with below-average rates of prophylaxis were targeted fur int ensive quality improvement;interventions.