1
|
Restifo RJ. An In-Depth Analysis of 1370 Consecutive Abdominoplasties: Fascial Plication Increases Risk of Venous Thromboembolism, and Scoring for Plication Improves the Caprini Risk Assessment Model. Aesthet Surg J 2024:sjae139. [PMID: 38967610 DOI: 10.1093/asj/sjae139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/13/2024] [Accepted: 06/21/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is the most dangerous complication of abdominoplasty. One relatively undefined risk factor is plication, which in theory increases VTE risk. OBJECTIVES To assess the thromboembolic risk of plication. METHODS A retrospective review of 1370 consecutive abdominoplasties by one surgeon was undertaken. Two groups were considered, plicated (n= 1089) and non-plicated (n = 281), and VTE rates were compared between these groups. RESULTS There were 25/1089 cases of VTE (2.3%) in plicated patients and 1/281 case of VTE (0.36%) in non-plicated patients, which was statistically significant (Fisher's exact test, p=0.028) despite the non-plicated group being a higher risk population. Case-Control matching yielded 225 pairs which differed statistically only by the presence or absence of plication; there were 12/225(5.3%) VTE events in the plicated group and 0/225 in the non-plicated group (McNemar's test, p=0.0015). Logistic regression demonstrated increased VTE risk with increasing age (OR 1.08, p<0.001), BMI (OR 1.34, p=0.002), Caprini score (OR 2.17, p<0.001), and especially plication (OR 16.76, p=0.008). Adding two points for plication to Caprini scores offered better risk stratification at a level of 7, with an improved combination of sensitivity/specificity (0.31/0.98 vs 0.69/0.96) and a 27% improvement over the 2005 Caprini RAM in the area under a Receiver Operating Characteristic (ROC) curve (0.826 vs 0.651, Z-value -3.596, p = 0.003). CONCLUSIONS Plication was shown to be a powerful risk factor for the development of VTE in abdominoplasty. Abdominal wall plication should be considered in risk assessment, and scoring for plication may improve the performance of the Caprini RAM.
Collapse
|
2
|
Horner DE, Davis S, Pandor A, Shulver H, Goodacre S, Hind D, Rex S, Gillett M, Bursnall M, Griffin X, Holland M, Hunt BJ, de Wit K, Bennett S, Pierce-Williams R. Evaluation of venous thromboembolism risk assessment models for hospital inpatients: the VTEAM evidence synthesis. Health Technol Assess 2024; 28:1-166. [PMID: 38634415 PMCID: PMC11056814 DOI: 10.3310/awtw6200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Background Pharmacological prophylaxis during hospital admission can reduce the risk of acquired blood clots (venous thromboembolism) but may cause complications, such as bleeding. Using a risk assessment model to predict the risk of blood clots could facilitate selection of patients for prophylaxis and optimise the balance of benefits, risks and costs. Objectives We aimed to identify validated risk assessment models and estimate their prognostic accuracy, evaluate the cost-effectiveness of different strategies for selecting hospitalised patients for prophylaxis, assess the feasibility of using efficient research methods and estimate key parameters for future research. Design We undertook a systematic review, decision-analytic modelling and observational cohort study conducted in accordance with Enhancing the QUAlity and Transparency Of health Research (EQUATOR) guidelines. Setting NHS hospitals, with primary data collection at four sites. Participants Medical and surgical hospital inpatients, excluding paediatric, critical care and pregnancy-related admissions. Interventions Prophylaxis for all patients, none and according to selected risk assessment models. Main outcome measures Model accuracy for predicting blood clots, lifetime costs and quality-adjusted life-years associated with alternative strategies, accuracy of efficient methods for identifying key outcomes and proportion of inpatients recommended prophylaxis using different models. Results We identified 24 validated risk assessment models, but low-quality heterogeneous data suggested weak accuracy for prediction of blood clots and generally high risk of bias in all studies. Decision-analytic modelling showed that pharmacological prophylaxis for all eligible is generally more cost-effective than model-based strategies for both medical and surgical inpatients, when valuing a quality-adjusted life-year at £20,000. The findings were more sensitive to uncertainties in the surgical population; strategies using risk assessment models were more cost-effective if the model was assumed to have a very high sensitivity, or the long-term risks of post-thrombotic complications were lower. Efficient methods using routine data did not accurately identify blood clots or bleeding events and several pre-specified feasibility criteria were not met. Theoretical prophylaxis rates across an inpatient cohort based on existing risk assessment models ranged from 13% to 91%. Limitations Existing studies may underestimate the accuracy of risk assessment models, leading to underestimation of their cost-effectiveness. The cost-effectiveness findings do not apply to patients with an increased risk of bleeding. Mechanical thromboprophylaxis options were excluded from the modelling. Primary data collection was predominately retrospective, risking case ascertainment bias. Conclusions Thromboprophylaxis for all patients appears to be generally more cost-effective than using a risk assessment model, in hospitalised patients at low risk of bleeding. To be cost-effective, any risk assessment model would need to be highly sensitive. Current evidence on risk assessment models is at high risk of bias and our findings should be interpreted in this context. We were unable to demonstrate the feasibility of using efficient methods to accurately detect relevant outcomes for future research. Future work Further research should evaluate routine prophylaxis strategies for all eligible hospitalised patients. Models that could accurately identify individuals at very low risk of blood clots (who could discontinue prophylaxis) warrant further evaluation. Study registration This study is registered as PROSPERO CRD42020165778 and Researchregistry5216. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR127454) and will be published in full in Health Technology Assessment; Vol. 28, No. 20. See the NIHR Funding and Awards website for further award information.
