270 An Audit Looking at the Peri-Operative Management of Venous Thromboembolism Prophylaxis in Surgical Patients Under the Upper Gastrointestinal Team at Royal Liverpool University Hospital

Abstract Aim Venous thromboembolism (VTE) remains a major preventable cause of postoperative morbidity and mortality. Inadequate prophylaxis may raise thrombotic risk by up to 30%. This audit evaluates compliance with VTE prevention guidelines in the Upper Gastrointestinal (UGI) surgical team at the Royal Liverpool University Hospital, focusing on prescription accuracy, timing, and peri-operative assessment. Method A retrospective audit was conducted for patients undergoing invasive UGI procedures from 1/12/24 to 31/1/25. Data from electronic patient and prescribing records included surgical urgency, VTE risk assessments, pharmacological (enoxaparin) and mechanical (anti-embolism stockings) prophylaxis, dosing accuracy (weight/renal adjusted), administration timing, perioperative suspension, and inpatient VTE events. Results Among 96 patients, 99% had risk assessments completed. Combined prophylaxis was advised in 71%, with enoxaparin prescribed in 84%. Yet, 11% received prophylaxis when not indicated, while 6% missed it despite indications. Appropriate dosing occurred in 82%, with 40 mg once daily most common. Administration timing met guidance in 79%, and 76% began within 24 hours. Prophylaxis was suspended peri-operatively in 40%, typically with two missed doses. Anti-embolism stockings were prescribed in 87%, with 93% appropriate. In hospital VTE occurred in 6%. Conclusions Overall compliance with assessment and prescribing was high, but issues were found in peri-operative assessment accuracy, prescription errors, missed doses, and timing. Suspension decisions seemed subjective, and missing critical care data limited the analysis. Targeted education, standardised protocols, and re-auditing are recommended to enhance adherence and reduce preventable VTE complications in surgical patients.