Development of a Venous Thromboembolism Prophylaxis and Pain Medication Pathway in Thoracic Surgery Enhanced Recovery After Surgery Program

Introduction

This study aimed to evaluate the beneficial role of clinical pharmacists through a quality improvement project to incorporate a medication pathway into a thoracic surgery Enhanced Recovery After Surgery (ERAS) program.

Methods

The retrospective cohort study developed a venous thromboembolism (VTE) prophylaxis and pain medication pathway covering the different phases of the perioperative period in the thoracic surgery ERAS program, adhering to Lean management principles, within a multidisciplinary team framework. Outcome indicators related to VTE prophylaxis and pain management, adverse events, per capita drug cost, length of stay, and the total inpatient cost between the first 6 mos (preintervention, January 2023 to June 2023) and the second 6 mos (postintervention, July 2023 to December 2023) were collected and compared.

Results

A total of 1463 individuals were observed. Following the intervention, VTE risk assessment exceeded 95%, and the number of VTE cases notably decreased from 2 to 0. Pain relief was significantly enhanced (χ² = 4.423, P = 0.035) and the incidence of nausea and vomiting was significantly lower (χ² = 4.869, P = 0.027) when surgeons stopped using opioid agonist-antagonists. The per capita drug cost reduced from $639.04 to $479.39, the length of stay decreased from 13.68 ds to 12.23 ds, and the per capita total inpatient cost decreased from $6705.62 to $5460.81.

Conclusions

A medication pathway was significantly associated with improved outcome metrics related to VTE prophylaxis and pain management in thoracic surgery and can be incorporated into ERAS management programs. Further investigations using more current data are needed.