Collapse
Affiliation(s)
- Daniel Edward Horner
- Emergency Department, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Oxford Road, Manchester, UK
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sarah Davis
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Abdullah Pandor
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Helen Shulver
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Steve Goodacre
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Hind
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Saleema Rex
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Michael Gillett
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Matthew Bursnall
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Xavier Griffin
- Barts Bone and Joint Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mark Holland
- School of Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Bolton, Bolton, UK
| | - Beverley Jane Hunt
- Thrombosis & Haemophilia Centre, St Thomas' Hospital, King's Healthcare Partners, London, UK
| | - Kerstin de Wit
- Department of Emergency Medicine, Queens University, Kingston, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shan Bennett
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | |
Collapse
|
3
|
Walter A, Bradley N, Flett M, Nagy J, Suttie S, Guthrie G. The prognostic value of clinical frailty and American Society of Anesthesiology score in patients with chronic limb threatening ischaemia. VASA 2023; 52:302-309. [PMID: 37528752 DOI: 10.1024/0301-1526/a001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Background: Frailty is a complex multisystem syndrome associated with increased comorbidity and decreased physiological reserve. There are associations between frailty and adverse outcome in surgical patients. Chronic limb threatening ischemia (CLTI) is increasingly prevalent, with a typically frail patient population. Existing frailty scoring systems focus on functional measures and do not reliably assess comorbidities. The present study aims to describe the prognostic value of multimodal frailty assessment in patients with CLTI. Patients and methods: Patients >50 years old admitted as an emergency with CLTI between May 2020 to June 2021 were included. Frailty was measured using Clinical Frailty Score (CFS), and comorbidities with American Society of Anesthiologists score (ASA). A composite score combining CFS and ASA was derived and the prognostic value compared with each component score. The primary outcome was overall survival. Results: There were 249 eligible patients, 53.4% (n=133) had CFS>4. The mean (95% CI) overall survival for the CFS>4 cohort was 15.9 (13.6-18.3) months vs. 28.5 (26.1-30.9) months for CFS≤4 cohort (p<0.001). Increasing CFS-ASA score was associated with inferior survival on univariate (HR=2.84, 95% CI [1.96-4.11], p<0.001) and multivariate (HR=1.78, 95% CI [1.20-2.64], p<0.01) analyses. ROC-analysis showed comparable prognostic value of CFS and CFS-ASA to predict one-year survival. Conclusions: Frailty is highly prevalent and a poor prognostic indicator in patients with CLTI admitted as an emergency. Our results suggest that incorporating assessment of comorbidities into frailty assessment may offer prognostic value, but comparable to existing clinical frailty assessment. Further work to identify patients with inferior prognosis is required.
Collapse
Affiliation(s)
- Amy Walter
- Department of Vascular Surgery, Ninewells Hospital, Dundee, United Kingdom
| | - Nicholas Bradley
- Department of Vascular Surgery, Ninewells Hospital, Dundee, United Kingdom
| | - Murray Flett
- Department of Vascular Surgery, Ninewells Hospital, Dundee, United Kingdom
| | - John Nagy
- Department of Vascular Surgery, Ninewells Hospital, Dundee, United Kingdom
| | - Stuart Suttie
- Department of Vascular Surgery, Ninewells Hospital, Dundee, United Kingdom
| | - Graeme Guthrie
- Department of Vascular Surgery, Ninewells Hospital, Dundee, United Kingdom
| |
Collapse
|
4
|
Swanson E. Abandoning Caprini Scores and Chemoprophylaxis ("Bloodletting 2.0"): A Call for Action. Ann Plast Surg 2023; 91:2-7. [PMID: 37254249 PMCID: PMC10373844 DOI: 10.1097/sap.0000000000003565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/18/2023] [Indexed: 06/01/2023]
|
5
|
