Before surgery: Have you done enough to mitigate risk?
The Journal of Family Practice. 2010 April;59(04):202-211
April 1, 2010|Family Medicine
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A preoperative evaluation demands more than a cursory history and physical. The tips and tables you’ll find here will boost your ability to safeguard your patients.
- Continue home diabetes medications perioperatively, supplemented with a basal-bolus insulin regimen.
- Initiate incentive spirometry postoperatively; use an NG tube if postoperative nausea and vomiting occur.
- Maintain MAP >65 mm Hg.
- Institute aggressive early ambulation and use of graduated compression stockings for DVT prophylaxis.
Submitted by ___________ on ________.
TABLE 3
Perioperative thromboembolism: Risk and prophylaxis
| DVT/VTE risk40 | Prophylaxis recommendations |
|---|---|
| Low (<10%) • Mobile patients40 • Minimal patient-specific risk factors • Surgery <30 min41 | • Early mobilization |
| Medium (10%-40%) • Most general, gynecologic, or urologic procedures40 • Surgery >30 min41 • Additional patient-specific risk factors • Moderate-risk procedure with high risk of bleeding35 | • Chemoprophylaxis (LMWH, LDUH, Fpx) • Mechanical prophylaxis GCS; may consider adding IPD) |
| High (40%-80%) • Trauma, major surgery40 • Either patient or procedure is high risk for VTE and patient is at high risk of bleeding | • Chemoprophylaxis (LMWH, Fpx, VKA) • Mechanical prophylaxis (GCS and IPD) |
| DVT, deep vein thrombosis; Fpx, fondaparinux; GCS, graduated compression stockings; IPD, intermittent pneumatic device; LDUH, low-dose unfractionated heparin; LMWH, low-molecular-weight heparin; VKA, vitamin K antagonists; VTE, venous thromboembolism. | |
CORRESPONDENCE Mark K. Huntington, MD, PhD, FAAFP, Center for Family Medicine, 1115 East Twentieth Street, Sioux Falls, SD 57105; mark.huntington@usd.edu
