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Inicio Cirugía Española (English Edition) Prophylaxis of venous thromboembolism in general surgery in Spain. Analysis of a...
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Vol. 98. Issue 9.
Pages 516-524 (November 2020)
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Vol. 98. Issue 9.
Pages 516-524 (November 2020)
Original article
DOI: 10.1016/j.cireng.2020.10.010
Prophylaxis of venous thromboembolism in general surgery in Spain. Analysis of a national survey
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Juan Ignacio Arcelus Martíneza,b,
Corresponding author
jarcelus@ugr.es

Corresponding author.
, Beatriz Leiva Jiméneza, Lorena Ruiz Barreraa, Manuela Expósito Ruizc, Nuria Muñoz Pérezb, Jesús Villar del Morala,b, José Luis Díez Vigilb, Cristina López Espadad
a Departamento de Cirugía y sus Especialidades, Universidad de Granada, Granada, España
b Servicio de Cirugía General y Digestiva, Hospital Universitario Virgen de las Nieves, Granada, Spain
c Fundación Pública Andaluza para la Investigación Biosanitaria Andalucía Oriental (FIBAO), Granada, Spain
d Servicio de Angiología y Cirugía Vascular, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Figures (1)
Tables (5)
Table 1. Perception of postoperative VTE, risk factors and prevention, and most frequently practiced surgical procedures.
Table 2. Perception of participating surgeons about the different VTE prevention methods in terms of safety, efficacy, simplicity and cost-effectiveness.
Table 3. Preferred dosage for the prevention of VTE in a patient requiring cholecystectomy for symptomatic cholelithiasis.
Table 4. Preferred measures for the prevention of VTE in a patient undergoing bariatric surgery.
Table 5. Preferred measures for the prevention of VTE in a patient undergoing colon cancer surgery.
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Abstract
Introduction

Venous thromboembolism (VTE) represents a serious postoperative complication that can be prevented by adequate thromboprophylaxis. Surveys provide relevant information about clinician’s attitudes and preferences regarding VTE prophylaxis.

Methods

Transversal, descriptive study based on a survey sent to general surgeons members of the Spanish Association of Surgeons (AEC), that included 31 questions regarding postoperative VTE and its prevention, as well as three clinical scenarios.

Results

530 surgeons, 21.8% of the 2429 invited by electronic mail to participate, completed the survey. Most of the answering clinicians work on in big teaching hospitals, and 28.5% are residents. VTE represents a serious problem for 28% of participants. Although 81% consider that their knowledge on the prevention of postoperative VTE is adequate, a similar percentage recognizes the need for further education. The vast majority (98.7%) use low molecular weight heparins, which are considered the most effective and safe modality, followed by mechanical methods. The Caprini risk assessment score is used by 81% of surgeons, who usually start pharmacological prophylaxis preoperatively. However, there are remarkable differences in the dosing of heparins, timing of initiation, and duration, especially in non-oncologic surgical patients.

Conclusions

Most Spanish surgeons are interested in the prevention of postoperative VTE. Overall, the level of knowledge on thromboprophylaxis is adequate. However, our results indicate that there is a need for better education on relevant practical aspects of prophylaxis that could be achieved by incorporating recommendations from recent guidelines to local hospital-based protocols.

Keywords:
Venous thrombosis
Pulmonary embolism
Survey
Surgery
Prophylaxis
Thromboembolism
Resumen
Introducción

El venous thromboembolism (VTE) representa una complicación postoperatoria grave, pero evitable con una profilaxis adecuada. Las encuestas aportan información útil acerca de las actitudes y preferencias respecto a la prevención del VTE.

Métodos

Estudio transversal descriptivo, basado en una encuesta, remitida a los cirujanos generales miembros de la Asociación Española de Cirujanos (AEC), y que incluye 31 preguntas acerca del VTE postoperatorio y su prevención, así como 3 casos clínicos.

Resultados

La encuesta fue contestada por 530 cirujanos, lo que representa el 21,8% de los 2.429 miembros invitados a participar por correo electrónico. La mayoría de los cirujanos participantes trabajan en hospitales docentes grandes, siendo el 28,5% médicos residentes. Para el 28% el VTE representa un problema importante. Aunque el 81% considera que tiene un conocimiento adecuado sobre la prevención del VTE postoperatorio, un porcentaje similar reconoce necesitar más formación. La mayoría (98,7%) utiliza las heparinas de bajo peso molecular, consideradas la modalidad más eficaz y segura, seguida de los métodos mecánicos. El método de estratificación de riesgo más utilizado es el de Caprini (81%). La mayoría comienza la profilaxis farmacológica preoperatoriamente, pero existe bastante variación en las dosis utilizadas, así como en las pautas de inicio y duración, sobre todo en cirugía no oncológica.

Conclusiones

Existe interés y, en general, un adecuado conocimiento acerca de la prevención del VTE entre los cirujanos españoles. Sin embargo, creemos necesaria mayor formación sobre aspectos prácticos de la profilaxis, adaptando las recomendaciones de las guías recientes a protocolos locales.

Palabras clave:
Trombosis venosa
Embolia pulmonar
Encuesta
Cirugía
Profilaxis
Tromboembolismo

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