关键词: 静脉血栓栓塞症, 普通外科, 横断面调查

Abstract: Survey of clinical diagnosis and treatment of venous thromboembolism in general surgery inpatients in Shanghai        LOU Wen-hui, CHENG Jian, LI Ju-xin, et al. On behalf the research team of Clinical Quality Control Center of General Surgery in Shanghai. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Corresponding author: QIN Xin-yu, E-mail: qin.xinyu@zs-hospital.sh.cn
Abstract    Objective    To investigate 3 priority issues of venous thromboembolism(VTE) in Shanghai including the establishment of prevention and control system of venous thromboembolism (VTE) in Department of General Surgery, doctors understanding of VTE knowledge and the incidence of VTE in the investigated department. Methods    From September 1 to 12, 2019, the questionnaire was designed strictly according to the international and Chinese guidelines of prophylaxis and treatment of VTE in general surgery, which formed as QR code, sent by the Shanghai General Surgery Clinical Quality Control Center with official email and social media: We Chat. Results    Sixty-nine hospitals were participated in the survey and a total of 112 valid questionnaires were retrieved. The incidence of confirmed pulmonary embolism (PE) cases were reported for 0.06% (5/7843), and the incidence of confirmed deep vein thrombosis (DVT) was 1.02% (80/7843). By September 12, 2019, 88.39% (99/112) of departments of third and second grade hospitals in Shanghai had established VTE prevention and control system; 84.82% (95/112) of departments had joint consultation teams of VTE and PE; 96.43% (108/112) departments stared to assess VTE risk for patients from admitting to hospital, 74.11% (83/112) of departments evaluated the VTE risk right after surgery and 38.39% (43/112) of departments evaluated the risk of VTE for patients before discharge. Before operation, 53.57% (60/112) of departments gave anticoagulation therapy for the patients with high risk of VTE, and stopped at 12 hours before operation; And 34.61% (18/52) of departments were concerned about bleeding, while 23.07% (12/52) didn’t give anticoagulation therapy holding the view that anticoagulation was not needed before surgery. In postoperative anticoagulation therapy, for the patients with benign diseases, 43.75% (49/112) of departments maintained for 3 to 5 days, 23.21% (26/112) continued until discharge, 4.46% (5/112) until free walking, 2.68% (3/112) until 28 days after operation, however 25.89% (29/112) of departments didn’t give anticoagulation therapy after operation; For the patients with malignant diseases, 47.32% (53/112) of departments gave anticoagulation therapy before discharge, 23.21% (26/112) maintained anticoagulation therapy until 3 to 5 days after operation, and only 8.04% (9/112) maintained anticoagulation therapy to 28 days after operation according to recommendation. When the situation comes to the prophylaxis of anticoagulation therapy, 96.43% (108/112) of departments chose low molecular weight heparin as the inpatient surgical methods. While for the outpatient surgical patients, 43.75% (49/112) of departments chose aspirin, 16.07% (18/112) chose LMWH, 24.11% (27/112) chose novel oral anticoagulants, and 15.18% (17/112) chose warfarin. Conclusion    Great progress has been made in doctors understanding and medical practice of prevention and control of VTE in Department of General Surgery in Shanghai compared with two years ago. However, there is still a medical practicing gap that prophylaxis and treatment of VTE between Shanghai and international guideline, especially the correct way to performing prophylaxis of anticoagulantion therapy (anticoagulants choosing and timing), and the prevention of patients with malignant diseases and high risk of VTE.

Key words: venous thromboembolism, general surgery, cross sectional investigation