Contracting role of graduated compression stockings in prevention of perioperative venous thromboembolism

There can be no doubt that the prevention of venous thromboembolism (VTE) is a healthcare need and priority1. The issue remains in sharp focus in surgery, with the implementation of VTE risk assessment, and the use of mechanical and pharmacological thromboprophylaxis. These measures have been further enhanced through education and dissemination, and have been reinforced through key clinical guidelines2,3 and incentivization4. There was a 15 per cent reduction in hospital-associated VTE deaths (within 90 days of admission) in the UK between 2010 and 20175, with concurrent falls in pulmonary embolism-related mortality among European countries6. This is likely to be more impressive considering that improved awareness and imaging are likely to have increased the diagnosis of VTE, resulting in a further reduction in the case fatality rate. The factors responsible for this reduction are likely to be multifactorial. This can be attributed to a long list of varied and important factors, including (but not limited to) prehabilitation, systematic VTE risk assessment (including computer-aided assessment7), enhanced recovery with early mobilization, patient hydration, use of advanced minimally invasive surgical techniques resulting in a reduction in the systemic inflammatory response (both magnitude and duration), and of course thromboprophylaxis.