Ultrasound Surveillance Offers a Safe and Effective Method for Venous Thromboembolism Prevention in Plastic Surgery Pati
- PDF / 380,215 Bytes
- 5 Pages / 595.276 x 790.866 pts Page_size
- 0 Downloads / 151 Views
LETTER TO THE EDITOR
Ultrasound Surveillance Offers a Safe and Effective Method for Venous Thromboembolism Prevention in Plastic Surgery Patients Eric Swanson1
Received: 19 July 2020 / Accepted: 23 August 2020 Ó The Author(s) 2020
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Five recent publications investigate venous thromboembolism (VTE) risk reduction [1–5]. Rochlin et al. [1] analyzed a large database and conclude that the length of hospital stay is a modifiable risk factor in microsurgical breast reconstruction patients. However, these authors found no significant difference in VTE rates over time comparing patients treated during 2007–2009 with women treated during 2013–2015, despite the fact that patients treated during the earlier time frame had significantly longer hospital stays (4.36 days versus 4.13 days) [1]. Pannucci, the senior author of this review [1], has long championed Caprini scores and individual risk stratification [6, 7]. Importantly, the length of hospital stay is not considered in a Caprini score [7, 8]. In fact, Caprini [8] believes that patients are just as sedentary at home after discharge as they were in the hospital, remarking, ‘‘these individuals spend most of the time in a recliner, which is not early ambulation but rather early angulation.’’ Although the 2011 Venous Thromboembolism Prevention Study [7] determined that length of stay correlates with VTE risk, the hospital stay subgroups were too small to be statistically reliable [9]. Surprisingly, the VTE risk for patients treated with and without chemoprophylaxis was the same, 1.2% [7].
& Eric Swanson [email protected] 1
Swanson Center, Leawood, KS 66211, USA
Rochlin et al. [1] suggest that shortening the hospital stay may be helpful in reducing VTE risk. This is a difficult thesis to prove because patients who are discharged sooner are also likely to be healthier. Sicker patients typically have longer hospital stays, making it impossible to isolate length of stay from patient health. It would be unwise to start discharging patients too soon from the hospital under the mistaken assumption that the longer they stay in the hospital the more likely they are to develop a VTE. Aime´ et al. [2] report the findings of a survey of plastic surgeons regarding VTE risk reduction methods in aesthetic surgery. The authors reiterate the conventional wisdom endorsing Caprini scores and anticoagulation for patients deemed to be at high risk [2]. Three other studies published within the last year also support chemoprophylaxis [3–5]. Notably, four of the five studies do not discuss or reference ultrasound surveillance for VTE [1, 2, 4, 5], although 4.5% of surveyed plastic surgeons report using this modality for screening and management [2]. Today, ultrasound applications in plastic surgery are a subject of intense int
Data Loading...
