Yaron Shargall1, Alessandro Brunelli2, Sudish Murthy3, Laura Schneider1, Fabrizio Minervini4, Luca Bertolaccini5, John Agzarian1, Lori-Ann Linkins6, Peter Kestenholz4, Hui Li7, Gaetano Rocco8, Philippe Girard9, Federico Venuta10, Marc Samama11, Marco Scarci12, Masaki Anraku13, Pierre-Emmanuel Falcoz14, Alan Kirk15, Piergiorgio Solli5, Wayne Hofstetter16, Meinoshin Okumura17, James Douketis6, Virginia Litle18. 1. Department of Surgery, McMaster University, Hamilton, ON, Canada. 2. Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK. 3. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA. 4. Department of Thoracic Surgery, Kantonsspital Luzern, Lucerne, Switzerland. 5. Department of Thoracic Surgery, Maggiore Hospital, Bologna, Italy. 6. Department of Medicine, McMaster University, Hamilton, ON, Canada. 7. Department of Thoracic Surgery, Capital Medical University, Beijing, China. 8. Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium. 9. Thoracic Department, Institut Mutualiste Montsouris, Paris, France. 10. Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 11. Department of Anaesthesia and Intensive Care Medicine, Cochin and Hôtel-Dieu University Hospitals, Paris, France. 12. Department of Thoracic Surgery, San Gerardo Hospital, Monza, Italy. 13. Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan. 14. Department of Thoracic Surgery, University Hospital Strasbourg, Strasbourg, France. 15. Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK. 16. Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 17. Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. 18. Department of Surgery, Boston University School of Medicine, Boston, MA, USA.
Abstract
OBJECTIVES: Venous thromboembolic events (VTE) after thoracic surgery (TS) can be prevented with mechanical and chemical prophylaxis. Unlike other surgical specialties, TS lacks evidence-based guidelines. In the process of developing these guidelines, an understanding of the current prophylaxis methods practiced internationally is necessary and is described in this article. METHODS: A 26-item survey was distributed to members of the European Society of Thoracic Surgeons (ESTS), American Association of Thoracic Surgery (AATS), Japanese Association for Chest Surgery (JACS) and Chinese Society for Thoracic and Cardiovascular Surgery (CSTCS) electronically or in person. Participants were asked to report their current prophylaxis selection, timing of initiation and duration of prophylaxis, perceived risk factors and the presence and adherence to institutional VTE guidelines for patients undergoing TS for malignancies. RESULTS: In total, 1613 surgeons anonymously completed the survey with an overall 36% response rate. Respondents were senior surgeons working in large academic hospitals (≥70%, respectively). More than 83.5% of ESTS, AATS and JACS respondents report formal TS thromboprophylaxis protocols in their institutions, but 53% of CSTCS members report not having such a protocol. The regions varied in the approaches utilized for VTE prophylaxis, the timing of initiation perioperatively and the use and type of extended prophylaxis. Respondents reported that multiple risk factors and sources of information impact their VTE prophylaxis decision-making processes, and these factors vastly diverge regionally. CONCLUSIONS: There is little agreement internationally on the optimal approach to thromboprophylaxis in the TS population, and guidelines will be helpful and vastly welcomed.
OBJECTIVES:Venous thromboembolic events (VTE) after thoracic surgery (TS) can be prevented with mechanical and chemical prophylaxis. Unlike other surgical specialties, TS lacks evidence-based guidelines. In the process of developing these guidelines, an understanding of the current prophylaxis methods practiced internationally is necessary and is described in this article. METHODS: A 26-item survey was distributed to members of the European Society of Thoracic Surgeons (ESTS), American Association of Thoracic Surgery (AATS), Japanese Association for Chest Surgery (JACS) and Chinese Society for Thoracic and Cardiovascular Surgery (CSTCS) electronically or in person. Participants were asked to report their current prophylaxis selection, timing of initiation and duration of prophylaxis, perceived risk factors and the presence and adherence to institutional VTE guidelines for patients undergoing TS for malignancies. RESULTS: In total, 1613 surgeons anonymously completed the survey with an overall 36% response rate. Respondents were senior surgeons working in large academic hospitals (≥70%, respectively). More than 83.5% of ESTS, AATS and JACS respondents report formal TS thromboprophylaxis protocols in their institutions, but 53% of CSTCS members report not having such a protocol. The regions varied in the approaches utilized for VTE prophylaxis, the timing of initiation perioperatively and the use and type of extended prophylaxis. Respondents reported that multiple risk factors and sources of information impact their VTE prophylaxis decision-making processes, and these factors vastly diverge regionally. CONCLUSIONS: There is little agreement internationally on the optimal approach to thromboprophylaxis in the TS population, and guidelines will be helpful and vastly welcomed.