Post‐operatively, patients are at increased risk of developing deep vein thrombosis (DVT); risk factors include muscular inactivity, post‐operative respiratory and circulatory depression, abdominal and pelvic surgery, prolonged pressure on calves (e.g. from lithotomy poles), increased production of thromboplastin as a result of surgical trauma, and pre‐existing coronary artery disease (Rashid et al. [170]). To prevent this complication, many patients undergoing surgery will be treated with anticoagulants, for example low‐molecular‐weight heparin subcutaneous injections or a continuous heparin infusion if the patient was previously anticoagulated (NICE [148]).

Unless contraindicated, patients will also wear antiembolic stockings. Stockings should usually only be removed for up to 30 minutes daily; however, they can be removed more frequently if clinically indicated (e.g. if the patient complains of pain or discomfort). Patients should be supported to provide daily skin hygiene by careful washing and application of an emollient cream if the skin is dry. See ‘Mechanical and pharmacological thromboembolism prophylaxis’ above for further information relating to DVTs and their prevention.

The surgeon's post‐operative instructions should describe any required special positioning of the patient. Where a patient's condition allows, early mobilization (wearing non‐slip slippers or shoes to reduce the risk of falls) is encouraged to reduce venous stasis. For patients on bedrest, a physiotherapist should provide the patient with verbal and written information about deep breathing and leg exercises (i.e. flexion, extension and rotation of the ankles). Furthermore, patients on bedrest should be encouraged to change position hourly to minimize the risk of atelectasis and circumvent the development of pressure sores (Jocelyn Chew et al. [85]). Patients on bedrest may also have intermittent pneumatic compression or foot impulse devices in addition to graduated antiembolic stockings while in hospital (NICE [148]).