Lobastov K, Urbanek T, Stepanov E, Lal BK, Marangoni J, Krauss ES, Cronin M, Dengler N, Segal A, Welch HJ, Gianesini S, Chen X, Caprini JA. The Thresholds of Caprini Score Associated With Increased Risk of Venous Thromboembolism Across Different Specialties: A Systematic Review. Ann Surg 2023; 277:929-937. [PMID: 36912040 DOI: 10.1097/sla.0000000000005843] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/18/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE Estimation of the specific thresholds of the Caprini risk score (CRS) that are associated with the increased incidence of venous thromboembolism (VTE) across different specialties, including identifying the highest level of risk. BACKGROUND Accurate risk assessment remains an important but often challenging aspect of VTE prophylaxis. One well-established risk assessment model is CRS, which has been validated in thousands of patients from many different medical and surgical specialties. METHODS A search of MEDLINE and the Cochrane Library was performed in March 2022. Manuscripts that reported on (1) patients admitted to medical or surgical departments and (2) had their VTE risk assessed by CRS and (3) reported on the correlation between the score and VTE incidence, were included in the analysis. RESULTS A total of 4562 references were identified, and the full text of 202 papers was assessed for eligibility. The correlation between CRS and VTE incidence was reported in 68 studies that enrolled 4,207,895 patients. In all specialties, a significant increase in VTE incidence was observed in patients with a CRS of ≥5. In most specialties thresholds of ≥7, ≥9, and ≥11 to 12 were associated with dramatically increased incidences of VTE. In COVID-19, cancer, trauma, vascular, general, head and neck, and thoracic surgery patients with ≥9 and ≥11 to 12 scores the VTE incidence was extremely high (ranging from 13% to 47%). CONCLUSION The Caprini score is being used increasingly to predict VTE in many medical and surgical specialties. In most cases, the VTE risk for individual patients increases dramatically at a threshold CRS of 7 to 11.
Collapse
Affiliation(s)
- Kirill Lobastov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - Eugeniy Stepanov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Brajesh K Lal
- University of Maryland School of Medicine, Baltimore, MD
| | | | - Eugene S Krauss
- Department of Orthopaedic Surgery, Syosset Hospital, Northwell Health, Syosset, NY
| | - MaryAnne Cronin
- Department of Orthopaedic Surgery, Syosset Hospital, Northwell Health, Syosset, NY
| | - Nancy Dengler
- Department of Orthopaedic Surgery, Syosset Hospital, Northwell Health, Syosset, NY
| | - Ayal Segal
- Department of Orthopaedic Surgery, Syosset Hospital, Northwell Health, Syosset, NY
| | - Harold J Welch
- Division of Vascular Surgery, Lahey Hospital and Medical Center, Burlington, MA
| | | | - Xiaolan Chen
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | | |
Collapse
|
6
|
Cuenca-Pardo J, Ramos-Gallardo G, Morales-Olivera M, Contreras-Bulnes L, Bucio-Duarte J, Iribarren-Moreno R, Vélez-Benítez E, Domínguez-Millán R, Salmean-Piña O. HOW TO STRATIFY THE RISK OF THROMBOSIS FOR AESTHETIC PLASTIC SURGERY? THE PROPOSAL OF A NEW SCALE. J Plast Reconstr Aesthet Surg 2023. [PMID: 37302242 DOI: 10.1016/j.bjps.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Scales to qualify the risk of thrombosis do not include all thrombogenic factors that are generated in esthetic plastic surgery. Methods: We performed a systematic review to assess the risk of thrombosis in plastic surgery. Thrombogenic factors in esthetic surgery were analyzed by a panel of experts. We proposed a scale with 2 versions. In the first version, factors were stratified according to their impact on the possible risk of thrombosis. The second version includes the same factors but in a simplified form. We evaluated the efficacy of the proposed scale by comparing it with the Caprini score; we scored the risk in 124 cases and controls. Results: Using the Caprini score, we found that 81.45% of the patients studied and 62.5% of the cases of thrombosis were observed in the low-risk group. Only 1 case of thrombosis was reported in the high-risk group. Using the stratified version of the scale, we found that the low-risk group comprised 25% of the patients, and there were no cases of thrombosis. The high-risk group included 14.51% of patients; 10 presented thrombosis (62.5%). The proposed scale was very effective in detecting both low-risk and high-risk patients undergoing esthetic surgery procedures.
