2026 Southeastern Residency Conference

Title: Adherence to Venous Thromboembolism Prophylaxis Protocol in High-Risk Bariatric Surgery Patients
Authors: Ashley Bennett, Adele Robbins, Angelita Incer
Emory Saint Joseph's Hospital - PGY1 - Atlanta, Georgia 
Background/Purpose:  Venous thromboembolism (VTE) is a recognized postoperative complication following bariatric surgery, with risk stratification performed using the Cleveland Clinic Risk Score (CRC). Emory Saint Joseph’s Hospital implemented a standardized postoperative enoxaparin protocol for high-risk patients to mitigate this risk. According to the protocol, enoxaparin should be initiated within 14 hours of surgery, with dosing adjusted based on body weight and creatinine clearance. High-risk patients, defined as those with a CRC score >0.4, are recommended to continue enoxaparin upon discharge for ongoing VTE prophylaxis. The purpose of this study was to evaluate the compliance rate with the bariatric surgery postoperative enoxaparin protocol for venous thromboembolism prophylaxis. 
Methodology: Single-center, retrospective chart review of adult patients who underwent bariatric surgery at Emory Saint Joseph’s Hospital between January 1, 2024, and December 31, 2024. Protected/vulnerable patient populations, including pregnant patients and prisoners, were excluded from the study. The primary outcome was compliance rate with the bariatric surgery postoperative enoxaparin protocol for venous thromboembolism (VTE) prophylaxis. Secondary outcomes included incidence of VTE within 30-days of operation, bleeding complications, length of stay, and all-cause mortality within 30 days of operation. Process-related outcomes included time to first dose of enoxaparin postoperatively and dosing adherence. Continuous variables were summarized using medians and interquartile ranges (IQR). Categorical variables were summarized as counts and percentages. 
Results: A total of 118 patients were included in the study, with 86 (72.9%) demonstrating full protocol compliance. Full compliance was achieved if the patient received the correct dose of enoxaparin on the evening of surgery and was appropriately discharged on prophylaxis. Process measure adherence was variable: 96/118 (81.4%) received the first dose within 14 hours postoperatively, and 102/118 (86.4%) were dosed appropriately based on BMI and renal function. Nine patients (5.2%) were classified as high risk (CRC score >0.4). Among these, only 1/9 (11.1%) were appropriately discharged on VTE prophylaxis. Clinical outcomes at 30 days included 3 VTE events (1.7%) and no bleeding or mortality observed. There were no differences in clinical outcomes, such as VTE events or length of stay (LOS), between compliant and non-compliant patients.
Conclusions: Overall, compliance with the bariatric surgery enoxaparin prophylaxis protocol was achieved in 72.9% of patients. Gaps were identified in postoperative administration, timing, dosing, and discharge prescribing for high-risk patients. Despite low compliance, the observed incidence of VTE, bleeding, and mortality was low within 30 days.