Journal of the American College of Surgeons
-
Comparative Study
Acute Rehabilitation after Trauma: Does it Really Matter?
The impact of post-discharge rehabilitation care for the trauma patient remains poorly investigated. Here we describe the functional outcomes of trauma patients discharged to an inpatient rehabilitation facility (IRF), and compare the likelihood of discharge home, 1-year rehospitalization, and 1-year mortality between patients discharged to an IRF and a propensity score-matched cohort of patients not discharged to an IRF. ⋯ Acute trauma patients should be recognized as an underserved population that would benefit considerably from inpatient rehabilitation services after discharge from the hospital.
-
Prophylactic anticoagulation is routinely used in the inpatient setting; however, the risk of venous thromboembolism (VTE) remains elevated after discharge. Extensive evidence and clinical guidelines suggest post-discharge VTE prophylaxis is critical in at-risk populations, but it remains severely underused in practice. ⋯ A systematic post-discharge VTE prophylaxis program including provider education, local guideline adaptation, bedside medication delivery, and education for at-risk patients, was associated with significantly fewer post-discharge VTE events.
-
Neoadjuvant treatment improves survival in resectable esophageal adenocarcinoma, but the optimal regimen has not been defined. Neoadjuvant chemoradiation (nCRT) is associated with higher pathologic complete response (pCR) relative to chemotherapy (nCTX), but has not been shown to improve survival; however, previous studies have been underpowered to demonstrate a survival difference. The objective of this study was to determine if nCRT is associated with increased survival relative to nCTX in patients with resectable esophageal adenocarcinoma. ⋯ Neoadjuvant chemoradiation is not associated with improved survival relative to nCTX for resectable esophageal adenocarcinoma. Radiation may potentially be omitted in some patients with this disease.