Applying risk assessment models in general surgery: effective risk stratification.

The risk of venous thromboembolism (VTE) in general surgery patients varies from 10-50% depending on the type of surgery and underlying patient risk factors. Despite the availability of effective antithrombotic therapies, thromboprophylaxis is substantially underused in the general surgical field. The development of risk assessment models (RAMs) that can accurately and prospectively categorize patients according to their thromboembolic risk level may lead to improved use of thromboprophylaxis. Several evidence-based RAMs are now available that include general surgery in their range of clinical categories, allowing patients to be stratified rapidly for thromboembolic risk. Therapeutic recommendations are included in some cases. Tailoring anticoagulant therapy according to risk of VTE should maximize the clinical benefit and cost-effectiveness of prophylaxis, and minimize the risk of bleeding complications. Further studies are required to validate novel RAMs in clinical practice, and to extend their scope to include patient groups with particular needs, such as those undergoing neurosurgical procedures.