Optimizing Prophylaxis Against Venous Thromboembolism in Bariatric Surgery

描述（由申请人提供）：随着过去十年的飙升，减肥（减肥）手术已成为美国第二常见的腹部手术。虽然减肥手术随着时间的推移变得更加安全，但静脉血栓栓塞（VTE）仍然是潜在可预防的发病率和死亡率的主要原因。预防性策略，包括围手术期抗凝和下腔静脉（IVC）滤器置入，可降低VTE及其后遗症的风险。然而，这些治疗本身与并发症的风险相关，并且非常昂贵。由于缺乏关于最佳VTE预防的良好证据，外科医生和医院之间的实践差异很大。例如，在密歇根州的23个减肥手术项目中，胃旁路术后出院后低分子量肝素的使用率从0%到96%不等;术前下腔静脉滤器放置的使用率从0到40%不等。最积极的实践方式不一定会转化为更安全的手术。例如，在密歇根州的5家医院中，最严重的并发症（导致死亡或永久性残疾）的发生率高出3倍，这些医院将IVC过滤器放置在超过10%的患者中。不必要的做法变化也有明显的影响，医疗保健费用。在5家“离群”医院，与IVC过滤器放置相关的支付每年超过数百万美元。该项目的目标是减少在密歇根州进行减肥手术的医院之间静脉血栓栓塞预防的差异，最终目标是改善结果和降低成本。这项研究将基于密歇根减肥手术协作组织（MBSC）的前瞻性临床登记和质量改进基础设施，该组织是一个全州范围的联盟，涉及密歇根州所有进行减肥手术的医院和外科医生。在方法方面，我们的项目将建立在Keystone ICU项目建立的数据驱动、协作质量改进的模板之上，Keystone ICU项目是约翰霍普金斯大学和密歇根州健康与医院协会的患者安全专家之间的联合奋进，在降低密歇根州导管败血症和其他重症监护并发症的发生率方面取得了非常成功。静脉血栓栓塞（VTE）是最常见的可预防的住院死亡原因。在缺乏良好证据的情况下，最佳的VTE预防减肥手术，实践和结果有很大的不同。该项目的目标是减少在密歇根州进行减肥手术的医院之间VTE预防的差异，最终目标是改善结果和降低成本。

DESCRIPTION (provided by the applicant): With rates skyrocketing over the last decade, weight loss (bariatric) surgery has become the second most common abdominal operation in the United States. Although bariatric surgery has become safer over time, venous thromboembolism (VTE) remains a major cause of potentially preventable morbidity and mortality. Prophylactic strategies, including perioperative anticoagulation and inferior vena cava (IVC) filter placement, may reduce the risk of VTE and its sequelae. However, these treatments are themselves associated with risks of complications and are very costly. In the absence of good evidence regarding optimal VTE prophylaxis, practices vary widely among surgeons and hospitals. Among the 23 bariatric surgery programs in Michigan, for example, the use of low-molecular weight heparin following discharge after gastric bypass varied from 0% to 96%; the use of preoperative IVC filter placement varied from 0-40%. The most aggressive practice styles do not necessarily translate to safer surgery. For example, rates of the most serious complications (resulting in death or permanent disability) are 3-times higher at the 5 Michigan hospitals that place IVC filters in more than 10% of their patients. Unwanted practice variation also has obvious implications for health care costs. Payments associated with IVC filter placement at the 5 "outlier" hospitals exceed several million dollars annually. The goals of this project are to reduce variation in VTE prophylaxis among hospitals performing bariatric surgery in Michigan, with the ultimate goal of improving outcomes and reducing costs. The study will be based on the prospective clinical registry and quality improvement infrastructure of the Michigan Bariatric Surgery Collaborative (MBSC), a statewide consortium involving all hospitals and surgeons performing bariatric surgery in Michigan. In terms of approach, our project will build off of templates for data-driven, collaborative quality improvement established by the Keystone ICU Project, a joint endeavor between patient safety experts at Johns Hopkins University and the Michigan Health and Hospital Association that has been extraordinarily successful in reducing rates of catheter sepsis and other intensive care complications in Michigan. Venous thromboembolism (VTE) is the most common preventable cause of hospital death. In the absence of good evidence regarding optimal VTE prohylaxis in bariatric surgery, practices and outcomes vary widely. The goals of this project are to reduce variation in VTE propylaxis among hospitals performing bariatric surgery in Michigan, with the ultimate goal of improving outcomes and reducing costs.