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Fidelia I, Lamba N, Papatheodorou SI, Yunusa I, O'Neil K, Chun S, Wilson J, Maher T, Tafel I, Smith TR, Aglio LS, Mekary RA, Zaidi HA. Adult spinal deformity surgery: a systematic review of venous thromboprophylaxis and incidence of venous thromboembolic events. Neurosurg Rev 2019; 43:923-930. [PMID: 30887142 DOI: 10.1007/s10143-019-01095-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/14/2019] [Accepted: 03/07/2019] [Indexed: 11/26/2022]
Abstract
Venous thromboprophylaxis consisting of chemical and/or mechanical prophylaxis is administered to patients undergoing adult spinal deformity (ASD) surgery to prevent venous thromboembolic events. However, the true incidence of venous thromboembolism (VTE) after these surgeries is unknown resulting in weak recommendations and lack of consensus regarding type and timing of prophylaxis in these patients. A systematic literature review was conducted to examine VTE incidence in addition to optimal type and timing of VTE prophylaxis. A detailed search was carried out on Embase, PubMed, and Cochrane Library databases through October 18, 2017, for studies that evaluated venous thromboembolic outcomes, type, and timing of prophylaxis administration among ASD surgery patients who were on VTE prophylaxis. The randomized study was assessed for risk of bias using the Cochrane tool and the observational studies using the Newcastle-Ottawa scale (NOS). The search yielded 1180 studies, and three articles published between 1996 and 2008 met the inclusion criteria. There were 583 surgeries performed on 537 patients with a mean age ranging from 45 to 52 years. Females dominated the study with percentages ranging from 60 to 94% in the different study populations. VTE prophylaxis was initiated before surgery in 87.7% patients and intraoperatively in 12.3% patients. VTE incidence ranged between 0 and 9.1% among the studies. VTE can occur after ASD surgery regardless of the type of prophylaxis, and incidence may be higher when mechanical prophylaxis alone is initiated intraoperatively. Further studies to examine VTE prophylaxis in patients undergoing ASD surgery should be considered.
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Affiliation(s)
| | - Nayan Lamba
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA, 02115, USA.
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | | | | | | | | | | | | | - Ian Tafel
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA, 02115, USA
| | - Timothy R Smith
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA, 02115, USA
| | - Linda S Aglio
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA, 02115, USA
- Department of Anesthesiology, Perioperative and Pain Management, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rania A Mekary
- School of Pharmacy, MCPHS, Boston, MA, USA
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA, 02115, USA
| | - Hasan A Zaidi
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston, MA, 02115, USA
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Enzweiler CNH, Wiese TH, Lembcke AE, Taupitz M, Rogalla P, Kivelitz DE, Jepsen H, Kettner B, Sheedy II PF, Baumann G, Hamm B. Electron beam tomography of interpulmonary saddle embolism: extent and vascular distribution. J Comput Assist Tomogr 2002; 26:26-32. [PMID: 11801901 DOI: 10.1097/00004728-200201000-00005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this work was to assess morphology and secondary signs of interpulmonary emboli extending across the bifurcation of the main pulmonary artery (PA). METHOD Retrospective evaluation of 780 electron beam tomographic studies of the chest yielded 17 cases of interpulmonary saddle embolism. Length, diameter, vascular distribution of the emboli, and secondary findings were prospectively assessed by two blinded reviewers. Follow-up studies were carried out in 12 of 17 patients (71%). RESULT Mean total length of the emboli was 46.6 cm (range 20.9-81.5 cm). The mean diameter of the saddle embolus was significantly smaller at the level of the bifurcation than in the left or right PA (4.5, 7.7, and 7.4 mm, respectively; p < 0.01). Dilatation of the right heart was found in 10 of 17 cases (59%). At follow-up, the saddle state was no longer present in 8 of 12 patients (67%). CONCLUSION Interpulmonary saddle emboli appear to be a transient form of acute pulmonary embolism, the site of predilection for rupture of the embolus being the level of the bifurcation. Their frequency may therefore be underestimated.
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Abstract
Radical pelvic surgery in gynecologic oncology patients poses a challenge to the surgeon and the ancillary team in charge of the peri-operative care. The high frequency of medical problems observed in this patient population, in conjunction with the stresses of radical surgery, necessitates careful monitoring of patients' medical status. A comprehensive team approach in the perioperative period is critical to patient care. Early intervention and anticipation of potential problems for the patient at risk in the postoperative period minimizes morbidity and mortality. This article will review the essentials of critical care as it relates to patients undergoing radical pelvic operations.
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Affiliation(s)
- R Mirhashemi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Miami, School of Medicine, Florida 33136, USA.
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Harris LM, Curl GR, Booth FV, Hassett JM, Leney G, Ricotta JJ. Screening for asymptomatic deep vein thrombosis in surgical intensive care patients. J Vasc Surg 1997; 26:764-9. [PMID: 9372813 DOI: 10.1016/s0741-5214(97)70088-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To identify the presence of occult deep vein thrombosis (DVT) in surgical intensive care unit (SICU) patients and to avoid unnecessary screening, we reviewed our experience with routine duplex screening for DVT in SICU patients. METHODS Over a 24-month period, all patients who were admitted to an SICU with an anticipated length of stay greater than 36 hours were studied to determine the prevalence of risk factors for asymptomatic proximal DVT. Risk factors, demographics, and operative data were collected and analyzed with multilinear regression, t tests and chi 2 analysis. RESULTS There was a 7.5% prevalence of major DVT in the 294 patients studied. APACHE II scores (14.5 +/- 6.24 vs 10.3 +/- 3.15; p < 0.0001) and emergent procedures (45.5% vs 23.2%; p > 0.0344) were associated with DVT by multifactorial analysis. Age was significant by univariate analysis. An algorithm based on the presence of any one of the three risk factors identified (APACHE II score 12 or more; emergent procedures; or age 65 or greater) could be used to limit screening by 30% while achieving a 95.5% sensitivity for identification of proximal DVT. CONCLUSION Absence of all three risk factors indicates a very low risk for DVT (1.1%). Screening of SICU patients is indicated because of a high prevalence of asymptomatic disease. Patients who have proximal DVT require active therapy and not prophylaxis. Costs and resources may be contained by using the above risk factors as a filter for duplex screening.
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Affiliation(s)
- L M Harris
- State University of New York at Buffalo, Department of Surgery, Millard Fillmore Hospital 14209, USA
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Kibel AS, Loughlin KR. Pathogenesis and Prophylaxis of Postoperative Thromboembolic Disease in Urological Pelvic Surgery. J Urol 1995. [DOI: 10.1016/s0022-5347(01)67302-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Adam S. Kibel
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kevin R. Loughlin
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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