Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Kwok KW(1), Wong MN(1)
Affiliation :
(1) Operating Room, Department of Anaesthesiology, Pain Medicine and Operating Services, United Christian Hospital
Introduction :
Venous thromboembolism (VTE) poses serious risks to perioperative patients during their hospital stay. Perioperative patients are at especially high risk of developing VTE due to several factors. Surgery itself causes trauma and inflammation which activate clotting mechanism. Anaesthesia reduces mobility and blood velocity. And medications, which favour hypercoagulability, also increase the chances of clots forming.
Currently, sequential compression device (SCD) and graduated compression stocking (GCS) are our primary mechanical prophylaxis. High-risk patients receive GCS alone, while patients undergoing certain major operations receive both SCD and GCS. However, we are questioning whether the combination of SCD and GCS is more effective than either option alone at preventing VTE in perioperative patients.
Objectives :
1. Summarize the best practices for VTE prevention in perioperative setting.
2. Review the hospital's clinical guideline for VTE prophylaxis.
Methodology :
A literature review was conducted with EMBASE and Cochrane Library databases. The search results were restricted to systematic reviews published in the last five years. Potentially relevant articles were further discussing with perioperative specialty nurses. Additionally, relevant international and local clinical practice guidelines were explored and reviewed.
Result & Outcome :
The literature search identified one relevant systematic review with meta-analyses comparing SCD and GCS for VTE prophylaxis. The review found SCD resulted in a lower VTE incidence than GCS. And SCD did not demonstrate an augmented effect when combining with GCS. Two international guidelines recommended SCD or GCS as mechanical prophylaxis, with preference for SCD over GCS by one organization. A review of ten local hospitals found nearly all use SCD alone as the primary prophylaxis.
After discussing with the anaesthesiologist and physiotherapist, we have revised our VTE prevention guideline. SCD will be used alone for patients at risk of VTE, while GCS will remain an option for those who is contraindicated to SCD.
The new practice has several advantages. The VTE rate has not risen since implementing the new protocol in October 2023, while an estimated HKD 900,000 per year previously spent on GCS can now be allocated for other resources. Additionally, this change reduces workload for ward staff and allows OR nurses to more easily observe patients' skin conditions. Patients also find SCD to be more comfortable than GCS. These factors demonstrate the benefits of the new practice.
