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Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Practice patterns in high-risk bariatric venous thromboembolism prophylaxis.
Howard I Pryor1, Adam Singleton, Elissa Lin
1Department of Surgery, The George Washington University, 2150 Pennsylvania Avenue, NW, Suite 6B, Washington, DC 20037, USA.
Surgical Endoscopy
|October 12, 2012
Summary
Venous thromboembolism (VTE) is a major risk in bariatric surgery patients. While surgeons agree on high-risk factors, practices for VTE screening and prophylaxis vary significantly, highlighting a need for standardized evidence-based guidelines.
Area of Science:
- Bariatric Surgery
- Vascular Surgery
- Surgical Outcomes
Background:
- Venous thromboembolism (VTE) poses a significant morbidity and mortality risk in the morbidly obese population undergoing bariatric surgery.
- Current consensus on VTE screening and prophylaxis for high-risk patients is lacking.
- This study investigates current screening and prophylaxis patterns for VTE in high-risk bariatric surgery patients.
Purpose of the Study:
- To survey current practices regarding VTE screening and prophylaxis in high-risk bariatric surgery.
- To identify factors defining high-risk patients for VTE in bariatric surgery.
- To understand the variability in VTE screening and prophylaxis strategies among surgeons.
Main Methods:
- A survey was distributed to members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).
- The survey queried surgeons on criteria for identifying high-risk VTE patients and their routine screening and prophylaxis practices.
- Practices included mechanical/chemical prophylaxis, duration of therapy, and inferior vena cava (IVC) filter use.
Main Results:
- 81% of 385 respondents were bariatric surgeons; most managed >50 cases annually.
- High-risk factors included VTE history, hypercoagulable state, BMI >55 kg/m², PaO2 <60 mmHg, and severe immobility.
- 56% screened preoperatively, 92.4% used preoperative chemoprophylaxis (heparin common), 49% used Lovenox postoperatively. Postoperative screening was done by 47%, and IVC filters were used routinely by 28%.
Conclusions:
- Surgeons agree on high-risk VTE factors in bariatric surgery, but preoperative screening is inconsistent (56%).
- Preoperative chemoprophylaxis is widely used, yet duration of therapy and postoperative screening practices vary.
- The study highlights variability in VTE prophylaxis and screening, indicating a need for evidence-based guidelines and standardization.
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