Preventing venous thromboembolism in elective upper limb surgery

Background: Deep venous thrombosis (DVT) and pulmonary embolism (PE) have considerable clinical and economic consequences. The prevention of venous thrombosis and PE are increasingly seen as quality markers for surgery. Guidance is available from a number of sources to stratify risk for different patients and procedures and to define an appropriate standard of care. Despite this, best practice is unclear. Methods: We reviewed the available guidance for orthopedic surgeons undertaking elective upper limb surgery with respect to prescribing DVT prophylaxis. Material was identified from publications produced by professional and regulatory bodies, including United States Surgeon General, United Kingdom Department of Health, the American Academy of Orthopaedic Surgeons, the Scottish Intercollegiate Guideline Network, the National Institute for Clinical Excellence, and the American College of Chest Physicians, as well as a structured MEDLINE database search. Results: The picture is particularly confused in the case of elective upper limb surgery. Much of the evidence for prescribing DVT prophylaxis is related to lower limb surgery or trauma surgery. Conclusions: Failing to prescribe prophylaxis against venous thromboembolism (VTE) may be presented as a failure of care. We present a review of current guidance and the supporting evidence in order to establish evidence-based best practice and a standard of care for elective upper limb surgery. Level of evidence: Review Article. (C) 2013 Journal of Shoulder and Elbow Surgery Board of Trustees.