Department of Anaesthesia and Intensive Care, Assistance publique-Hôpitaux de Paris, Cochin University Hospital, université Paris Descartes, 27, rue du Faubourg-St-Jacques, 75014 Paris, France.
Department of Anaesthesia and Intensive Care, groupe hospitalier et faculté de médecine Paris Sud, Assistance publique-Hôpitaux de Paris, hôpital Bicêtre, Le Kremlin-Bicêtre 94270, France.
Anaesth Crit Care Pain Med. 2018 Aug;37(4):343-347. doi: 10.1016/j.accpm.2018.01.003. Epub 2018 Feb 15.
Venous thromboembolism (VTE) prophylaxis is not always part of the usual care of ambulatory surgery patients, and few guidelines are available.
To collect data on the application of VTE prophylaxis in ambulatory patients.
The OPERA study is a large national survey performed in 221 healthcare facilities.
Among patients, 2174 who underwent one of ten selected procedures over two pre-defined days of investigation.
Assessment and management of the postoperative VTE risk.
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%).
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.
静脉血栓栓塞症（VTE）预防措施并非始终是门诊手术患者常规护理的一部分，且可用的指南很少。
收集门诊患者中 VTE 预防措施应用的数据。
OPERA 研究是在 221 家医疗保健机构中进行的一项大型全国性调查。
在患者中，有 2174 名患者在调查的前两天接受了十种选定手术之一。
术后 VTE 风险的评估和管理。
术后 VTE 风险评估为零（4.1%的医生）、低（74%）或中度（20%）。与常规手术相比，门诊手术中这种风险较低（71%）。在大多数中心（94%），术前记录了患者的个人 VTE 病史，72%系统地应用了预防方案，但只有 40%的有回应的中心有书面的 VTE 预防方案。75%的中心在术后期间（出院回家）覆盖了 VTE 方案，21%的患者在术后开始使用 VTE 预防。在这些患者中，应用了不同的治疗方法：小腿压缩袜（25%）；大腿长度压缩袜（21%）；恢复室间歇性气动压缩（1.2%）；未分级肝素（2.0%）；低分子肝素（65%）；维生素 K 拮抗剂（0.5%）；其他治疗方法，包括直接口服抗凝剂（0.5%）。
这些数据强调了需要更好地评估门诊患者的 VTE 风险，并需要新的研究，无论是使用常规药物还是新药物，以便在这一新环境中制定指南。
