Reducing the financial and environmental burden of mechanical thromboprophylaxis.
Authors: S Iqbal, I Patchell, C Griffiths, E Thomas, H Johnson-Hughes, S Rassam, F Brennan.
Chemical and mechanical measures are commonly used in the prevention of venous thromboembolism (VTE) in surgical patients. Mechanical thromboprophylaxis is usually in the form of anti-embolic stockings (AES) or intermittent pneumatic compression devices (IPC). National Institute for Health and Care Excellence (NICE) guidelines do not recommend the combined use of AESs and IPCs , and specify AESs alone for the majority of patients and procedures, with a select few circumstances where IPCs are recommended first-line. The aim of this project was to determine the use of these devices within theatres in our tertiary centre, and quantify the financial and environmental impact of our practice.
Data was collected prospectively in operating theatres over the space of seven days. In addition to patient demographics (age, gender, ASA), other factors perceived to be linked with higher risk of VTE were also recorded (surgery, speciality, duration).
229 cases were captured, mostly from elective lists. The average age was 54 years and median ASA 2. 28% (64) of the patients had no mechanical VTE prophylaxis. 38% (87) had one device (AES or IPC), while 34% (78) received both devices. Dual device use was more common in gynaecology, neurosurgery, urology and colorectal cases. These cases were an hour longer than those where a single device was used.
The combined use of AES and IPC is not beneficial or recommended , and has significant financial and environmental implications. AESs are cheaper than IPC sleeves, and are recommended first-line for most surgical patients. IPC also requires the use of a pump and the sleeves are almost always used intraoperatively and then discarded for incineration. Our data – likely an underestimate – revealed a minimum overspend of £665 over seven days on IPC sleeves alone, equating to at least £32,000 per year and 9.6 tonnes of CO2e emissions per year (using 0.3kgCO2e/£ ). The incineration of IPC sleeves could generate an additional 6.7 tonnes CO2e per year, and add a further cost of £2,784 per year to the organisation. These estimates do not include the running and maintenance of IPC pumps. These results were presented within the department and communicated to theatre and surgical teams. Reminders with relevant NICE guidelines were displayed in all theatres. A re-audit on our current use of mechanical VTE prophylaxis will soon be underway, but anecdotal evidence suggests improvement in practice.
1. National Institute for Health and Care Excellence, NICE guideline [NG89]: Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. https://www.nice.org.uk/guidance/ng89. March 2018.
2. Centre for Sustainable Healthcare, Measuring the carbon footprint of a QI project. https://networks.sustainablehealthcare.org.uk/file/10406/download?token=G_L-Yzzs. February 2017.