Venous thromboembolism (VTE) is the most common preventable cause of hospital death. Several audits in the west have demonstrated that appropriate thromboprophylaxis is not being offered to a large number of surgical patients. Similar audits are lacking in the Indian population, and a perception exists among Indian surgeons that Indian patients are not susceptible to VTE. Hence we undertook a survey to analyze the existing knowledge and practice of VTE prophylaxis amongst general surgeons in India. A questionnaire-based survey was conducted on 100 active general surgeons. We found that 97% of surgeons had encountered VTE in their practice, and 49% had encountered mortality from pulmonary embolism. 64% of surgeons do not routinely score patients preoperatively for their VTE risk, and only 33% reported the presence of an institute-based protocol for the same. There was a wide disparity in the prophylaxis methods used for each risk group, particularly in the moderate-risk group. These findings suggest the need for adoption of institute-based protocols for prophylaxis and the evolution of Indian guidelines for VTE prophylaxis. 1. Introduction Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is an important preventable cause for morbidity and mortality among surgical patients. Several studies have identified PE as the most common preventable cause of hospital death [1–3]. The prevention of VTE is the number one strategy to improve patient care according to the Agency for Health Care Research and Quality [4]. Due to the often clinically silent nature of VTE and its increased risk and potential morbidity and mortality in surgical patients, routine thromboprophylaxis is advocated in western countries. The most commonly followed protocols are those established by the American College of Chest Physicians (ACCP) which were recently revised in 2012 [5]. In spite of the establishment of these protocols and availability of a number of safe prophylactic agents, numerous audits have shown that adequate prophylaxis is not being offered to a large number of surgical patients [6–8]. Traditionally, VTE has been thought to be less common in Asian populations, particularly in Indians. Few small, uncontrolled studies largely performed on orthopaedic patients supported this belief [9, 10]. As a result, there were little awareness or practice of VTE prophylaxis in India and a lack of established guidelines for Indian patients. However recent studies reveal that the incidence of VTE in Indian patients is comparable with that in
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