DEEP VENOUS THROMBOSIS PROPHYLAXIS IN GYNECOLOGIC SURGERY: IMPROVED COMPLIANCE WITH A NOVEL MINIATURIZED PNEUMATIC COMPRESSION DEVICE

M Kahn, MD, C Lord, MD, M Murakami, MD, J Lucci, III, MD, L Killewich, MD PhD

   Objective: To determine whether a new miniaturized, portable, battery-powered intermittent pneumatic compression (IPC) device would improve the rate of compliance for prevention of lower extremity deep venous thrombosis (DVT) prophylaxis in postoperative patients over that provided by a standard device.

   Materials and Methods: Forty subjects undergoing gynecologic surgery in whom the length of stay was estimated be to be at least 48 hours were enrolled the day of surgery, and randomized to DVT prophylaxis with one of two calf-length sequential IPC devices: (1) a standard device (Kendall Response System, “SCD” group) or (2) a miniaturized (1.5 lb), portable device (WizAir DVT Continuous Enhanced Circulation Therapy, “CECT” group). The CECT device can be battery operated for up to 6 hours and worn during ambulation. Timers attached to each device measured the time the device was applied and functioning. Compliance was determined by dividing the number of minutes the device was worn by the total number of minutes the subject was enrolled in the study (initial device application in the operating room until hospital discharge). Subjects, doctors and nurses completed satisfaction surveys. Differences between the groups were analyzed by the student’s t-test. Frequencies were anal! yzed by Fisher’s exact test.

   Results: One CECT device was lost on the ward. There were no statistically significant differences between the two groups with respect to age (CECT: mean age 49.7 years; SCD: mean age 47.0 years; p=0.52); frequency of malignancy (CECT: 3 subjects; SCD: 2 subjects; p>0.99); vaginal vs abdominal approach (5 cases vs. 1 case; p=0.18) or length of enrollment (CECT: 4127.1min; SCD:4707.1min; p=0.20). The CECT devices were worn 3325 min /4127 min for a compliance rate of 78%. The SCDs were worn 2303 min/ 4707 min for a compliance rate of 49% (CECT vs. SCD, p<.00001). Patients and nurses liked the devices equally well. Doctors thought the CECT was quieter and were more apt to recommend it to patients in the future (p<.05).

   Conclusions: Previous studies have demonstrated that reduced compliance with IPC devices results in a higher incidence of lower extremity DVT. Given its improved compliance and acceptance by medical staff and patients, the CECT should provide superior DVT prevention to that provided by non-mobile devices.

   Key Words: deep venous thrombosis prophylaxis, intermittent pneumatic compression