Collapse
|
7
|
A New Approach for Venous Thromboembolism Prevention in Plastic Surgery. Plast Reconstr Surg Glob Open 2022; 10:e4190. [PMID: 35291330 PMCID: PMC8916212 DOI: 10.1097/gox.0000000000004190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 01/19/2022] [Indexed: 11/29/2022]
|
8
|
White AJ, Kanapathy M, Nikkhah D, Akhavani M. Systematic review of the venous thromboembolism risk assessment models used in aesthetic plastic surgery. JPRAS Open 2021; 30:116-127. [PMID: 34522758 PMCID: PMC8427088 DOI: 10.1016/j.jpra.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/30/2021] [Indexed: 12/11/2022] Open
Abstract
Background A reliable venous thromboembolism (VTE) risk assessment model (RAM) can assist surgeons in identifying patients who would benefit from VTE prophylaxis. This systematic review was aimed at summarising the current available evidence on VTE RAMs used in aesthetic plastic surgery. Methods A comprehensive search was performed in the PubMed, EMBASE and Cochrane databases to include primary studies describing VTE RAMs in aesthetic plastic surgery from 1946 to February 2019. The objective was to compare the different VTE RAMs described for aesthetic plastic surgery to recommend a reliable model to stratify patients. Results Of the 557 articles identified in the PubMed, EMBASE and Cochrane databases, six articles were included in the final review. Five different RAMs were used in the included studies: Caprini 2005 RAM, Caprini 2010 RAM, Davison-Caprini 2004 RAM, the American Society of Anaesthesiologist's (ASA) physical status grading system and a tool developed by Wes et al. The difference in risk weightage amongst the tools along with the VTE incidences for different categories was compared. The Caprini 2005 RAM was the most widely reported tool and validated in plastic surgery patients. Conclusion Amongst the five different tools currently used, the Caprini 2005 RAM was the most widely reported. This tool was validated in plastic surgery patients and reported to be a sensitive and reliable tool for VTE risk stratification; therefore, current data support its use until further higher quality evidence becomes available. Because of the heterogeneity of the data and low quality of the current evidence, a definitive recommendation cannot be made on the best VTE RAM for patients undergoing aesthetic plastic surgery. This paper highlights the need for randomised controlled trials evaluating the various RAMs which are essential to support future recommendations and guidelines.
Collapse
Affiliation(s)
- Amelia J White
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, United Kingdom
| | - Muholan Kanapathy
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, United Kingdom.,Division of Surgery & Interventional Science, University College London, London, United Kingdom
| | - Dariush Nikkhah
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, United Kingdom
| | - Mo Akhavani
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, United Kingdom
| |
Collapse
|
9
|
Westhofen T, Schott M, Keller P, Tamalunas A, Atzler M, Ebner B, Schultheiß M, Damm A, Kowalski C, Stief CG, Magistro G. Spinal versus general anesthesia for Holmium laser enucleation of the prostate of high-risk patients - A propensity-score-matched-analysis. Urology 2021; 159:182-190. [PMID: 34339752 DOI: 10.1016/j.urology.2021.04.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/30/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare perioperative management and functional outcome of spinal anesthesia (SpA) to general anesthesia (GA) in high-risk patients treated for lower urinary tract symptoms (LUTS) with Holmium laser enucleation of the prostate (HoLEP). METHODS In the current retrospective analysis, a propensity-score-matching of patients treated for LUTS with HoLEP (n=300) in SpA with ASA>2 (n=100), GA with ASA>2 (GA-high-risk) (n=100) or GA with ASA≤2 (GA-low-risk) (n=100) was performed. The impact of anesthesiologic mode on perioperative anesthesiologic outcome, early functional outcome and treatment related adverse events (according to Clavien Dindo), was evaluated. RESULTS Hypotensive episodes were significantly less frequent in the SpA-cohort (9%) compared to the GA-high-risk cohort (32%) and the GA low-risk cohort (22%) (each p<0.05 respectively). SpA-patients showed a significantly shorter median time in post anesthesia care unit (PACU-time: 135min; 120-166.5) compared to GA-high-risk patients (186min; 154-189.5), with significant less referrals to Intermediate care unit (ICU) (1% vs. 9 %); (each p<0.05). PACU-time (99min) and ICU referrals (0%) for GA-low-risk were lower than for both other cohorts. Postoperative requirement for analgesics was significantly lower in the SpA-cohort (2%), compared to both GA-cohorts (74% and 61% respectively; p<0.05). No significant difference was found regarding early functional outcome or treatment related adverse events (AE) (p-range:0.201-1.000). CONCLUSION For patients undergoing HoLEP, SpA provides greater hemodynamic stability and allows faster overall postoperative recovery with preferable pain management. Yielding a comparable functional outcome, it is a safe and efficient alternative to GA in high-risk patients.
