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* 1. What your primary surgical specialty?

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* 2. What is your primary practice setting?

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* 3. How many surgical procedures do your center perform in one year?

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* 4. What kind of surgical procedures do your center perform?

  YES NO
High Complexity Surgery
Intermediate Complexity Surgery
Low Complexity Surgery

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* 5. Is a predictive risk score for Venous Thromboembolism (VTE) used at your center?

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* 6. Is it mandatory for all surgeons to use this predictive risk score?

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* 7. Do you use to the predictive risk score?

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* 8. Is a VTE prophylaxis protocol maintained at your center?

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* 9. Is it mandatory for all surgeons to follow this protocol?

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* 10. Do you adhere to the protocol?

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* 11. In the past 5 years, have you had a patient develop any of the following conditions within 3 months of undergoing a surgery procedure that you performed? (Please include patients only once and select their most severe condition.)

  YES NO
Deep Vein Thrombosis (DVT)
Pulmonary embolism (PE)
Death secondary to VTE

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* 12. How many patients developed DVT within 3 months of undergoing a procedure that you performed?

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* 13. How many patients developed PE within 3 months of undergoing a procedure that you performed?

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* 14. How many patients died within 3 months of undergoing a procedure that you performed?

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* 15. Do you test for coagulopathies in your patients undergoing surgery?

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* 16. IF YES, when do you test patients undergoing surgery?

  YES NO
When there is a positive family history bleeding/clotting disorder
When there is a personal history of unexplained DVT or PE
Where there are potential risk factors such as recurrent miscarriage (and/or other possibly c pregnancy complications: intrauterine growth restriction, stillbirth, severe pre-eclampsia and abruptio placentae), obesity, tobacco abuse, history or potus, intravenous drugs abuse.

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* 17. IN CASE OF HIGH COMPLEXITY SURGEY
When do you use mechanical prophylaxis and chemoprophylaxis?

  YES NO
Pre-operatively
Intra-operatively
Post-operatively

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* 18. IN CASE OF HIGH COMPLEXITY SURGEY
Your VTE prophylaxis practice   
If any of the following ever affect your decision to use VTE prophylaxis, please mark if you use mechanical prophylaxis (graduated compression stockings, intermittent pneumatic compression devices, intra-operative patient re-positioning) and/or chemoprophylaxis.

  Mechanical  Prophylaxis Chemoprophylaxis Does not affect my decision
Local Anesthesia
Sedation
General Anesthesia
Cases lasting greater than 1 hour
Cases lasting greater than 3 hours
Cases lasting greater than 6 hours
Trauma
Oncological Surgery
High-risk of VTE per risk calculator
History of cancer
History of prior DVT and/or PE
Obese or morbidly obese
History of smoking

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* 19. IN CASE OF HIGH COMPLEXITY SURGEY
Do you routinely prescribe post-operative pharmacological therapy?

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* 20. IN CASE OF HIGH COMPLEXITY SURGEY
Which preventive pharmacological therapy do you most commonly prescribe?

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* 21. IN CASE OF HIGH COMPLEXITY SURGEY
When you prescribe post-operative drugs, what is the typical duration (in days) that you prescribe? (If you never prescribe anti-coagulants, please enter “0”)

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* 22. IN CASE OF HIGH COMPLEXITY SURGEY
Which of the following discourages your personal use of pharmacologic VTE prophylaxis on your surgical patients?

  YES NO
Risk of post-operative bleeding or hematoma
Cost
Nuisance to manage
Lack of evidence that prophylaxis in surgery patients is useful after early mobilization

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* 23. IN CASE OF HIGH COMPLEXITY SURGEY
Do you give patients post-operative written instructions specific to VTE prevention (i.e. encouraging early ambulation and hydration, seeking medical attention for chest pain, calf pain, shortness of breath, etc.)?

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* 24. IN CASE OF HIGH COMPLEXITY SURGEY
Do you routinely screen for VTE to discharge?

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* 25. IN CASE OF HIGH COMPLEXITY SURGEY
If YES, how do you screen for VTE prior to discharge?

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* 26. IN CASE OF HIGH COMPLEXITY SURGEY
Do you routinely screen within 30 days of surgery?

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* 27. IN CASE OF HIGH COMPLEXITY SURGEY
If YES, how do you screen for VTE within 30 days of surgery?

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* 28. IN CASE OF INTERMEDIATE COMPLEXITY SURGEY
When do you use mechanical prophylaxis and chemoprophylaxis?

  YES NO
Pre-operatively
Intra-operatively
Post-operatively

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* 29. IN CASE OF INTERMEDIATE COMPLEXITY SURGEY
Your VTE prophylaxis practice   
If any of the following ever affect your decision to use VTE prophylaxis, please mark if you use mechanical prophylaxis (graduated compression stockings, intermittent pneumatic compression devices, intra-operative patient re-positioning) and/or chemoprophylaxis.

