Short cases and speedy ambulation put same-day surgery patients at a relatively low risk for deep-vein thrombosis and pulmonary embolism during the perioperative process. But that's no reason to skip measures that can prevent the potentially fatal complications, say experts, who maintain that these extra steps may provide a silent benefit against a silent hazard.
Who's at risk?
Impaired circulation and pooled blood can result in the formation of a blood clot, or thrombus, in a large vein, such as those in the legs. If an embolus should break from that clot and block the pulmonary artery in the lungs, the result can be fatal.
While this vascular complication presents unpredictably, it is possible to identify the patients who are at greater risk of suffering it. "All patients who are scheduled for outpatient surgery should have a DVT risk factor assessment at the time of booking, and it should be documented," says Lynn Razzano, RN, MSN, ONCC, a clinical nurse consultant with the Physician-Patient Alliance for Health and Safety in Westborough, Mass.
These assessments will typically arrive by way of physicians' pre-op consultations, says Sharon Butler, MSN, BSN, RN, a clinical nurse IV at Stanford University Hospital and Clinics in Palo Alto, Calif. "Unless they come through the ER, all surgical patients would've spoken before the day of surgery with a physician, who would have determined their risk factors well in advance" and ordered the implementation of special preventative measures in pre-op if they're deemed necessary.
Several different models exist for classifying patients' risk for DVT and PE, including checklists, grids and automated warnings programmed into electronic medical records systems.
The logic of preventative efforts
Anti-DVT prophylaxis is patient- and risk-factor specific. The type and anticipated length of surgery, along with a patient's individual risk profile, are often the primary drivers of the preventative efforts that are implemented. However, the ability to classify patients as low-risk populations for DVT should not foster a false sense of confidence, experts note.