Collapse
Affiliation(s)
- Thilo Westhofen
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Melanie Schott
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Patrick Keller
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Alexander Tamalunas
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Michael Atzler
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Benedikt Ebner
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Michael Schultheiß
- Department of Anesthesiology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Alexander Damm
- Department of Anesthesiology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian Kowalski
- Department of Anesthesiology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Giuseppe Magistro
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| |
Collapse
|
10
|
Pandor A, Tonkins M, Goodacre S, Sworn K, Clowes M, Griffin XL, Holland M, Hunt BJ, de Wit K, Horner D. Risk assessment models for venous thromboembolism in hospitalised adult patients: a systematic review. BMJ Open 2021; 11:e045672. [PMID: 34326045 PMCID: PMC8323381 DOI: 10.1136/bmjopen-2020-045672] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 06/23/2021] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Hospital-acquired thrombosis accounts for a large proportion of all venous thromboembolism (VTE), with significant morbidity and mortality. This subset of VTE can be reduced through accurate risk assessment and tailored pharmacological thromboprophylaxis. This systematic review aimed to determine the comparative accuracy of risk assessment models (RAMs) for predicting VTE in patients admitted to hospital. METHODS A systematic search was performed across five electronic databases (including MEDLINE, EMBASE and the Cochrane Library) from inception to February 2021. All primary validation studies were eligible if they examined the accuracy of a multivariable RAM (or scoring system) for predicting the risk of developing VTE in hospitalised inpatients. Two or more reviewers independently undertook study selection, data extraction and risk of bias assessments using the PROBAST (Prediction model Risk Of Bias ASsessment Tool) tool. We used narrative synthesis to summarise the findings. RESULTS Among 6355 records, we included 51 studies, comprising 24 unique validated RAMs. The majority of studies included hospital inpatients who required medical care (21 studies), were undergoing surgery (15 studies) or receiving care for trauma (4 studies). The most widely evaluated RAMs were the Caprini RAM (22 studies), Padua prediction score (16 studies), IMPROVE models (8 studies), the Geneva risk score (4 studies) and the Kucher score (4 studies). C-statistics varied markedly between studies and between models, with no one RAM performing obviously better than other models. Across all models, C-statistics were often weak (<0.7), sometimes good (0.7-0.8) and a few were excellent (>0.8). Similarly, estimates for sensitivity and specificity were highly variable. Sensitivity estimates ranged from 12.0% to 100% and specificity estimates ranged from 7.2% to 100%. CONCLUSION Available data suggest that RAMs have generally weak predictive accuracy for VTE. There is insufficient evidence and too much heterogeneity to recommend the use of any particular RAM. PROSPERO REGISTRATION NUMBER Steve Goodacre, Abdullah Pandor, Katie Sworn, Daniel Horner, Mark Clowes. A systematic review of venous thromboembolism RAMs for hospital inpatients. PROSPERO 2020 CRD42020165778. Available from https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=165778https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=165778.
Collapse
Affiliation(s)
| | | | | | - Katie Sworn
- ScHARR, The University of Sheffield, Sheffield, UK
| | - Mark Clowes
- ScHARR, The University of Sheffield, Sheffield, UK
| | - Xavier L Griffin
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mark Holland
- Department of Clinical and Biomedical Sciences, University of Bolton, Bolton, UK
| | - Beverley J Hunt
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kerstin de Wit
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Horner
- Emergency Department, Salford Royal NHS Foundation Trust, Salford, UK
| |
Collapse
|
11
|
Sato K, Date H, Michikawa T, Morita M, Hayakawa K, Kaneko S, Fujita N. Preoperative prevalence of deep vein thrombosis in patients scheduled to have surgery for degenerative musculoskeletal disorders. BMC Musculoskelet Disord 2021; 22:513. [PMID: 34088287 PMCID: PMC8178884 DOI: 10.1186/s12891-021-04405-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/21/2021] [Indexed: 12/20/2022] Open
Abstract
Background Although the incidence of symptomatic pulmonary thromboembolism after elective surgery for degenerative musculoskeletal disorders is comparatively low, it is extremely detrimental to both patients and health-care providers. Therefore, its prevention is mandatory. We aimed to perform a cross-sectional analysis of deep venous thrombosis (DVT) before elective surgery for degenerative musculoskeletal disorders, including total knee arthroplasty (TKA), total hip arthroplasty (THA), and spinal surgery, and identify the factors associated with the incidence of preoperative DVT. Methods The clinical data of patients aged ≥ 30 years who underwent TKA or THA, and spine surgery for lumbar or cervical degenerative disorders at our institution were retrospectively collected. D-dimer levels were measured preoperatively in all the patients scheduled for surgery. For the patients with D-dimer levels ≥ 1 µg/mL or who were determined by their physicians to be at high risk of DVT, the lower extremity vein was preoperatively examined for DVT on ultrasonography. Results Overall, we retrospectively evaluated 1236 consecutive patients, including 701 men and 535 women. Of the patients, 431 and 805 had D-dimer levels ≥ 1 and < 1 µg/mL, respectively. Of 683 patients who underwent lower extremity ultrasonography, 92 had proximal (n = 7) and distal types (n = 85) of DVT. The preoperative prevalence of DVT was 7.4 %. No patient had the incidence of postoperative symptomatic venous thromboembolism. A multivariate analysis revealed that age ≥ 80 years (odds ratio [OR], 95 % confidence interval [CI]: 2.8, 1.1–7.3), knee surgery (2.1, 1.1–4.0), American Society of Anesthesiologists (ASA) grade 2 (2.8, 1.2–6.8), ASA grades 3 or 4 (3.1, 1.0–9.4), and malignancy (1.9, 1.1–3.2) were significantly associated with DVT incidence. Conclusions This is the first study to conduct a cross-sectional analysis of preoperative DVT data of patients scheduled for elective surgery for degenerative musculoskeletal disorders. Although whether screening for preoperative DVT is needed to prevent postoperative symptomatic pulmonary thromboembolism remains to be clarified, our data suggested that DVT should be noted before surgery in the patients with advanced age, knee surgery, high ASA physical status, and malignancy.
