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Comment & Response |

Misclassification of Acceptable Venous Thromboembolism Prophylaxis Leading to Flawed Inferences and Recommendations Regarding Prevention Efforts

Victor O. Popoola, MBBS, MPH, ScM1; Brandyn D. Lau, MPH, CPH1,2,3,4; Elliott R. Haut, MD, PhD1,2,4,5,6
[+] Author Affiliations
1Division of Acute Care Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
2Armstrong Institute for Patient Safety, Johns Hopkins Medicine, Baltimore, Maryland
3Division of Health Science Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland
4Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
5Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
6Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Surg. 2016;151(2):197-198. doi:10.1001/jamasurg.2015.3411.
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To the Editor We were interested to read the recent study by the Colorectal Writing Group for the Surgical Care and Outcomes Assessment Program–Comparative Effectiveness Research Translation Network (SCOAP-CERTAIN) Collaborative1 published in JAMA Surgery. However, we have concerns that the methodologic flaws in the study may lead to inaccurate inferences.

First, the authors report an increased rate of venous thromboembolism (VTE) despite improved prophylaxis, leading to the conclusion that prophylaxis is ineffective. We favor an alternate interpretation; low standards for acceptable VTE prophylaxis lead to a better institutional performance of VTE prophylaxis but not better patient outcomes. The Surgical Care Improvement Project VTE-2 measure defines acceptable perioperative VTE prophylaxis as “appropriate pharmacologic VTE prophylaxis within 24 hours before or after surgery.”1(p713) This unacceptably low standard is likely to misclassify suboptimal care as appropriate. We recently reported this phenomenon as the explanation for the lack of an association between publicly reported VTE prophylaxis rates and outcomes.2

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February 1, 2016
Scott R. Steele, MD; Vlad V. Simianu, MD, MPH; David R. Flum, MD, MPH
1Department of Colon and Rectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
2Department of Surgery, University of Washington, Seattle
JAMA Surg. 2016;151(2):198-199. doi:10.1001/jamasurg.2015.3428.
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