Ever since The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism was released in 2008, an emphasis has been placed on the prevention and treatment of deep vein thrombosis (DVT) and the serious related condition of pulmonary embolism (PE).
In the preamble to that report, Michael O. Leavitt, then Secretary of Health and Human Services, stated “the best estimates indicate that 350,000 to 600,000 Americans each year suffer from DVT and PE, and that at least 100,000 deaths may be directly or indirectly related to these diseases.”
In addition, The Surgeon General’s Call to Action reported that “the Agency for Healthcare Research and Quality has ranked the provision of such preventive treatment as one of the most important things that can be done to improve patient safety.”1
The Surgeon General’s Call to Action is a concerted effort to make patients, their families, and healthcare providers aware of venous thromboembolism (VTE) so as to reduce the incidence of this dreaded surgical and medical complication.
The American Society of Plastic Surgeons (ASPS) developed its own task force, which published a report in July 2011.2 The task force was charged with:
It is important to note that the task force issued the following disclaimer:
This task force report provides strategies for patient management and was developed to assist physicians in clinical decision making. This task force report, based on a thorough evaluation of the present scientific literature and relevant clinical experience, describes a range of generally acceptable approaches to diagnose, manage, or prevent specific disease or conditions. This report attempts to define principles of practice that should generally meet the needs of most patients in most circumstances.
This report, however, should not be construed as a rule, nor should it be deemed inclusive of all proper methods of care or exclusive of other methods of care reasonably directed at obtaining the appropriate results. It is anticipated that it will be necessary to approach some patients’ needs in different ways. The ultimate judgment regarding the care of a particular patient must be made by the physician in light of all the circumstances presented by the patient, the diagnostic and treatment options available, and available resources.
This task force report is not intended to define or serve as the standard of medical care. Standards of medical care are determined on the basis of all the facts or circumstances involved in an individual case and are subject to change as scientific knowledge and technology advance, and as practice patterns evolve. This task force report reflects the state of knowledge current at the conclusion of the task force’s activities (July 2011). Given the inevitable changes in the state of scientific information and technology, periodic review and revision will be necessary.3
ASPS also published an article in Plastic Surgery News in June 2013 by Gary Culbertson, MD, on VTE prevention.4 The article serves as a reminder to all plastic surgeons to be aware of the nature of VTE and the importance of a preoperative assessment and preventive management, as well as the use of the Caprini RAM as a tool to evaluate the risk of VTE.5
Dr. Culbertson writes, “For the safety of your patients, the ASPS Patient Safety Committee recommends becoming up to date with the screening and prevention of VTE—particularly for your abdominoplasty and combined-procedure patient. CME is available at www.psenetwork.org, and there’s a VTE Prevention Patient Safety Course offered at every ASPS annual meeting.” A useful patient awareness handout is available.6
By David M. Charles, MD, Board Member, The Doctors Company
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.