Collapse
Affiliation(s)
- Keigo Sato
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Aichi, Toyoake, Japan
| | - Hideki Date
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Aichi, Toyoake, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Mitsuhiro Morita
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Aichi, Toyoake, Japan
| | - Kazue Hayakawa
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Aichi, Toyoake, Japan
| | - Shinjiro Kaneko
- Department of Spine and Spinal Cord Surgery, Fujita Health University, Aichi, Toyoake, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Aichi, Toyoake, Japan.
| |
Collapse
|
12
|
Reconsidering the Role of Routine Anticoagulation for Venous Thromboembolism Prevention in Plastic Surgery. Ann Plast Surg 2021; 85:97-99. [PMID: 31809477 PMCID: PMC7363439 DOI: 10.1097/sap.0000000000002162] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
13
|
Swanson E. Ultrasound Surveillance Offers a Safe and Effective Method for Venous Thromboembolism Prevention in Plastic Surgery Patients. Aesthetic Plast Surg 2020; 44:2335-2339. [PMID: 32869134 PMCID: PMC7683443 DOI: 10.1007/s00266-020-01935-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 08/23/2020] [Indexed: 11/30/2022]
|
14
|
Li J, Qiang WM, Wang Y, Wang XY. Development and validation of a risk assessment nomogram for venous thromboembolism associated with hospitalized postoperative Chinese breast cancer patients. J Adv Nurs 2020; 77:473-483. [PMID: 33159325 DOI: 10.1111/jan.14571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/22/2020] [Accepted: 08/07/2020] [Indexed: 12/26/2022]
Abstract
AIM The purpose of this study was to develop and validate an individualized nomogram to predict venous thromboembolism (VTE) risk in hospitalized postoperative breast cancer patients. DESIGN A single-central retrospective and non-interventional trial. METHODS For model development, we used data from 4,755 breast cancer patients between 1 November 2016-30 June 2018 (3,310 patients in the development group and 1,445 in the validation group). Overall, 216 patients developed VTE (150 in development group and 66 in validation group). The model was validated by receiver operating characteristic curves and the calibration plot. The clinical utility of the model was determined through decision curve analysis. RESULTS The individualized nomogram consisted of six clinical factors: age, body mass index, number of cardiovascular comorbidities, neoadjuvant chemotherapy, surgical treatment, hospital length of stay and two pre-operative biomarkers of Homocysteine and D-dimer. The model at the 3.9% optimal cut-off had the area under the curve of 0.854 (95% CI, 0.824-0.884) and 0.805 (95% CI, 0.740-0.870) in the development and validation groups. A p = 0.570 of the calibration test showed that the model was well-calibrated. The net benefit of the model was better between threshold probabilities of 5%-30% in decision curve analysis. CONCLUSION The nomogram of VTE risk assessment, is applicable to hospitalized postoperative breast cancer patients. However, multi-central prospective studies are needed to improve and validate the model. Effectiveness and safety of thromboprophylaxis in high-risk patients are needed to demonstrate in interventional trials. IMPACT This nomogram can be used in clinical to inform practice of physicians and nurses to predict the VTE probability and maybe direct personalized decision making for thromboprophylaxis in hospitalized postoperative breast cancer patients.
Collapse
Affiliation(s)
- Jing Li
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, P.R. China
| | - Wan-Min Qiang
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, P.R. China
| | - Yan Wang
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, P.R. China
| | - Xiao-Yuan Wang
- Tianjin Medical University Cancer Institute & Hospital, Tianjin, P.R. China
| |
Collapse
|
15
|
Smith D, Raices M, Diego C, Julián D, Montagne J, Dietrich A. Incidence of venous thromboembolism and bleeding after pulmonary lobectomy: evaluating the timing for thromboprophylaxis. J Thromb Thrombolysis 2020; 51:997-1004. [PMID: 32929687 DOI: 10.1007/s11239-020-02277-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/24/2022]
Abstract
Venous thromboembolism (VTE) is an important postoperative complication after major lung cancer resective surgery, such as lobectomy. It is recommended to start chemical thromboprophylaxis within the first 12 h following the procedure. Postoperative bleeding is also a relevant complication in patients with predisposing conditions. However, the criterion for classifying a patient as "high risk of bleeding" is not standardized and is left to the expertise of the attending physician or surgeon. We aim to describe the incidence and risk factors for postoperative VTE and hemorrhage after pulmonary lobectomy; and to assess the impact of the timing of thromboprophylaxis on the incidence of postoperative thrombotic or hemorrhagic events. A retrospective observational study of 358 lobectomies performed in a single center was performed, analyzing the rates of postoperative thrombotic and hemorrhagic events and predisposing factors, including postoperative thromboprophylaxis management. Cumulative incidence of VTE was 3.07% (95% CI 1.54-5.43), and early postoperative bleeding was 10.05% (95% CI 7.14-13.64). Underlying pulmonary disease was associated with VTE (p = 0.001) and open approach was associated with hemorrhagic events (p = 0.01). The use of thromboprophylaxis and timing of its initiation were not associated with a higher incidence of events. VTE and postoperative hemorrhage are relevant complications following pulmonary lobectomy. Compliance with VTE prophylaxis guidelines is essential. Even so, a case-by-case risk evaluation of VTE and bleeding remains preferable and safe in order to decide on the most suitable timing of thromboprophylaxis.
