Thromboprophylaxis for ambulatory surgery: Results from a prospective national cohort

Abstract

Background: Venous thromboembolism (VTE) prophylaxis is not always part of the usual care of ambulatory surgery patients, and few guidelines are available.

Objectives: To collect data on the application of VTE prophylaxis in ambulatory patients.

Design: The OPERA study is a large national survey performed in 221 healthcare facilities.

Patients: Among patients, 2174 who underwent one of ten selected procedures over two pre-defined days of investigation.

Main outcome measures: Assessment and management of the postoperative VTE risk.

Results: The postoperative VTE risk was assessed as nil (4.1% of the physicians), low (74%) or moderate (20%). This risk was assessed as lower (71%) in ambulatory surgery as compared to conventional surgery. In most centres (94%), a personal patient history of VTE was recorded preoperatively, and in 72% a prophylaxis protocol was systematically applied but only 40% of the responding centres had a written protocol for VTE prophylaxis. The postoperative period (discharge at home) was covered by a VTE protocol for 75% of the centres, with VTE prophylaxis starting postoperatively in 21% of the patients. In these patients, different treatments were applied: below-knee compression stockings (25%); thigh-length compression stockings (21%); intermittent pneumatic compression in the recovery room (1.2%); unfractionated heparin (2.0%); low molecular weight heparins (65%); vitamin K antagonists (0.5%); other treatments, including direct oral anticoagulants (0.5%).

Conclusion: These data underline the need for a better assessment of the VTE risk in ambulatory patients and new studies either with conventional or new agents to be able to build guidelines in this new setting.

Keywords: Ambulatory surgery; Graduated compression stockings; Low molecular weight heparin; Venous thromboembolism prophylaxis.