How to assess your risk of potentially deadly blood clots and DVTs during surgery
Deep vein thrombosis during surgery can lead to deadly pulmonary embolism
When facing practically any surgery, one of the major risks that is often not talked about is blood clots.
When a patient is under general anesthesia and immobile for a long time on the operating table, there is dramatically increased risk of deep vein thrombosis (DVT). This is a condition caused by blood pooling in the deep veins of the legs, which creates an ideal environment for clots to form.
Typically, when clots form, the body absorbs them over time. In some situations, though, clots can break off from the deep veins in the leg and travel to the lungs, which is called a pulmonary embolism.
Pulmonary embolism can block blood flow to the lungs through a pulmonary artery. By cutting off blood supply to one or both lungs, it causes a chain of events starting with a shortage of oxygen (hypoxia), then cardiac (heart) functions, and can end in death.
I have recently been working on a medical malpractice wrongful death case involving the tragic death of a woman in her 40.
This woman consulted with a plastic surgeon in the Dallas area about having some elective cosmetic procedures, including liposuction of multiple areas (arms, thighs, and 360 core), abdominoplasty (removing excess skin from weight loss), and mastopexy (breast reduction). The plastic surgeon recommended having all of these procedures performed in one operation.
The cosmetic surgeon recommended a small hospital that essentially only handles highly profitable bariatric and cosmetic surgical procedures. On the day of the surgery, this patient was under anesthesia for almost 12 hours, with the operation itself lasting 11 hours.
This lady went home the next day, and within a few days experienced a pulmonary embolism when she got up to go to the bathroom, and died later that day.
As a Texas medical malpractice lawyer, I spend a lot of time carefully acquiring and then examining the medical records. This case was no different. I was surprised to find no evidence that the plastic surgeon ever fully considered exactly how high risk it was to take this lady to surgery for that long without taking adequate precautions to avoid formation of DVTs.
Measuring the risk of dangerous blood clots (DVT)
There is a mountain of medical evidence and studies that demonstrates the different risk factors for surgical patients developing dangerous deep vein thrombosis (DVT).
One big factor that applies to all surgeries is the length of the procedure itself. A study published in JAMA Surgery, in February 2015, found a direct correlation to the length of surgery and formation of DVT.
In the case I am investigating, the surgeon did not talk to the patient about the significant increased risk of DVT formation present in long surgeries. Because this was not an emergency procedure, but rather were elective cosmetic procedures, the surgeon could have easily split the procedures into multiple surgeries, which would have decreased the patient’s risk of forming potentially deadly blood clots.
Another factor that impacts the risk of deep vein thrombosis is the type of surgery performed. When it comes to cosmetic procedures, liposuction and abdominoplasty have a heightened risk for DVTs.
In addition to these factors, the Caprini Risk Model is widely-available and used by surgeons and doctors to measure a particular patient’s DVT risk. It is easy to understand and its creator has also made the available online for patients to use.
The Caprini Risk Model has a series of questions about a patient’s current and past health and medical history. Each “yes” answer has a point value assigned to it.
Once you add up all of the points, here is the scorecard key:
· Score 0-1: Low risk of DVT(Caprini uses the term similar VTE, for venous thromboembolism)
· Score 2: Moderate of DVT
· Score 3-4: High risk of DVT
· Score 5 or greater: Highest risk of DVT
In the wrongful death case that I am investigating for the family of this deceased lady, before the surgery began, she had points for the following: (1) one point for being 41-60; (2) one point for having a body mass index (BMI) of over 25; and (3) two points for a general surgery lasting more than 45 minutes. She had a total of four points, which put her in the “high risk” category for VTE.
After surgery and before the pulmonary embolism, she had edema (swelling), which adds another one point to her scorecard, bumping her into the “highest risk” category for VTE.
If you think about the Caprini Risk Model and look through the various factors, you will quickly realize that practically every cosmetic surgery patient will have at least moderate risk of VTE, and perhaps a high risk.
What can be done to decrease DVT risk?
As I already mentioned about the case I am handling, the plastic surgeon had the option to split the procedures into two or more shorter surgeries. That would have decreased her DVT risk, but the surgeon chose not to do that, or to even offer it as an option to the patient.
Beyond that, the surgeon appropriately ordered sequential compression devices (SCDs). SCDs are connected to a machine that compresses or squeezes the leg to promote blood flow.
In addition, in a high risk patient, the standard of care requires the surgeon to use chemoprophylaxis, meaning an anticoagulant drug like Heparin of Lovenox to prevent clot formation. Some plastic surgeons do not like to use these drugs because of concern about controlling bleeding during the operation. However, when they decide not to use one of these medications during surgery, they are placing their own convenience over patient safety.
What you can do
If you are facing an elective surgery, I recommend that you have a look at the Caprini Risk Model and score yourself before having your pre-surgery meeting with your surgeon. Talk with the surgeon about the risk of deep vein clots, DVTs, and pulmonary embolism, and what planning is in place to minimize your risk.
If you or someone you care for has been seriously injured—or worse—as a result of blood clots, DVTs, or pulmonary embolism, we are here to help. Call Painter Law Firm, in Houston, Texas, at 281-580-8800, for a free consultation about your potential case with an experienced medical negligence attorney.
Robert Painter is a medical malpractice attorney Painter Law PLLC, in Houston, Texas. Over the course of his legal career, he has focused on medical negligence cases, and has filed lawsuits for clients and their families involving pulmonary embolism and DVT deaths, as well as serious personal injury, death, brain injury, and birth injury cases caused by many types of physician, hospital, nursing, and pharmacy mistakes.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
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A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes
This article was originally published in the September/October 2017 edition of "The Houston Lawyer" magazine
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