Abstract:

Objective To develop an expert consensus on the prevention of venous thromboembolism in patients undergoing major orthopaedic surgery，providing scientific and standardized guidance for clinical practice. Methods A systematic search was conducted in guideline databases，professional society websites，and major Chinese and international databases from database inception to July 30，2025，to identify evidence related to the prevention of venous thromboembolism in major orthopaedic surgery and to draft a preliminary version of the consensus. The Delphi method was used to conduct 2 rounds of expert consultations with 23 experts from 15 provinces and cities across China. In addition，22 experts participated in 2 rounds of panel meetings to review and revise the draft，and 44 experts subsequently evaluated the strength and retention of each recommendation，resulting in the final consensus. Results All expert questionnaires were returned with a 100% effective response rate. The authority coefficient of experts was 0.965，and Kendall’s W ranged from 0.29 to 0.35（P<0.05），indicating good consistency among expert opinions. The finalized consensus covered 7 major domains，including venous thromboembolism risk assessment，bleeding risk assessment，selection of prevention strategies，basic prevention，physical prevention，pharma-cological prevention，and health education，with a total of 51 recommendations. Conclusion Based on the best available evidence and expert consensuses，this consensus establishes guidelines for venous thromboembolism prevention in patients undergoing major orthopaedic surgery. It aims to address current inconsistencies in clinical practice，and its efficacy requires further clinical evaluation.

Key words: Major Orthopaedic Surgery, Venous Thromboembolism, Delphi Technique, Prevention, Expert Consensus, Evidence-Based Nursing

摘要：

目的 构建骨科大手术患者静脉血栓栓塞症预防专家共识（以下简称“共识”），为临床提供科学规范的实践指引。方法 系统检索建库至2025年7月30日指南网站、专业学会网站、中英文数据库，纳入骨科大手术患者静脉血栓栓塞症预防相关证据并拟订初稿。采用德尔菲专家函询法对15个省（区、市）的23名专家进行2轮专家函询，邀请22名专家进行2次会议评审，并由44名专家对推荐意见强度和是否保留进行评定，最终形成“共识”。结果 专家函询问卷有效回收率均为100%，专家权威系数为0.965，肯德尔和谐系数为0.29~0.35（P<0.05），专家意见协调性良好。最终形成的“共识”涵盖静脉血栓栓塞症发生风险评估、出血风险评估、静脉血栓栓塞症预防方案选择、基本预防、物理预防、药物预防及健康宣教7个方面，包括51条推荐意见。结论 该“共识”基于最佳证据与专家经验，确立了骨科大手术患者静脉血栓栓塞症预防规范，旨在解决当前实践规范不统一的问题，其应用效果需进一步临床验证。

关键词: 骨科大手术, 静脉血栓栓塞症, 德尔菲技术, 预防, 专家共识, 循证护理学