Collapse
Affiliation(s)
- David Smith
- Department of Thoracic Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina
| | - Micaela Raices
- Department of General Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina.
| | - Carolina Diego
- Department of General Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina
| | - Drago Julián
- Department of General Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina
| | - Juan Montagne
- Department of Thoracic Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina
| | - Agustín Dietrich
- Department of Thoracic Surgery. Hospital Italiano de Buenos Aires. Juan D. Perón, 4190. C1199ABD, Buenos Aires, Argentina
| |
Collapse
|
16
|
Prospective Study of Doppler Ultrasound Surveillance for Deep Venous Thromboses in 1000 Plastic Surgery Outpatients. Plast Reconstr Surg 2020; 145:85-96. [DOI: 10.1097/prs.0000000000006343] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
Berlin NL, Pannucci CJ, Wilkins EG. Commentary on: Oral Contraceptive Management in Aesthetic Surgery: A Survey of Current Practice Trends. Aesthet Surg J 2019; 39:NP515-NP516. [PMID: 29452337 DOI: 10.1093/asj/sjx260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Christopher J Pannucci
- Division of Plastic Surgery, Division of Health Services Research, University of Utah, Salt Lake City, UT
| | - Edwin G Wilkins
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI
| |
Collapse
|
18
|
Yago H, Yamaki T, Sasaki Y, Homma K, Mizobuchi T, Hasegawa Y, Osada A, Sakurai H. Application of the Caprini Risk Assessment Model for Evaluating Postoperative Deep Vein Thrombosis in Patients Undergoing Plastic and Reconstructive Surgery. Ann Vasc Surg 2019; 65:82-89. [PMID: 31678541 DOI: 10.1016/j.avsg.2019.10.082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 09/02/2019] [Accepted: 10/22/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The optimal approach for assessing the risk of venous thromboembolism (VTE) in patients undergoing plastic surgery is yet to be established. This study aimed to determine the validity of the Caprini Risk Assessment Scale in identifying patients undergoing plastic surgery who are at a high risk of developing VTE. METHODS Between December 2014 and November 2015, we enrolled 90 patients. Risk factors for VTE were assessed at baseline. The Caprini Risk Assessment Model was used to stratify patients into Caprini <4, Caprini 5-6, Caprini 7-8, and Caprini >8 groups before examination. We preoperatively screened for deep vein thrombosis (DVT) using duplex ultrasound. During operation, surgical duration and blood loss were recorded. Duplex ultrasound was repeated 2 and 7 days postoperatively to evaluate for DVT. We used a univariate analysis to determine risk factors for postoperative VTE. Confounding predictors were finally tested using a multivariate logistic regression analysis. RESULTS One patient had preoperative DVT and was excluded from the study. Eighty-nine patients were included in the final analyses. Of the 89 patients, 7 (8%) developed postoperative DVT. Mean age, body mass index, Caprini score, and surgical duration were significantly higher in patients who developed postoperative DVT. Variables associated with increased risk of postoperative DVT using univariate analysis were Caprini scores of 7-8 and >8. Multivariate logistic regression analysis finally identified Caprini scores 7-8 [odds ratio (OR) 13, 95% confidence interval (CI) 1.67-101.98, P = 0.014] and >8 (OR 19.5, 95% CI 1.02-371.96, P = 0.048) to be independently associated with postoperative DVT. CONCLUSIONS Although the incidence of postoperative DVT is relatively low among patients undergoing plastic surgery, Caprini scores can be used to predict postoperative VTE complications.
Collapse
Affiliation(s)
- Hiroki Yago
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan.
| | - Takashi Yamaki
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yumiko Sasaki
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kento Homma
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takatoshi Mizobuchi
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuki Hasegawa
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsuyoshi Osada
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Sakurai
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
19
|
Mendez BM, Coleman JE, Kenkel JM. Optimizing Patient Outcomes and Safety With Liposuction. Aesthet Surg J 2019; 39:66-82. [PMID: 29947738 DOI: 10.1093/asj/sjy151] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Since its advent in the early 1980s, liposuction has made tremendous advancements, making it the most popular aesthetic surgery performed today. The goal of this Continuing Medical Education (CME) article is to provide a foundation of knowledge of the relevant anatomy, preoperative evaluation, intraoperative technique, and postoperative management for surgeons performing liposuction. Finally, the prevention and management of potential complications will be reviewed along with measures to optimize patient safety and outcomes.
