Journal of the American College of Surgeons
-
Comparative Study Observational Study
Timing of Pharmacologic Venous Thromboembolism Prophylaxis in Severe Traumatic Brain Injury: a Propensity-Matched Cohort Study.
Patients with severe traumatic brain injury (sTBI) are at high risk for developing venous thromboembolism (VTE). Nonetheless, pharmacologic VTE prophylaxis is often delayed out of concern for precipitating extension of intracranial hemorrhage (ICH). The purpose of this study was to compare the effectiveness of early vs late VTE prophylaxis in patients with sTBI, and to characterize the risk of subsequent ICH-related complication. ⋯ In this observational study of patients with sTBI, early initiation of VTE prophylaxis was associated with decreased risk of pulmonary embolism and deep vein thrombosis, but no increase in risk of late neurosurgical intervention or death. Early prophylaxis may be safe and should be the goal for each patient in the context of appropriate risk stratification.
-
Immediate reconstruction of perineal defects secondary to abdominoperineal resection (APR) or pelvic exenteration with pedicled flaps decreases postoperative wound complications when compared with direct closure in high-risk patients. Although some authors have been proponents of abdominal-based flaps, here we evaluate the role for thigh-based flaps founded on acceptable outcomes and low morbidity. ⋯ The overall complication rate with this technique is comparable with the more commonly used vertical rectus abdominis myocutaneous flap, but the potential for, and severity of, donor site complications is reduced with this technique. As such, gracilis flaps can be considered an acceptable alternative to abdominal flaps for selected perineal wounds.
-
Earlier work suggested that telephone follow-up could be used in lieu of in-person follow-up after surgery, saving patients time and travel and maximizing use of scarce surgeon and facility resources. We report our experience implementing and evaluating telephone postoperative follow-up within an integrated health system. ⋯ Telephone postoperative care can be used in select populations as a triage tool to identify patients who require in-person care and decrease overall in-person clinic use.