Risk of Lethal Blood Clots Increases in Same-Day Surgery

Outpatient surgery is an increasingly popular medical option, thanks to the cost of inpatient care and the expanding capability of outpatient facilities. More than 6 in 10 surgical procedures are conducted on a same-day-to-home basis. They include operations for cancer, orthopedic and gastrointestinal problems and plastic surgery.

But as we recently wrote in a related post, ambulatory care centers lack the rigorous oversight that is standard protocol for hospitals.

Now, a new study published in The Annals of Surgery raises the flag of concern that outpatient procedures carry a higher risk of life-threatening blood clots than similar inpatient care. Hospital patients undergoing surgery generally are apprised of the possibility of venous thromboembolism (VTE), and how to thwart it. VTE is a blood clot that forms within a vein, usually in the calf in an immobile leg. It’s potentially lethal because it can migrate to the lungs (pulmonary embolism, or PE) and impede the ability to breathe, sometimes fatally.

Unlike inpatients, people who under go outpatient surgery often are not warned to watch for signs of VTE, according to the study’s authors. Less than half of outpatient centers have VTE prevention guidelines. Worse, the study showed, even fewer adhere to them.

Approximately 300, 000 Americans die each year from PE each year, most because of a failure of diagnosis rather than unsuccessful treatment. Surgical patients and their caregivers must be aware of VTE symptoms in order to neutralize the threat.

Researchers analyzed a national registry of more than 200,000 outpatient surgeries across the country to design a paradigm to predict a patient’s risk for VTE. Their study showed that 1 in 84 patients at highest risk suffered a dangerous blood clot after surgery. It’s well-known that vein surgery and arthroscopic surgery boost the risk for VTE. Other risk factors include:

  • advanced age;
  • obesity;
  • longer surgery;
  • pregnancy;
  • active cancer.

The more of these factors a patient presents, the greater the risk.

“[The] data are in stark contrast to provider and patient expectations that outpatient surgery is a low-risk event,” said Christopher J. Pannucci, a surgeon at the University of Michigan and the the study’s lead author. “It also underscores the importance of evaluating a patient’s individual risk factors as opposed to procedure-type alone.”

The study signaled the need for better screening and prevention of venous thromboembolism especially for people who are obese and/or older than 65. Researchers advised that the informed consent process for outpatient surgery provide clear information about the risk for developing VTE, just as such guidelines are routine for inpatient surgery.

If you are scheduled to undergo same-day surgery, ask for the facility’s patient guidelines for preventing blood clots. If it has none, consider getting treatment elsewhere, or at least consult with your doctor about how to prevent VTE. No one is immune from this potentially lethal but quite preventable condition.

Medical malpractice is a huge problem in blood clot management, as this article on our firm’s website discusses. You can read patient safety tips on blood clot prevention in another article here, which talks about the key warning signs of blood clots in the legs, and different warning signs of clots that may have moved to the lungs.

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