Low Risk of Thromboembolic Complications After Fast-Track Abdominal Surgery With Thrombosis-Prophylaxis Only During Hospital Stay

BACKGROUND: Subcutaneous low molecular weight heparin (LMWH) reduces the risk of thromboembolic complications after abdominal surgery. With enhanced recovery after surgery (ERAS), median hospital stay after abdominal surgery may be as short as 3 - 4 days. The aim of our study was to investigate whether thrombosis prophylaxis during the short hospital stay was sufficient to maintain a low frequency of thromboembolic complications. METHODS: Ninety-eight patients, median age 67 years, were enrolled in a prospective two-center observational study of colorectal resections following the ERAS principles. Seventy-seven patients (78.6%) were resected for colonic cancer, the rest for benign colonic diseases. Fifty percent of the patients were discharged from hospital within three days after surgery. Follow-up examinations took place at 8 and 30 days after surgery with clinical examination for thromboembolism. The patients enrolled at one of the centers were also scheduled for a routine venography at day 8. Seventeen of these were evaluated. RESULTS: Clinical follow-up at day 8 of 72 patients (73.5%) revealed no venous thromboembolism (VTE), and the 17 venograms did not show any thromboses. Clinical follow-up at day 30 of 74 patients (75.5%) showed no deep venous thrombosis (DVT), whereas pulmonary embolus (PE) was suspected and verified in one patient (1.3%) with pulmonary metastases and pneumonia. CONCLUSIONS: Prophylaxis until full mobilization seems to be sufficient following major surgery in patients treated with the principles of ERAS who remain in hospital for 3 - 4 days.