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Dilemmas

We encourage our audience to interact and let us know of their dilemmas in day surgery and we shall try to come up with some discussion on how best to solve them.

Do patients need thromboprophylaxis after day surgery procedures?
Although patients having a day surgery procedure are mobile within hours of their surgery they are known to be at risk of venous thromboembolism(VTE) and NICE Guidance published in 2010 on reducing the risk of venous thromboembolism(VTE) specifically recommends that all patients admitted for day surgery under general anaesthetic should be risk assessed and consideration given to use of mechanical and/or chemical thromboprophylaxis.

Since the NICE Guidance was originally published in 2010 the range of procedures offered on a day case basis has extended considerably and many procedures now take in excess of the 90 minutes considered to pose a risk for thromboembolism.  The patients who are able to benefit from day surgery now include many patients with significant co morbidity such as a BMI > 30 and age > 60 years, both of which are considered a risk for VTE (see Box).  However work presented at BADS ASM over the last few years suggests that nationally the majority of patients having day surgery procedures are not given 5-7 days heparin postoperatively but are managed with compression stockings, early mobilisation and prevention of dehydration and that the incidence  of VTE in patients having day surgery is apparently low ii, iii.  So, how should thromboprophylaxis be managed for patients having day surgery?

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