Compression Socks After Surgery: Should You Wear Them?

For a number of different types of surgeries, compression socks provide an important part of the post-operative care routine. Doctors recommend compression socks because they have the ability to prevent blood clots in the deep leg veins, and they can also support healing after varicose vein surgery and sclerotherapy. 

Studies suggest that patients may benefit from compression therapy after the following procedures:

• General surgery
• Gynecological surgery
• Neurosurgery
• Elective Hip Replacement
• Elective Knee Replacement
• Varicose Vein Surgery

After surgery, many patients are particularly at risk for developing deep vein thrombosis (DVT), also known as blood clots in the leg, thrombophlebitis, venous thrombosis, or venous thromboembolism. When blood clots form in the deep veins, they can break off and block blood vessels throughout the body. These blockages, known as embolisms, can be particularly dangerous when they form in the lungs.

Why Is DVT More Common After Surgery?

After surgery, the body tends to have less fluid. At the same time, trauma can activate the clotting mechanism in your blood as your body works to heal itself. When these two factors combine with periods of bed rest and immobility, the likelihood of developing deep vein blood clots increases significantly. 

In a systematic review of the medical literature, researchers explain that hospitalized patients are more likely to develop DVT due to "changes in the blood vessel wall, changes in blood flow and changes in the properties of the blood, caused by factors such as immobilisation, decreased fluid intake and excessive body fluid loss."  In addition, they write, "Trauma and surgery can also cause activation of the coagulation system, leading to a higher risk of DVT." (Wade) Because the risk of developing DVT increases after surgery, many doctors recommend a combination of compression therapy and other prophylaxis to prevent the formation of blood clots during the post-surgical period. 

While almost everyone can benefit from the use of compression socks after surgery, some groups are particularly vulnerable to DVT. A 2009 study determined that, "Compared with not having surgery, women were 70 times more likely to be admitted with venous thromboembolism in the first six weeks after an inpatient operation," with a tenfold increased risk after a same-day operation. (Sweetland) If you’re already predisposed to DVT, having surgery will increase your likelihood of developing blood clots. 

The groups most at risk for developing DVT after surgery include:

• Those with a history of DVT
• People with inherited blood disorders
• Those undergoing hormone therapy or taking birth control pills
• People with injury to a deep vein, a broken bone, or other trauma
• People who have experienced prolonged bed rest or travel
• Pregnant women or women who have given birth within the past 6 weeks
• Those being treated for cancer
• Anyone with a central venous catheter
• Those over 60
• Overweight or obese people
• Smokers

How Do Compression Socks Prevent DVT?

Compression socks exert gentle pressure on your lower legs, reducing the diameter of the veins. Through the smaller vessel, blood flows with greater velocity. In turn, you'll experience improved blood circulation from wearing compression socks. Without compression garments, blood can become stagnant, allowing fluid to accumulate in your lower legs. Compression therapy helps the veins return blood to the heart, reduces leg swelling, and prevents blood from clotting in the deep veins. Anytime you sit or stand for long periods of time, poor circulation may result. Compression socks keep your blood flowing in a healthy way, reducing your risk of vascular complications such as varicose and spider veins, blood clots, and edema.

Dozens of studies show the efficacy of compression socks and stockings in preventing DVT, across a number of different surgery types. For example, in a study of patients undergoing gynecological surgery, researchers reported, "Used alone compression stockings reduce the incidence of postoperative deep vein thrombosis by approximately 60 per cent and when used in combination with other preventive methods, such as low dose heparin or intermittent calf compression, they further reduce the incidence by up to 85 per cent." (Wade) For patients undergoing neurosurgery, a study published in the journal Circulation concluded that graduated elastic stockings are effective and safe and may be combined with low-molecular-weight heparin to further reduce the risk of DVT. (Giancarlo)

Beyond preventing stagnant blood, compression socks also provide support for overall vascular healing, as evidenced by an analysis of patients recovering from vascular surgery. The researchers determined that low compression stockings provided adequate support for the leg after varicose vein surgery, and bandaging was not required after sclerotherapy when high compression stockings were used. (Shouler) This research indicates that compression socks help to heal injury to the vein, another risk factor in developing DVT. 

What Makes DVT So Dangerous?

Deep vein thrombosis leads to additional complications. The condition usually originates in the deep veins of the lower leg or thigh. Deep vein blood clots can be particularly dangerous because they often break off and travel through the bloodstream, blocking other vessels throughout the body, including vessels in the lungs. Pulmonary embolism, a potentially fatal blockage within the lung, appears in 50% of the patients who develop DVT. (Salzman) Even for patients who survive a pulmonary embolism, such a blockage may cause serious long-term complications, including a decreased quality of life, functional limitations, abnormal pulmonary artery pressure and right ventricular function, and many other problems. The best way to avoid pulmonary embolism is to avoid developing DVT in the first place. 

About one third of people who suffer from DVT will also develop a condition called post thrombotic syndrome (PTS). In the weeks and months following a deep vein blood clot, these patients develop chronic pain, swelling, ulcers, and other symptoms. PTS can affect patients for up to two years after the initial DVT diagnosis. Since no straightforward test exists for PTS, health care professionals use a cumulative assessment, called a Villalta score, to analyze symptoms and assign a diagnosis. 

