Extended Thromboprophylaxis following Major Open Abdominopelvic Surgery for Malignancy: A Review of Efficacy, Safety and Economic Impact
Bibliographic record
Abstract
The primary aim of this project was to perform a systematic review and meta-analysis of the currently available literature, comparing the effectiveness and safety of inpatient versus extended venous thromboembolism (VTE) prophylaxis with heparin following major open abdominal or pelvic surgery for malignancy. A secondary aim was to use the results of this review to evaluate the economic implications of providing extended pharmacological VTE prophylaxis in this population. A protocol for a systematic review of the literature was first developed, registered and published. Systematic literature review and meta-analysis were then performed in accordance with the protocol, and the results published. Finally, the results of the literature review were compared to literature estimates of the incidence and cost of VTE events in the absence of pharmacological prophylaxis, and current cost of Enoxaparin on the Pharmaceutical Benefits Scheme (PBS) in Australia, and a further manuscript produced which is currently submitted for consideration of publication. The result of the literature review was that no significant difference was found in either postoperative VTE rates or bleeding complications when comparing patients receiving extended duration versus inpatient only heparin VTE prophylaxis following major open abdominopelvic surgery for malignancy. However, the available contemporaneously published evidence was limited and of poor quality so this finding must be interpreted with caution. Regarding the secondary aim, cost analysis based on results of the literature review found the cost of providing extended duration heparin VTE prophylaxis to be less than that of treating predicted VTE events without prophylaxis, and therefore financially justifiable. However, if the initial finding of no significant difference in postoperative VTE events with extended compared to inpatient prophylaxis is assumed to be correct, on a purely financial basis inpatient only duration prophylaxis may be a more efficient use of resources.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.034 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.014 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".