Effectiveness of neuromuscular electrical stimulation on venous thromboprophylaxis in surgical patients: A systematic review and meta-analysis

Background and purpose

The effectiveness of neuromuscular electrical stimulation (NMES) for venous thromboprophylaxis is still debatable. This systematic review and meta-analysis evaluated the effectiveness and safety of NMES among surgical patients undergoing elective surgery.

Methods

Randomized controlled trials (RCTs) and quasi-experimental studies were retrieved from PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, Wanfang, China National Knowledge Infrastructure and Chinese Biomedical Database from their inception to February 1st, 2024. Two reviewers independently assessed, extracted, and appraised the included studies. The meta-analyses incorporated two primary comparisons: NMES versus basic thromboprophylaxis and NMES versus other mechanical thromboprophylaxis. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of evidence.

Results

Sixteen studies involving 1685 participants were analysed, with all outcomes being assessed within 14 days postoperatively. Compared with basic thromboprophylaxis and graduated compression stockings, NMES significantly reduced the incidence of postoperative deep venous thrombosis (all p < 0.05). Compared with basic thromboprophylaxis and other mechanical basic thromboprophylaxis, NMES significantly improved postoperative D-dimer level and femoral venous peak velocity (all p < 0.05). No studies reported NMES device-related adverse events. The GRADE results showed low to very low certainty levels of evidence.

Conclusion

NMES is a promising mechanical strategy for venous thromboprophylaxis in surgical patients. High-quality RCTs are required to elucidate the therapeutic benefits of NMES compared to other mechanical prevention methods and to standardize its clinical application.