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Original Investigation
March 15, 2017

Use of Computerized Clinical Decision Support Systems to Prevent Venous Thromboembolism in Surgical PatientsA Systematic Review and Meta-analysis

Author Affiliations
  • 1Wyss Department of Plastic and Reconstructive Surgery, New York University School of Medicine, New York
  • 2Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia
  • 3Division of Plastic Surgery, School of Medicine, University of Utah, Salt Lake City
JAMA Surg. Published online March 15, 2017. doi:10.1001/jamasurg.2017.0131
Key Points

Question  Do computerized clinical decision support systems decrease the risk of venous thromboembolism (VTE) in surgical patients?

Findings  In this systematic review and meta-analysis, increased rates of prophylaxis for VTE and decreased VTE events were associated with the use of computerized clinical decision support systems compared with routine care without decision support.

Meaning  Computerized clinical decision support systems should be implemented to help clinicians assess the risk of VTE and provide the appropriate prophylaxis to prevent VTE events experienced in surgical patient populations.


Importance  Health care professionals do not adequately stratify risk or provide prophylaxis for venous thromboembolism (VTE) among surgical patients. Computerized clinical decision support systems (CCDSSs) have been implemented to assist clinicians and improve prophylaxis for VTE.

Objective  To evaluate the effect of implementing CCDSSs on the ordering of VTE prophylaxis and the rates of VTE.

Data Sources  PubMed, MEDLINE via OVID, EMBASE via OVID, Scopus, Cochrane CENTRAL Register of Controlled Trials, and clinicaltrials.gov were searched in June 2016 for articles published in English from October 15, 1991, to February 16, 2016. A manual search of references from relevant articles was also performed.

Study Selection  Clinical trials and observational studies among surgical patients comparing CCDSSs with VTE risk stratification and assistance in ordering prophylaxis vs routine care without decision support were included. Of the 188 articles screened, 11 (5.9%) were eligible for meta-analysis.

Data Extraction and Synthesis  Meta-analysis of Observational Studies in Epidemiology guidelines were followed. Two reviewers extracted data and assessed quality independently.

Main Outcomes and Measures  Rates of prophylaxis for VTE and VTE events. Random- and fixed-effects models were used to summarize odds ratios and risk ratios.

Results  Eleven articles (9 prospective cohort trials and 2 retrospective cohort trials) comprising 156 366 individuals (104 241 in the intervention group and 52 125 in the control group) were included. The use of CCDSSs was associated with a significant increase in the rate of appropriate ordering of prophylaxis for VTE (odds ratio, 2.35; 95% CI, 1.78-3.10; P < .001) and a significant decrease in the risk of VTE events (risk ratio, 0.78; 95% CI, 0.72-0.85; P < .001).

Conclusions and Relevance  Use of CCDSSs increases the proportion of surgical patients who were prescribed adequate prophylaxis for VTE and correlates with a reduction in VTE events.