Jason Wright, MD
Jason Wright, MD, assistant clinical professor, department of obstetrics and gynecology, Columbia University College of Physicians and Surgeons, New York City. His study was published in Journal of the American Medical Association.
If you have to have surgery, you naturally want to feel confident that your surgeon is doing everything possible to prevent complications that could put you in harm’s way…or at death’s door. Yet for an alarmingly high number of women having gynecologic surgery, such confidence would be sadly misplaced, a recent study showed.
Background: About 16% of women who undergo major gynecologic surgery develop venous thromboembolism (VTE), a postsurgical hazard in which a blood clot blocks a blood vessel. VTE can lead to pain, swelling, blood vessel damage—and to the potentially fatal pulmonary embolism (blood clot in the lungs). To reduce this risk, doctors can prescribe prophylactic VTE care in the form of anticlotting medication and/or mechanical devices (such as compression stockings or pneumatic compression equipment that promotes circulation by massaging the legs) before and after surgery. VTE is a risk with many types of surgery—however, evidence suggests that gynecological surgeons are less likely to comply with VTE prevention guidelines than surgeons in other high-risk specialties.
New 10-year study: Investigators examined hospital records of 738,150 women who had major gynecologic surgery, such as removal of the uterus, fallopian tubes and/or ovaries. Among these patients, 40% received no prophylactic VTE care at all—a shocking finding given how often this potentially deadly complication develops. The only encouraging news is that the situation seems to be improving. In 2000, 47% of the patients got no prophylactic VTE care…by 2010, that number had fallen to 33%, which is better but still disturbingly high.
If you need gynecologic surgery: Choose a surgeon who operates frequently, and have your surgery in a hospital that does a high volume of gynecologic procedures—the research showed that those factors upped the odds that a woman would receive prophylactic VTE care. Also, ask your doctor specifically what he or she will do—and whether there is anything you can do yourself—to lower your risk for a postsurgical clot. More info: The Agency for Healthcare Research and Quality publishes blood-clot prevention guidelines at www.Guideline.gov/content.aspx?id=11429.