Who Should Wear Compression Socks After Surgery?

Whether or not you fall into one of the "at risk" categories for developing DVT, undergoing surgery increases your risk of blood clots. That's why many doctors prescribe or recommend compression therapy to patients after inpatient surgery or same-day surgery.

Some medical conditions contraindicate the use of compression socks. These include leg edema, pulmonary edema (heart failure), severe peripheral arterial disease, severe peripheral neuropathy, major leg deformity, and dermatitis. (Wade) For post-surgical patients with these issues, graduated compression therapy may not be the best option for preventing DVT. Your doctor or surgeon can weigh the benefits of compression therapy against the potential side effects in order to make the best recommendation for you.

If your doctor has not recommended compression socks or anti-embolism stockings as part of your post-surgical care, you may want to ask about whether or not compression therapy is safe for you. As long as you are mobile enough to remove socks before bedtime and adjust your socks to avoid bunching, you may be able benefit from compression therapy after surgery.

How Do Anti-Embolism Stockings Differ From Compressions Socks?

Both compression socks and anti-embolism stockings help to prevent deep vein thrombosis (DVT) and pulmonary embolism. Whereas compression socks work well for people who are able to walk around, anti-embolism stockings—also called thrombo-embolic deterrent hose or TED hose—reduce the risk of DVT for bedridden patients. 

Typically, anti-embolism stockings come in uniform compression with a pressure level less than 20 mmHg. Since bedridden patients stay in a reclining position, they may not need graduated compression, which works against gravity by exerting pressure up the leg. While compression socks and anti-embolism stockings both reduce the risk of blood clots and DVT, anti-embolism stockings are designed to be worn during times of decreased mobility such as a period immediately following sclerotherapy, endovenous ablation, phlebectomy, or any major surgery. ("Anti-Embolism") As a patient regains mobility after surgery, graduated compression socks may become the more appropriate choice for preventing DVT. 

How Long Should You Wear Compression Socks After Surgery?

A 2009 study suggests that the risk of hospital admission for, or death from, venous thromboembolism lasts for at least three months after a major surgery—a longer timeframe than researchers had previously imagined. According to that study, "...7-12 weeks after inpatient surgery[,] rates were still almost 20 times higher than without surgery." (Sweetland) So, post-surgical patients should consider themselves at risk for DVT for at least three months after a major surgery. Along with other forms of prevention, compression socks offer an easy, inexpensive way to reduce the risk of blood clots and complications. By avoiding DVT, you eliminate the chances of developing post thrombotic syndrome and pulmonary embolism as well. 

Knee high compression socks, like the ones we sell at Comrad, don't just look and feel great. They also have the potential to ward off life-threatening complications after surgery. Physical therapist Andrea Salzman writes, "Throughout history, pulmonary embolism (PE) has almost always been diagnosed on the autopsy table." Nowadays, we know more about the best way to prevent pulmonary embolism—and it starts with preventative care. By avoiding blood clots, you can help to ensure that your surgery and post-surgical care is successful. Compression socks, available over-the-counter and online, may seem like too simple a solution for such a complicated medical problem, but they go a long way towards ensuring that you get the best surgical outcomes possible. 

The best part? Avoiding dangerous blood clots may be as easy as putting on a pair of socks.

Sources:

“Anti-Embolism Socks: for Safety's Sake (after Surgery).” Atlanta Vascular & Vein Center, 12 Jan. 2018, http://atlantavascularandveincenters.com/anti-embolism-socks-safetys-sake-surgery/.

Giancarlo, Agnelli. "Prevention of Venous Thromboembolism in Surgical Patients." Circulation, vol. 110, iss. 24, suppl. 1, 2004, https://www.ahajournals.org/doi/full/10.1161/01.cir.0000150639.98514.6c.

Salzman, A. "Pulmonary Embolism - DVT to PE." Ausmed, 2018, https://www.ausmed.com/cpd/articles/pulmonary-embolism.

Shouler, P J, and P C Runchman. “Varicose veins: optimum compression after surgery and sclerotherapy.” Annals of the Royal College of Surgeons of England vol. 71, iss. 6, 1989, pp. 402-404, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2499037/.

Sweetland, Siân, Green, Jane, Liu, Bette, de González, Amy Berrington, Canonico, Marianne, Reeves, Gillian et al. "Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study," BMJ, 2009, pp. 1-8, https://www.bmj.com/content/339/bmj.b4583.abstract.

Turner, G.M., Cole, S.E. and Brooks, J.H., "The efficacy of graduated compression stockings in the prevention of deep vein thrombosis after major gynaecological surgery." BJOG: An International Journal of Obstetrics & Gynaecology, vol. 91, iss. 6, 1984, pp. 588-591, https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-0528.1984.tb04808.x.

Wade R, Sideris E, Paton F, et al. "Graduated compression stockings for the prevention of deep-vein thrombosis in postoperative surgical patients: a systematic review and economic model with a value of information analysis." Health Technology Assessment, Vol. 19, Iss. 98, Chapter 1, 2004, https://www.ncbi.nlm.nih.gov/books/NBK327582/.