Prophylaxis of venous thromboembolism in general surgery in Spain. Analysis of a national survey

Cir Esp (Engl Ed). 2020 Nov;98(9):516-524. doi: 10.1016/j.ciresp.2020.04.020. Epub 2020 Jun 5.
[Article in English, Spanish]

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 2,429 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: Cirugía; Embolia pulmonar; Encuesta; Profilaxis; Prophylaxis; Pulmonary embolism; Surgery; Survey; Thromboembolism; Tromboembolismo; Trombosis venosa; Venous thrombosis.

MeSH terms

  • Aged
  • Anticoagulants / administration & dosage
  • Anticoagulants / standards
  • Anticoagulants / therapeutic use*
  • Attitude of Health Personnel
  • Cross-Sectional Studies
  • Female
  • Heparin, Low-Molecular-Weight / administration & dosage
  • Heparin, Low-Molecular-Weight / standards
  • Heparin, Low-Molecular-Weight / therapeutic use*
  • Humans
  • Intermittent Pneumatic Compression Devices / adverse effects
  • Intermittent Pneumatic Compression Devices / economics
  • Knowledge
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology
  • Postoperative Complications / pathology
  • Postoperative Complications / prevention & control*
  • Pulmonary Embolism / mortality
  • Risk Assessment
  • Risk Factors
  • Spain / epidemiology
  • Stockings, Compression / adverse effects
  • Stockings, Compression / economics
  • Surgeons / education
  • Surgeons / statistics & numerical data*
  • Surveys and Questionnaires / standards
  • Venous Thromboembolism / complications
  • Venous Thromboembolism / drug therapy
  • Venous Thromboembolism / prevention & control*
  • Venous Thrombosis / complications
  • Venous Thrombosis / drug therapy
  • Venous Thrombosis / prevention & control

Substances

  • Anticoagulants
  • Heparin, Low-Molecular-Weight