Thromboprophylaxis for ambulatory surgery: Results from a prospective national cohort

Abstract

BackgroundVenous thromboembolism (VTE) prophylaxis is not always part of the usual care of ambulatory surgery patients, and few guidelines are available. ObjectivesTo collect data on the application of VTE prophylaxis in ambulatory patients. DesignThe OPERA study is a large national survey performed in 221 healthcare facilities. PatientsAmong patients, 2174 who underwent one of ten selected procedures over two pre-defined days of investigation. Main outcome measuresAssessment and management of the postoperative VTE risk. ResultsThe 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%). ConclusionThese 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.