  Mechanical  Prophylaxis Chemoprophylaxis Does not affect my decision
Local Anesthesia
Sedation
General Anesthesia
Cases lasting greater than 1 hour
Cases lasting greater than 3 hours
Cases lasting greater than 6 hours
Trauma
Oncological Surgery
High-risk of VTE per risk calculator
History of cancer
History of prior DVT and/or PE
Obese or morbidly obese
History of smoking

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* 30. IN CASE OF INTERMEDIATE COMPLEXITY SURGEY
Do you routinely prescribe post-operative pharmacological therapy?

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* 31. IN CASE OF INTERMEDIATE COMPLEXITY SURGEY
Which preventive pharmacological therapy do you most commonly prescribe?

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* 32. IN CASE OF INTERMEDIATE COMPLEXITY SURGEY
When you prescribe post-operative drugs, what is the typical duration (in days) that you prescribe? (If you never prescribe anti-coagulants, please enter “0”)

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* 33. IN CASE OF INTERMEDIATE COMPLEXITY SURGEY
Which of the following discourages your personal use of pharmacologic VTE prophylaxis on your surgical patients?

  YES NO
Risk of post-operative bleeding or hematoma
Cost
Nuisance to manage
Lack of evidence that prophylaxis in surgery patients is useful after early mobilization

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* 34. IN CASE OF INTERMEDIATE COMPLEXITY SURGEY
Do you give patients post-operative written instructions specific to VTE prevention (i.e. encouraging early ambulation and hydration, seeking medical attention for chest pain, calf pain, shortness of breath, etc.)?

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* 35. IN CASE OF INTERMEDIATE COMPLEXITY SURGEY
Do you routinely screen for VTE to discharge?

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* 36. IN CASE OF INTERMEDIATE COMPLEXITY SURGEY
If YES, how do you screen for VTE prior to discharge?

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* 37. IN CASE OF INTERMEDIATE COMPLEXITY SURGEY
Do you routinely screen within 30 days of surgery?

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* 38. IN CASE OF INTERMEDIATE COMPLEXITY SURGEY
If YES, how do you screen for VTE within 30 days of surgery?

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* 39. IN CASE OF LOW COMPLEXITY SURGEY
When do you use mechanical prophylaxis and chemoprophylaxis?

  YES NO
Pre-operatively
Intra-operatively
Post-operatively

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* 40. IN CASE OF LOW COMPLEXITY SURGEY
Your VTE prophylaxis practice   
If any of the following ever affect your decision to use VTE prophylaxis, please mark if you use mechanical prophylaxis (graduated compression stockings, intermittent pneumatic compression devices, intra-operative patient re-positioning) and/or chemoprophylaxis.

  Mechanical  Prophylaxis Chemoprophylaxis Does not affect my decision
Local Anesthesia
Sedation
General Anesthesia
Cases lasting greater than 1 hour
Cases lasting greater than 3 hours
Cases lasting greater than 6 hours
Trauma
Oncological Surgery
High-risk of VTE per risk calculator
History of cancer
History of prior DVT and/or PE
Obese or morbidly obese
History of smoking

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* 41. IN CASE OF LOW COMPLEXITY SURGEY
Do you routinely prescribe post-operative pharmacological therapy?

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* 42. IN CASE OF LOW COMPLEXITY SURGEY
Which preventive pharmacological therapy do you most commonly prescribe?

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* 43. IN CASE OF LOW COMPLEXITY SURGEY
When you prescribe post-operative drugs, what is the typical duration (in days) that you prescribe? (If you never prescribe anti-coagulants, please enter “0”)

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* 44. IN CASE OF LOW COMPLEXITY SURGEY
Which of the following discourages your personal use of pharmacologic VTE prophylaxis on your surgical patients?

  YES NO
Risk of post-operative bleeding or hematoma
Cost
Nuisance to manage
Lack of evidence that prophylaxis in surgery patients is useful after early mobilization

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* 45. IN CASE OF LOW COMPLEXITY SURGEY
Do you give patients post-operative written instructions specific to VTE prevention (i.e. encouraging early ambulation and hydration, seeking medical attention for chest pain, calf pain, shortness of breath, etc.)?

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* 46. IN CASE OF LOW COMPLEXITY SURGEY
Do you routinely screen for VTE to discharge?

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* 47. IN CASE OF LOW COMPLEXITY SURGEY
If YES, how do you screen for VTE prior to discharge?

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* 48. IN CASE OF LOW COMPLEXITY SURGEY
Do you routinely screen within 30 days of surgery?

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* 49. IN CASE OF LOW COMPLEXITY SURGEY
If YES, how do you screen for VTE within 30 days of surgery?

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* 50. How do you manage asymptomatic DVT?

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* 51. When do you think the risk is greatest for developing a DVT or PE?

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* 52. When do you think there is no more risk for developing a DVT or PE respect to general population?

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* 53. How old are you?

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* 54. What is your gender?

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* 55. How many years have you practiced surgery? 

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* 56. In which Italian region do you practice?  

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* 57. Additional Comments

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