Day surgery and thromboembolic complications: time for structured assessment and prophylaxis

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Abstract
This article provides an overview of studies on thromboembolic complications and thromboprophylaxis in outpatients. The aim is to evaluate the indications and practice of thromboprophylaxis in day surgery. Retrospective studies reported a low incidence of venous thromboembolism after day surgery, although some prospective studies that included systematic screening for deep vein thrombosis reported a high incidence of this entity among outpatients. There are few randomized controlled trial data to inform indications for thromboprophylaxis in day surgery, however. After the decision to start treatment has been made, the optimal time for the first dose is 6 h postoperatively. There is no evidence favouring 1-2 days of prophylaxis, and the duration should be 7-10 days. Increasing numbers of elderly patients with comorbidity and younger patients with risk factors for venous thromboembolism are undergoing surgery, and procedures of increased complexity are performed in the day-care setting. There is a lack of data on indications for thromboprophylaxis, however, and the practice is thus opinion based. Screening for risk factors for venous thromboembolism should become routine, and randomized controlled trials are needed to provide data to inform institutional guidelines.