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Optimising care following major surgery to prevent clots: How much intervention is really needed and at what cost?

John Hunter Hospital

Grant:
  • Translational Research Grants Scheme
Date Funded:
  • 1 July, 2022
Chief Investigator/s:
  • Associate Professor Stephen Smith

Project Summary

To compare the effectiveness, cost and environmental impact of using two rather than three prophylactic methods to prevent blood clots after surgery.

The main researcher for this project is Associate Professor Stephen Smith.

What is the issue for NSW?

Compression devices are marketed to surgeons to prevent venous thromboembolism (VTE), despite only low-quality evidence supporting their additional benefit over other existing methods.

Compression devices are not well tolerated by patients, limit mobility and independence, and increase risk of adverse clinical outcomes, including pressure sores, nerve damage, compartment syndrome, and skin ulceration. Compression device fitting and removal requires around 20,000 hours of nursing time each year in NSW.

At John Hunter Hospital, NSW, 7,800 devices are used annually, generate 70kg of landfill and 1,645kg of contaminated waste for incineration. Across NSW, around 200,000 devices ($110 each) are used each year for major surgery, representing a potential cost savings to NSW Health of $22 million per annum in initial purchase costs alone, should they show no additional benefit over other prophylactic methods already used in Australia. Their removal from routine use would bring Australian practice in line with existing international guidelines.

What does the research aim to do and how?

This study is a randomised controlled trial of 6,800 patients undergoing major surgery at five regional hospitals to determine if heparin and stockings alone are non-inferior to using heparin, stockings and compression devices in reducing rates of VTE following major surgery.

A health economic analysis will be conducted to determine the potential cost savings to the health system should compression devices not be required, and determine the environmental impact generated by compression devices.

The outcomes of this research will ultimately identify whether compression devices can be removed from practice without impacting patient health outcomes, while generating cost savings to NSW Health.

The project will assess:

  • Clinical suspicion of venous thromboembolism at day 30 and day 90 confirmed by ultrasound or imaging.
  • Health care costs (from the perspective of the patient and the hospital)
  • Environmental impact.