Aidan Baker
Introduction
Venous thromboembolism (VTE) is a significant and potentially preventable post-operative complication, particularly following major abdominal surgery for cancer. NICE guideline NG89 recommends 28 days of extended pharmacological VTE prophylaxis in this cohort. Despite clear guidance, compliance remains inconsistent across institutions. This audit aimed to evaluate NG89 adherence at a District General Hospital (DGH), assess documentation of clinical decision-making, and determine whether targeted interventions improve compliance.
Methods
A two-cycle retrospective audit of adults undergoing major abdominal cancer surgery was conducted at a DGH in Greater Manchester. Cycle 1 (November 2024–February 2025; n=30) established baseline compliance. Following analysis, interventions were introduced including multidisciplinary education, ward-based visual reminders, and proposed system level changes. Cycle 2 (April–July 2025; n=28) assessed post-intervention outcomes. Data were collected from electronic records, drug charts and discharge summaries. Primary outcome was to assess compliance with NG89. Secondary outcomes evaluated documentation of clinical reasoning and 30-day post-operative VTE incidence. Statistical analysis used Chi-squared and Fisher’s exact tests (p<0.05).
Results
Baseline compliance was 60% (18/30). Among patients not receiving prophylaxis (n=12), 50% had documented justifications. Following intervention, compliance improved significantly to 96% (27/28) (χ2(1)=9.06, p=0.0026; Fisher’s exact p=0.0011). Documentation improved by 16 percentage points but was not statistically significant (p=0.13). 30-day VTE incidence decreased from 3% (1/30) to 0% (0/28).
Conclusion
Simple, low-cost interventions significantly improved adherence to NG89, supporting safer perioperative care and improved outcomes for cancer patients. These interventions are scalable and could be implemented in larger centres to maximise patient safety improvements.
Authors
Aidan Baker, Benedict Green, Iqra Noor, Ali Javaid
Tameside general Hospital, Manchester, United Kingdom