{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T01:31:12Z","timestamp":1784770272441,"version":"3.55.0"},"reference-count":30,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2020,6,7]],"date-time":"2020-06-07T00:00:00Z","timestamp":1591488000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004224","name":"Peter MacCallum Cancer Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004224","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Efforts to reduce postoperative venous thromboembolism are challenging due to heterogeneity in thromboprophylaxis practice. As a result, a \u2018one\u2010size\u2010fits\u2010all\u2019 approach that accounts for surgery\u2010specific risk, but fails to account for patient\u2010level variation, is often adopted by healthcare networks. Updated clinical practice guidelines have advocated an individualised risk\u2010stratified approach that balances the risk:benefit ratio associated with thromboprophylaxis; however, there are limited data confirming effectiveness of these recommendations on the incidence of postoperative venous thromboembolism and bleeding. We developed the surgical\u2010thrombo\u2010embolism\u2010prevention protocol, a novel risk\u2010stratified algorithm that classified patients into low\u2010, intermediate\u2010, and high\u2010risk profiles according to surgical procedure and patient baseline medical risk. Expert\u2010endorsed risk\u2010specific thromboprophylaxis strategies were then applied. A staged quality improvement program was developed to implement the protocol. We postulated that compliance with the protocol would reduce postoperative venous thromboembolism rates without increasing the incidence of postoperative bleeding. Between June 2013 and March 2018, we evaluated the efficacy, safety and sustainability of this risk\u2010stratified approach in 24,953 surgical admissions at a dedicated cancer centre. By final implementation, program compliance was 91%. Postoperative venous thromboembolism rates reduced from 3.1 per 1000 surgical admissions to 0.6 per 1000 surgical admissions (relative risk reduction 79%; p &lt; 0.005). Postoperative bleeding rates also declined from 10.0 per 1000 surgical admissions to 6.3 per 1000 surgical admissions (relative risk reduction 37%; p = 0.02). Sustained improvement was evident more than 3 years after implementation. Implementation of the surgical\u2010thrombo\u2010embolism\u2010prevention protocol significantly reduced the incidence of postoperative venous thromboembolism supporting its validation at other institutions.<\/jats:p>","DOI":"10.1111\/anae.15077","type":"journal-article","created":{"date-parts":[[2020,6,7]],"date-time":"2020-06-07T09:47:13Z","timestamp":1591523233000},"page":"1028-1038","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Impact of a risk\u2010stratified thromboprophylaxis protocol on the incidence of postoperative venous thromboembolism and bleeding"],"prefix":"10.1111","volume":"75","author":[{"given":"R.","family":"Chahal","sequence":"first","affiliation":[{"name":"Department of Cancer Anaesthesia, Peri\u2010operative and Pain Medicine Peter MacCallum Cancer Centre Melbourne Vic. Australia"},{"name":"Centre for Integrated Critical Care University of Melbourne Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Alexander","sequence":"additional","affiliation":[{"name":"Peter MacCallum Cancer Centre Melbourne Vic. Australia"},{"name":"Sir Peter MacCallum Department of Oncology University of Melbourne Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Yee","sequence":"additional","affiliation":[{"name":"Department of Cancer Anaesthesia, Peri\u2010operative and Pain Medicine Peter MacCallum Cancer Centre Melbourne Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. M. K.","family":"Jun","sequence":"additional","affiliation":[{"name":"Department of Medicine and Radiology University of Melbourne Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. G.","family":"Dagher","sequence":"additional","affiliation":[{"name":"Department of Medicine and Radiology University of Melbourne Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Ismail","sequence":"additional","affiliation":[{"name":"Department of Cancer Anaesthesia, Peri\u2010operative and Pain Medicine Peter MacCallum Cancer Centre Melbourne Vic. Australia"},{"name":"Centre for Integrated Critical Care University of Melbourne Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Riedel","sequence":"additional","affiliation":[{"name":"Department of Cancer Anaesthesia, Peri\u2010operative and Pain Medicine Peter MacCallum Cancer Centre Melbourne Vic. Australia"},{"name":"Sir Peter MacCallum Department of Oncology University of Melbourne Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Burbury","sequence":"additional","affiliation":[{"name":"Peter MacCallum Cancer Centre Melbourne Vic. Australia"},{"name":"Sir Peter MacCallum Department of Oncology University of Melbourne Vic. Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,6,7]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.08-0656"},{"key":"e_1_2_6_3_1","unstructured":"The Organisation for Economic Co\u2010operation and Development (OECD) health statistics.Secondary OECD health statistics.2013.http:\/\/www.oecd.org\/els\/health\u2010systems\/oecdhealthdata.htm(accessed 20\/11\/2013)."},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2014.08.014"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-016-1766-y"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-5-201303051-00001"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1160\/TH16-07-0509"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002183"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-12-758995"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60202-0"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.11124\/jbisrir-2012-12"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002126"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12959-018-0180-6"},{"key":"e_1_2_6_14_1","unstructured":"Institute for Healthcare Improvement.How to improve.2009.http:\/\/www.ihi.org\/resources\/Pages\/HowtoImprove\/default.aspx(accessed 15\/10\/2013)."},{"key":"e_1_2_6_15_1","unstructured":"Agency for Healthcare Research and Quality.Fact sheet on Patient Safety Indicators.2014.https:\/\/www.ahrq.gov\/sites\/default\/files\/wysiwyg\/professionals\/systems\/hospital\/qitoolkit\/combined\/a1b_combo_psifactsheet.pdf(accessed 19\/10\/2013)."},{"key":"e_1_2_6_16_1","unstructured":"Victorian Agency for Health Information.Patient safety indicators\u2010translated technical specifications.2013.http:\/\/www.health.vic.gov.au\/psi\/auspsi(accessed 25\/09\/2017)."},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2009.03678.x"},{"key":"e_1_2_6_18_1","unstructured":"Australian Institute of Health and Welfare 2018.Admitted patient care 2016\u20132017: Australian hospital statistics. Health services series no. 84. Cat. no. HSE 201. Canberra: AIHW.2018.https:\/\/www.aihw.gov.au\/getmedia\/acee86da\u2010d98e\u20104286\u201085a4\u201052840836706f\/aihw\u2010hse\u2010201.pdf.aspx?inline=true(accessed 18\/07\/2018)."},{"key":"e_1_2_6_19_1","first-page":"678","article-title":"Implementing guidelines for venous thromboembolism prophylaxis in a large Italian teaching hospital: lights and shadows","volume":"90","author":"Scaglione L","year":"2005","journal-title":"Haematologica"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.10-3162"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2012.2024"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2014.01.046"},{"key":"e_1_2_6_23_1","unstructured":"Clinical Excellence Commission.Clinical focus report: Hospital\u2010associated venous thromboembolism. Sydney: Clinical Excellence Commission.2015.http:\/\/www.cec.health.nsw.gov.au\/patient\u2010safety\u2010programs\/adult\u2010patient\u2010safety\/vte\u2010prevention(accessed 29\/07\/2019)."},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2012-001782"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.026897"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3181b58940"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1553-7250(09)35052-7"},{"key":"e_1_2_6_28_1","first-page":"1","article-title":"Validity of AHRQ patient safety indicators derived from ICD\u201010 hospital discharge abstract data (chart review study)","volume":"3","author":"Quan H","year":"2013","journal-title":"British Medical Journal Open"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-200008000-00010"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2010.09.033"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2013.04.062"}],"container-title":["Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fanae.15077","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anae.15077","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/anae.15077","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anae.15077","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T16:31:55Z","timestamp":1761669115000},"score":1,"resource":{"primary":{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/10.1111\/anae.15077"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,7]]},"references-count":30,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2020,8]]}},"alternative-id":["10.1111\/anae.15077"],"URL":"https:\/\/doi.org\/10.1111\/anae.15077","archive":["Portico"],"relation":{},"ISSN":["0003-2409","1365-2044"],"issn-type":[{"value":"0003-2409","type":"print"},{"value":"1365-2044","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,7]]},"assertion":[{"value":"2020-04-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-06-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}