SRS174 - Venous thromboembolism prophylaxis in day surgery: a systematic review and meta-analysis

Abstract Background Venous thromboembolism (VTE) significantly contributes to perioperative morbidity and mortality. Mitigating VTE risk across surgical specialties varies widely. This review aims to assess the efficacy and safety of various forms of VTE prophylaxis in patients undergoing day-case surgery. Methods A systematic review was conducted using PRISMA guidelines comparing no-prophylaxis, mechanical prophylaxis, and pharmacological prophylaxis in patients undergoing ambulatory surgery. No limits were set for the reported outcomes, language, or year of publication. Data were pooled by both common- and random-effects models for risk ratios (RR) with 95% confidence intervals (c.i.s) and analysed in R. Results Among the 1874 studies imported for screening, 1179 were excluded. A further 74 patients were excluded after full-text review, mainly owing to incorrect study design or patient population. Twenty-one studies meeting the inclusion criteria (n > 200 000) were included in the meta-analysis, mostly in orthopaedic surgery. Meta-analyses comparing prophylaxis strategies demonstrated no significant reduction in VTE risk with either mechanical or pharmacological prophylaxis compared with no prophylaxis. Using a common-effects model, pharmacological prophylaxis showed a benefit versus no prophylaxis (RR = 1.78; 95% c.i., 1.18–2.67), but this was not statistically significant under a random-effects model (I² = 39.3%). Bleeding risk was negligible overall but was more commonly reported in patients receiving pharmacological prophylaxis. Conclusions There is insufficient high-quality evidence to support routine mechanical or pharmacological VTE prophylaxis in all patients undergoing ambulatory surgery. Selective prophylaxis based on individualized risk assessments may be appropriate. Prospective, procedure-specific trials are needed, particularly for general surgery.