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首页> 外文期刊>Surgical Endoscopy >Practice patterns in high-risk bariatric venous thromboembolism prophylaxis.
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Practice patterns in high-risk bariatric venous thromboembolism prophylaxis.

机译：预防肥胖的高危减肥静脉血栓栓塞的实践模式。

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In the morbidly obese population that undergoes bariatric surgery, venous thromboembolism (VTE) is the leading cause of morbidity and mortality. Certain factors place a patient at higher risk for VTE. No consensus exists on VTE screening or prophylaxis for the high-risk patient. This report describes the results of a survey on VTE screening and prophylaxis patterns in high-risk bariatric surgery.Members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) were queried on factors that identified bariatric patients as high risk for VTE and on routine screening and prophylaxis practices. This included mechanical and chemical prophylaxis, duration of therapy, and use of inferior vena cava (IVC) filters.Of the 385 surgeons who responded to the survey, 81 % were bariatric surgeons, and the majority managed more than 50 cases annually. One or more of the following risk factors qualified patients as high risk: history of VTE, hypercoagulable status, body mass index (BMI) exceeding 55 kg/m(2), partial pressure of arterial oxygen (PaO(2)) lower than 60 mmHg, and severe immobility. Preoperative screening of patients for VTE was practiced routinely by 56 % of the surgeons, and 92.4 % used preoperative chemoprophylaxis. The most common agent used preoperatively was heparin (48 %), and Lovenox was most commonly used postoperatively (49 %). Whereas 48 % of the patients discontinued chemoprophylaxis at discharge, 43 % continued chemoprophylaxis as outpatients, and 47 % routinely screened for VTE postoperatively. Use of IVC filters was routine for 28 % of the patients, who most commonly removed them after 1-3 months.This study describes current practice patterns of VTE screening and prophylaxis in high-risk bariatric surgery. Nearly all surgeons agree on risk factors that qualify patients as high risk, but only half routinely screen patients preoperatively. Preoperative VTE chemoprophylaxis is used by nearly all surgeons, but the duration of therapy varies. Use of IVC filters is not routine, and postoperative screening was performed by less than half of the respondents. An understanding of current practice patterns yields insight into the rates of VTE and shows variability in the need for evidence-based prophylaxis and standardized screening.
机译：在接受减肥手术的病态肥胖人群中，静脉血栓栓塞症（VTE）是发病率和死亡率的主要原因。某些因素使患者发生VTE的风险更高。对于高危患者的VTE筛查或预防尚无共识。本报告描述了对高危减肥手术中VTE筛查和预防模式的调查结果。对美国胃肠道和内窥镜外科医生协会（SAGES）的成员进行了调查，询问是否将肥胖患者确定为VTE的高风险因素以及常规情况筛查和预防措施。这包括机械和化学预防，治疗时间和下腔静脉（IVC）过滤器的使用。在接受调查的385名外科医生中，有81％为减肥手术，并且大多数人每年处理50例以上。以下一种或多种风险因素使患者具有高风险：VTE病史，高凝状态，体重指数（BMI）超过55 kg / m（2），动脉血氧分压（PaO（2））低于60毫米汞柱，严重不动。 56％的外科医生常规地对VTE患者进行术前筛查，而92.4％的术前进行了化学预防。术前最常用的药物是肝素（48％），而Lovenox是术后最常用的（49％）。出院时停止化学预防的患者占48％，门诊继续化学预防的患者占43％，术后常规筛查VTE的患者占47％。 28％的患者常规使用IVC过滤器，这些患者最常在1-3个月后移除。该研究描述了目前在高风险减肥手术中VTE筛查和预防的实践模式。几乎所有的外科医生都同意将患者视为高风险的危险因素，但是只有一半的患者在术前例行筛查患者。几乎所有外科医生都使用术前VTE进行化学预防，但是治疗时间长短不一。 IVC过滤器的使用不是常规操作，术后筛查的对象不到一半。对当前实践模式的了解可以深入了解VTE的发生率，并显示出对循证预防和标准化筛查的需求存在差异。

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