Pre-, intra-, and/or postoperative arterial and venous thromboembolism prophylaxis for breast surgery: Systematic review and meta-analysis

Journal of Gastrointestinal Surgery

Newbold

Stevens

et al. 2022

Background Abdominal visceral resections incur relatively higher rates of postoperative bleeding and venous thromboembolism (VTE). While guidelines recommend the use of perioperative chemical thromboprophylaxis, the most appropriate time for its initiation is unknown. Here, we investigated whether early (before skin closure) versus postoperative commencement of chemoprophylaxis affected VTE and bleeding rates following abdominal visceral resection. Methods Retrospective review of all elective abdominal visceral resections undertaken between January 1, 2018, and June 30, 2019, across four tertiary-referral hospitals. Major bleeding was defined as the need for blood transfusion, reintervention, or > 20 g/L fall in hemoglobin from baseline. Clinical VTE was defined as imaging-proven symptomatic disease < 30 days post-surgery. Results A total of 945 cases were analyzed. Chemoprophylaxis was given early in 265 (28.0%) patients and postoperatively in 680 (72.0%) patients. Mean chemoprophylaxis exposure doses were similar between the two groups. Clinical VTE developed in 14 (1.5%) patients and was unrelated to chemoprophylaxis timing. Postoperative bleeding occurred in 71 (7.5%) patients, with 57 (80.3%) major bleeds, requiring blood transfusion in 48 (67.6%) cases and reintervention in 31 (43.7%) cases. Bleeding extended length-of-stay (median (IQR), 12 (7–27) versus 7 (5–11) days, p < 0.001). Importantly, compared to postoperative chemoprophylaxis, early administration significantly increased the risk of bleeding (10.6% versus 6.3%, RR 1.45, 95% CI 1.05–1.93, p = 0.038) and independently predicted its occurrence. Conclusions The risk of bleeding following elective abdominal visceral resections is substantial and is higher than the risk of clinical VTE. Compared with early chemoprophylaxis, postoperative initiation reduces bleeding risk without an increased risk of clinical VTE.

Section: Introductionmentioning

confidence: 99%

Early Versus Postoperative Chemical Thromboprophylaxis Is Associated with Increased Bleeding Risk Following Abdominal Visceral Resections: a Multicenter Cohort Study

Journal of Gastrointestinal Surgery

Newbold

Stevens

et al. 2022

“…With the continuous development of society and the economy, people are increasingly pursuing beauty, and breast augmentation operations are on the rise, which can effectively improve the beauty of women's breasts 1 . However, postoperative complications, such as infection and prosthesis displacement, are prone to occur, which will impact the effect of the surgical treatment and endanger the physical and psychological health and quality of life of patients.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, as standards for women's appearance have continuously increased, some breast problems, including poor congenital breast development, sagging, breast atrophy, or asymmetric breasts on both sides, have laid heavy burden on some women in both physical and psychological aspects. Therefore, there are increasing people turning to breast augmentation surgery 1 . However, related studies suggested that, although breast augmentation can effectively improve women's breast health, improved perioperative nursing services are also indispensable in reducing or preventing postoperative complications as well as ensuring the effect of cosmetic plastic surgery, as breast augmentation carries many complications that affect the patient's postoperative recovery, physical and psychological health, and quality of life 2 .…”

Section: Introductionmentioning

confidence: 99%

Application of evidence‐based nursing in prevention of postoperative complications of breast augmentation

Gao

J of Cosmetic Dermatology

et al. 2021

Objective To study the application of evidence‐based nursing in prosthesis postoperative complications. Methods A total of 78 cases of patients who underwent prosthetic breast augmentation were selected from July 2017 to July 2019. All the patients were divided into control group and study group according to the random number table method. The patients in the control group received routine nursing interventions, and the patients in the study group performed evidence‐based nursing interventions based on the control group's care. The mental health, external esthetic effects, and complications of the two groups were observed and compared. Results Before the implementation of nursing intervention, there was no significant difference in mental health indicators (SAS, SDS) between the two groups (p > 0.05). After the intervention, the SAS and SDS scores of the two groups were lower than before the intervention, and the study group was lower than the control group, and the difference was statistically significant (p < 0.05); before the implementation of nursing intervention, there was no significant difference in the scores of HADS‐A and HADS‐D between the two groups (p > 0.05). After the intervention, the scores of HADS‐A and HADS‐D of the two groups were lower than those before the intervention, and the scores of the study group were lower than those of the control group, and the difference was statistically significant (p < 0.05); 94.9% (37 / 39) was better than 71. 8% (28 / 39) in the control group. The difference was statistically significant (p < 0.05), and the total incidence of postoperative complications in the study group was 5.1% (2 / 39), which was lower than 15.4% (6 / 39) in the control group (p < 0.05). Conclusion Evidence‐based nursing intervention is effective in preventing postoperative complications of silicone breast augmentation prosthesis. It can effectively reduce postoperative complications, improve external esthetic effects, and improve the level of mental health of patients. It is worthy of clinical promotion and application.

“…9 Importantly, chemoprophylaxis use has been associated with increased bleeding in these operations. 4,6,7 Notably, bleeding risk post thyroid/parathyroid surgeries significantly outweighs that of VTE in most patients. 6 Taken together, these findings highlight the need to refine guidelines for these commonly performed operations.…”

Section: Discussionmentioning

confidence: 99%

“…This may be explained by their inherently low but not absent VTE risk, their relatively higher although not exceedingly high rate of post‐operative bleeding, 4–7 discrepant literature which encourages yet questions the need for chemoprophylaxis, 8 confusing guidelines which broadly recommends chemoprophylaxis without accounting for individual risks 2 and a fear of litigation which may influence decision‐making 9 . Importantly, chemoprophylaxis use has been associated with increased bleeding in these operations 4,6,7 . Notably, bleeding risk post thyroid/parathyroid surgeries significantly outweighs that of VTE in most patients 6 .…”

Section: Discussionmentioning

confidence: 99%

Variations in practice of thromboprophylaxis across general surgical subspecialties: a multicentre (PROTECTinG) study of elective major surgeries

Stevens

Wong

et al. 2020

ANZ Journal of Surgery

Background: Despite guidelines recommending perioperative thromboprophylaxis for patients undergoing general surgery, we have observed significant variations in its practice. This may compromise patient safety. Here, we quantify the heterogeneity of perioperative thromboprophylaxis across all major general surgical operations, and place them in relation to their risk of bleeding and venous thromboembolism. Methods: Retrospective review of all elective major general surgeries performed between 1 January 2018 and 30 June 2019 across seven Victorian hospitals was conducted. Results: A total of 5912 patients who underwent 6628 procedures were reviewed. Significant heterogeneity was found in the use of chemoprophylaxis, timing of its initiation, type of anticoagulant administered and application of extended chemoprophylaxis. These variations were observed within the same procedure, and between different surgeries and subspecialties. Contrastingly, there was minimal heterogeneity with the use of mechanical thromboprophylaxis. Oesophago-gastric, liver and colorectal cancer resections had the highest thromboembolic risk. Breast, oesophago-gastric, liver, pancreas and colon cancer resections had the highest bleeding risk. Conclusion: Perioperative chemoprophylaxis across general surgery is highly variable. This study has highlighted key areas of variance. Our findings also enable surgeons to compare their practices, and provide baseline data to inform future efforts towards optimizing thromboprophylaxis for general surgical patients.