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July 2012, Volume 42 Number 7 , p 21 - 23



The number of surgeries performed in the outpatient setting is growing, but the incidence of venous thromboembolism (VTE) requiring treatment after outpatient surgery isn't known. Investigating this issue, researchers conducted a prospective observational cohort study using a large American College of Surgeons database from 2005 to 2009. Included were over 200,000 adults who'd undergone outpatient surgery or surgery with subsequent 23-hour observation. They found that 1 in 84 outpatients at highest risk for VTE develops a VTE requiring treatment within 30 days of the procedure.The overall 30-day incidence of VTE was 0.15%. Independent risk factors for VTE included current pregnancy, active cancer, age 41 and older, body mass index of 40 or higher, operative time 120 minutes or longer, arthroscopic surgery, saphenofemoral junction surgery, and venous surgery not involving the great saphenous vein.Based on their data, researchers created a risk-stratification tool to predict a patient's risk for VTE. The tool identified a 20-fold variation in VTE risk from 0.04% to 1.12% among the outpatient surgery population."These data are in stark contrast to provider and patient expectations that outpatient surgery is a low-risk event," says lead study author Christopher J. Pannucci, MD. "It also underscores the importance of evaluating a patient's individual risk factors as opposed to procedure-type alone."The new risk model may improve the informed-consent process for outpatient surgery patients by providing clear, data-driven information to patients about their risk for developing VTE, authors say.Sources: Pannucci CJ, Shanks A, Moote MJ, et al. Identifying patients at high risk for venous thromboembolism requiring treatment after outpatient surgery. Ann Surg. 2012;255(6):1096-1099; Outpatient surgery patients also at risk for dangerous blood clots. . 2012; April 23. .Patients in ICUs who wear earplugs to

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