SAMBA promotes “simplified approach” to VTE risk assessment and prophylaxis in ambulatory settings

The Society for Ambulatory Anesthesia (SAMBA) has published a position statement regarding a simplified approach to risk assessment and prophylaxis for prevention of venous thromboembolism (VTE) after ambulatory surgery.

The clinical practice recommendation paper, free to read in its entirety, was published in the October edition of the journal Anesthesia & Analgesia.

VTE prevention, a crucial safety consideration in inpatient perioperative environments, will only grow in importance at ASCs as more complex procedures on patients with multiple comorbidities are pushed to the outpatient setting. The stakes are high, as the authors note that “more than half of the VTE events occurring after hospital discharge are directly linked to a recent hospitalization or surgery”; that VTE is “associated with reduced survival, substantial health-care costs, and a high rate of recurrence”; and that “sudden death is the first symptom in 25% of those who experience a pulmonary embolism.”

The SAMBA paper states that “ambulatory anesthesiologists, by being part of multidisciplinary teams to establish enhanced recovery pathways at their outpatient facilities, play a pivotal role in identifying patients at risk for developing VTE, customizing risk assessment tools, and establishing thromboprophylaxis protocols for patients at their centers. In addition, anesthesiologists can play a key role in patient education, which is an important component of VTE prevention.”

SAMBA notes that “VTE risk assessment may often be overlooked” in ambulatory settings due to “the belief that ambulatory surgery does not increase risk for VTE” and that high patient volumes at ASCs make it “cumbersome to implement the many inpatient VTE risk assessment tools.”

SAMBA states that its members “critically appraised the existing literature” to develop its position statement with suggestions for VTE risk assessment and prophylaxis in adult patients undergoing ambulatory surgery, while also identifying areas where further research should be prioritized. The position statement, reviewed and approved by SAMBA’s Board of Directors, “summarizes and synthesizes existing VTE risk assessment and prophylaxis tools into an easy-to-use algorithm.”

SAMBA notes that “the algorithm is not yet validated and much more research needs to be done in this area,” but it believes its algorithm represents “the most common elements of current practice among many SAMBA members, and similar clinical decision support algorithms and protocols are currently being used by SAMBA members.”

SAMBA also suggests:

• “A practical strategy [that] involves first identifying patients and procedures that are lower risk for whom VTE prophylaxis is not indicated in the ambulatory setting.”
• “For higher-risk patients and procedures, a structured VTE risk assessment should guide decisions on thromboprophylaxis. Patients at high risk may require baseline VTE risk reduction, mechanical thromboprophylaxis, and pharmacological prophylaxis, if not contraindicated.”
• “Given their integral involvement across all phases of the perioperative continuum—preoperative, intraoperative, and postoperative—[anesthesiologists] are well positioned to lead initiatives that enhance patient outcomes. We suggest a joint evidence-based approach with the surgeon to decide the most appropriate pharmacological prophylaxis plan for patients.”
• “SAMBA is proposing a pragmatic approach to VTE risk assessment and prophylaxis in busy ambulatory settings using a synthesis from the existing tools. We have simplified the approach with the objective of universal applicability and have condensed decision-making to two points, thus optimizing implementation. However, developing customized tools for VTE risk assessment and prophylaxis, tailored both to the specific clinical setting of ASCs and to specific surgical populations such as cancer patients, is crucial for optimal preventive care.”
• “Future tools should integrate seamlessly into existing workflows and provide clear guidance for clinicians to make informed decisions about patient care.”
• “Future research is needed to validate the proposed approach with respect to its efficacy and refine risk factors as well as develop reliable tools to guide VTE prevention in ambulatory surgery.”

Read SAMBA’s full position statement here.