Flying after surgery: Is it safe ?
It is NOT safe to fly after surgery. Blood clots are already a known risk following surgery. There are many factors that can increase or decrease that risk – flying has been known to be a risk for some time. Some of these we cannot control, such as the type of surgery or a patient’s own inherent blood clotting disorder. Activity following surgery however can be adjusted as needed to help minimize the risk. Surgical procedures like knee replacement surgery have a very high risk of blood clot while simple outpatient arthroscopic procedures have a much lower risk. Despite this low risk, it is not zero, and blood clots do occur. Especially with patients that choose to fly. A choice to fly after surgery should be discussed with your doctor. It is very important to understand the risk.
Its not just talk: Patients get blood clots after surgery when they fly
A few weeks ago, I performed a 15 minute arthroscopic surgery. When I called the patient’s mother, we reviewed the procedure and she told me they planned to fly home to Hawaii (a 5 hour flight) the next day. I told her his risk was high and that it was a bad idea. When they returned for their 2 week visit, He told me he had flown as planned, against my advice, and was back to see me. He also complained of achy calf pain. I sent him for an ultrasound which showed . . . a blood clot !! This is a real person who could have died because of a blood clot.
There are many effective prophylactic measures that can be taken to decrease the risk of a blood clot while you are flying. This includes tights compressive stockings, devices which squeeze the foot or calf, early activity and weight-bearing, and a variety of medications that affect the body’s ability to clot, therefore thinning the blood.
Although it is rare for a patient on a long flight to develop a DVT, there are several factors which contribute to the increased risk of blood clot formation.
- While in flight, most passengers are typically sedentary. This results in pooling of blood in the legs and the cabs, increasing the risk of clotting. Sitting for a prolonged period of time with the knees bent can also increase this risk. Most people don’t get up and move around very much on a flight.
- After flying for a few hours, because of the dryness of the air on the plane, passengers frequently become dehydrated. This results in an increased blood concentration and also contributes to potential blood clots.
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Preventing blood clots on long flights
Get up and move
Getting up, standing, stretching, and walking are key. I suggest patients do this about once every 45 to 60 minutes. While up, do some simple mini squats and calf raises to keep the blood pumping. While you are seated you can do some simple exercises. Start by doing a seated calf raise: Lift your heels off the ground, contracting your calf, and hold it for 15 seconds. Do this about 10 times and repeat it every 30 minutes. Next, do some ankle circles. lift your foot and make circles with your big toe. Do this for 30 seconds.
Drink plenty of water
This will easily prevent you from becoming dehydrated. It will also help you get off the flight feeling more refreshed. Buy a bottle before you get on the flight so you don’t have to wait for the flight attendant.
Wear compression stockings
I may suggest you consider the use of a medication that may help to thin your blood. This is something I would discuss with my patients and make a specific recommendation. Please let me know if you really need to fly after surgery, as I routinely recommend against it.
What does the research say about flying after surgery?
There are very few studies that have looked at the rate of blood clots with flying after surgery. One study in 2014 looked at 1465 patients of whom 15% flew 3 days after surgery and the rest did not. There was no rate of increased blood clot, pulmonary embolus or overall thromboembolic event in these groups. Interestingly, the study did not show that patients were at increased risk of blood clot if they flew after their surgery.
Conclusion on blood clots and flying after surgery
Most surgeons, including myself, would not recommend flying for a few weeks after surgery. During this time you are at increased risk for a blood clot and I would prefer to keep this risk as low as possible. Current research is conclusive in orthopedics: better to err on the side of safety. As the risk varies between people, it is best to ask me, or your doctor, for the best answer for you, and if you must fly, what can be done to keep you safe.
Cooper HJ, Sanders SA, Berger RA, Risk of symptomatic venous thromboembolism associated with flying in the early postoperative period following elective total hip and knee arthroplasty, J Arthroplasty. 2014 Jun;29(6):1119-22.