Abstract: Survey of peri-operative venous thromboembolism prevention and management in metabolic and bariatric surgery in the region of Beijing, Tianjin, Hebei and Shanxi        ZHANG Peng*, ZHAO Ying, TIAN Pei-rong, et al.
*Division of Metabolic and Bariatric Surgery, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University；National Clinical Research Center for Digestive Diseases, Beijing 100050, China
Corresponding author：ZHANG Zhong-tao，E-mail：zhangzht@ccmu.edu.cn；CUI Xiang-li，E-mail：cui10@163.com
ZHANG Peng and ZHAO Ying are the first authors who contributed equally to the article.
Abstract    Objective    To survey and analyze the awareness，knowledge and current prevention and management status of perioperative venous thromboembolism（VTE）in metabolic and bariatric surgery in the region of Beijing，Tianjin，Hebei and Shanxi. Methods    A questionnaire survey was carried out among the surgical team leaders and experts of related specialties from 16 hospitals in Beijing，Tianjin，Hebei and Shanxi provinces where metabolic and bariatric surgery was offered. The questionnaire had three parts，including the basic information of the respondents and their hospitals，respondents’knowledge about VTE，and the current status of prevention and treatment of VTE in their metabolic and bariatric units，including risk assessment，preventive measures and treatment decision-making. Results  Most of the hospitals in the region offered weight loss and metabolic surgery for less than 10 years（77.27%），and the annual operation volume of most hospitals was less than 100（77.27%）. In the past three years，1 to 2 cases of VTE occurred in two hospitals during the perioperative period of metabolic and bariatric surgery，but no VTE related death cases were reported. Most of doctors were lack of systematic training of VTE and failed to master the special knowledge of VTE in metabolic and bariatric surgery. The vast majority of hospitals had hospital level VTE prevention and management standards. They could assess the risk of VTE before operation，and use mechanical and medication combinational prevention for high-risk patients during perioperative period. Low molecular weight heparin was the most choice of drugs，and most of them started the prevention program more than 12 hours before operation. There were differences existed in the preventive measures of patients among respondents，and they were generally worried about the increase of perioperative bleeding events caused by anticoagulants.Conclusion    Most of the patients who undergo metabolic and bariatric surgery have moderate to high risk of VTE，which needs to be aware of by surgeons and related healthcare staff. And systematic training should be enforced. In addition，due to the wide variation of BMI in patients receiving bariatric surgery，BMI is an important influencing factor of VTE risk. It is necessary to formulate perioperative VTE prevention and treatment guidelines or expert consensus in accordance with the characteristics of metabolic and bariatric surgery.

Key words: obesity, metabolic and bariatric surgery, peri-operative management, venous thromboembolism

摘要： 目的    调查分析京津冀晋地区专家对减重与代谢外科围手术期血栓栓塞症（VTE）的重视程度、知识掌握情况以及防治现状。方法    问卷调查京津冀晋地区16家开展减重与代谢手术的医院外科带组医生以及相关专业的专家。题目分为3个部分，分别为被调查专家及所在单位的基本情况，专家对VTE知识掌握程度，及专家所在医院的减重与代谢外科目前VTE临床防治现状，包括VTE风险评估、预防措施和治疗决策。结果    所调查绝大多数医院开展减重与代谢手术不超过10年（77.27%），且多数医院年手术量＜100台（77.27%）。在过去的3年间，共有两家医院在减重与代谢手术围手术期发生过1~2例VTE事件，但未有VTE相关死亡病例的报道。大多数医生缺乏VTE的系统培训，且未能正确掌握减重外科VTE的特殊知识。绝大多数医院有院级VTE防治管理规范，在术前能对病人进行VTE风险评估，并对于高危病人围手术期采用机械与药物联合预防，药物选择以低分子肝素为最多，且多数在术前12 h以上即开始启动预防方案，但对于抗凝药物使用剂量、术后抗凝药物预防疗程和中风险病人的预防措施，各位专家差异较大，并普遍担心抗凝药物增加围手术期出血事件。结论    减重与代谢外科病人多数属于VTE中高风险，需要引起本专科医生的重视，并接受系统的培训。此外，由于减重外科病人群体体重指数（BMI）跨度大，而BMI又是VTE风险的重要影响因素，因而需要制定符合减重与代谢外科特点的围手术期VTE防治指南或者专家共识。

关键词: 肥胖症, 减重与代谢外科, 围手术期, 静脉血栓栓塞症