This study assesses routine intraoperative SCD use in the prevention of VTEs in thoracic surgical oncology patients following an ERAS protocol.ĭevelopment and classification of patient cohorts and data management With the introduction of perioperative multimodal interventions and their associated superior outcomes, such as minimal postoperative morbidities with a reduction in length of stay (LOS) to 2–3 days, there is evermore a reason to further optimize these pathways. They have become an incremental expense and burdensome recommendation in this patient population following the precautionary application based on preoperative VTE risk assessment models such as the Caprini score. These compression devices cost CAN$53 per pair at our institution. Several thoracic surgical and thrombosis societies further echo the limited literature from thoracic surgery in antithrombotic guideline formation. ![]() However, in the era of pharmacological VTE prophylaxis and ERAS pathways, the role of SCDs is becoming narrower. Knight and Dawson’s hallmark study elucidated the mechanism and efficacy of SCDs. ![]() ĭespite the prominence of ERAS, there is sparse evidence assessing quality provided by SCDs in strategic pathways of care. The key recommendations of ERAS include early ambulation, smoking cessation, nutritional screening, carbohydrate loading, VTE prophylaxis, minimally invasive approach, use of antibiotics, dynamic pain relief, early chest drain removal and avoidance of urinary catheters, to name a few. Guidelines for lung cancer surgery ERAS have been assembled by the European Society of Thoracic Surgeons, from which they developed 45 ERAS recommendations to mediate concomitant morbidities from initial presentation to postoperative discharge and follow-up. Similar initiatives set out earlier in the field of colorectal surgery such as “early pathway” or “fast-track rehabilitation” captured the advantages of this pathway protocol to emphasize quality rather than speed of recovery. Enhanced Recovery After Surgery (ERAS) or Enhanced Recovery After Thoracic Surgery protocols are designed to reduce the surgical stress response. There is moderate to low-quality evidence to support these guidelines in thoracic surgery, and data are often extrapolated from similar surgical fields with a strong precautionary recommendation favouring anticoagulants over mechanical compression. The American College of Chest Physicians and the National Institute of Health and Care Excellence VTE prophylaxis guidelines support the administration of low-dose unfractionated heparin or low-molecular-weight heparin (LMWH), in addition to mechanical prophylaxis such as applied compression devices in moderate-high risk patients with VTE. However, they report weak consensus and evidence on the incremental benefit of the routine usage of sequential compression devices (SCDs) for VTE risk in the context of the ERAS thoracic surgery pathway of care. ![]() The current mainstay in addressing embolic risk involves implementing recommendations set out by the American College of Chest Physicians–9th edition VTE prophylaxis guideline and the British National Institutes of Health Care and Excellence (NICE)–VTE NG89 guideline. Changes in neural, endocrine and metabolic systems can induce activation of the compensatory stress response following surgery, promoting coagulation-fibrinolytic dysfunction in which the development of symptomatic or asymptomatic thromboembolic risk increases. The incidence and causes of VTE such as deep vein thrombosis (DVT) and pulmonary embolism (PE) are characterized as morbidity of the surgical stress response. The literature surrounding the recommendation of mechanical venous thromboembolism (VTE) prophylaxis in thoracic ERAS protocols remains limited. The implementation of Enhanced Recovery After Surgery (ERAS) protocols in all surgical specialties is rising in prominence, involving an interdisciplinary team focused on integrating perioperative evidence-based medicine into clinical practice.
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