Collapse
Affiliation(s)
- Bernardino M Mendez
- Departments of Plastic Surgery and Anesthesia, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jayne E Coleman
- Departments of Plastic Surgery and Anesthesia, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey M Kenkel
- Departments of Plastic Surgery and Anesthesia, University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
20
|
Song JY, Kim JM, Shin J, Lee SG, Kim TH, Oh EH, Kim S, Hong SJ, Lee KY. Analysis of variations in anesthesia cost according to severity of physical status and cancer stage in colorectal cancer patients. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.4.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Joo Young Song
- Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Ji Man Kim
- Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Jaeyong Shin
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Gyu Lee
- Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Tae Hyun Kim
- Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Eun Hwan Oh
- Department of Health Management, Hyupsung University, Hwaseong, Korea
| | - Sijin Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Jin Hong
- Department of Anesthesiology, Pain and Critical Care Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki-Young Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
21
|
Keyes GR, Singer R, Iverson RE, Nahai F. Incidence and Predictors of Venous Thromboembolism in Abdominoplasty. Aesthet Surg J 2018; 38:162-173. [PMID: 29117339 DOI: 10.1093/asj/sjx154] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/27/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The prevention of venous thromboembolism (VTE) is a high priority in aesthetic surgery. Abdominoplasty is the aesthetic procedure most commonly associated with VTE, yet the mechanisms for the development of VTE associated with this procedure are unclear. OBJECTIVES The purpose of this study was to analyze the incidence and predictors of VTE in patients undergoing abdominoplasty procedures in outpatient surgery centers using data from the Internet Based Quality Assurance Program (IBQAP). METHODS IBQAP data from 2001 to 2011 were queried retrospectively to identify abdominoplasty cases and VTE cases. Patient- and procedure-specific variables were analyzed to identify potential predictors of VTE in abdominoplasty. RESULTS Among all outpatient aesthetic surgery cases entered from 2001 to 2011, 414 resulted in VTE, representing a VTE incidence of 0.02%. Of these, 240 (58%) occurred in abdominoplasty cases. Predictors of VTE were age greater than 40 years and BMI greater than 25 kg/m2. Patient sex, duration of anesthesia and surgery, type of anesthesia, type of additional procedure, and number of procedures did not appear to influence the risk of VTE. Importantly, 95.5% of the VTEs identified for this study occurred in patients whose Caprini risk assessment model score was between 2 and 8, which would not be an indication for chemoprophylaxis according to current recommendations. CONCLUSIONS Many factors must be considered when determining the true incidence of VTE in abdominoplasty. Research is needed to discover the reason abdominoplasty carries a greater risk compared with other aesthetic surgery procedures so that appropriate steps can be taken to prevent its occurrence and improve the safety of the procedure.
Collapse
Affiliation(s)
- Geoffrey R Keyes
- Clinical Associate Professor of Surgery, Division of Plastic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Robert Singer
- Clinical Professor of Plastic Surgery (Voluntary), The University of California, San Diego (UCSD), San Diego, CA
| | - Ronald E Iverson
- Adjunct Clinical Professor of Plastic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Foad Nahai
- Jurkiewicz Chair in Plastic Surgery and Professor of Plastic Surgery, Emory University School of Medicine, Atlanta, GA; and is Editor-in-Chief of Aesthetic Surgery Journal
| |
Collapse
|
22
|
Villanueva NL, Kenkel JM. Commentary on: Cosmetic Liposuction: Preoperative Risk Factors, Major Complication Rates, and Safety of Combined Procedures. Aesthet Surg J 2017; 37:695-697. [PMID: 28449037 DOI: 10.1093/asj/sjw283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nathaniel L. Villanueva
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Kenkel is the Associate Editor of Aesthetic Surgery Journal
| | - Jeffrey M. Kenkel
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Kenkel is the Associate Editor of Aesthetic Surgery Journal
| |
Collapse
|
23
|
An Analysis of Independent Variables Affecting Surgical Outcomes in Patients Undergoing Repair of Maxillofacial Trauma. J Craniofac Surg 2017; 28:596-599. [DOI: 10.1097/scs.0000000000003545] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
24
|
A Rebuttal of Published Recommendations for Venous Thromboembolism Prophylaxis in Plastic Surgery. Plast Reconstr Surg 2016; 138:951e-952e. [PMID: 27437728 DOI: 10.1097/prs.0000000000002695] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
25
|
Swanson E. Concerns Regarding the Use of Oral Anticoagulants (Rivaroxaban and Apixaban) for Venous Thromboembolism Prophylaxis in Plastic Surgery Patients. Aesthet Surg J 2016; 36:NP262-4. [PMID: 27439496 DOI: 10.1093/asj/sjw075] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 01/11/2023] Open
Affiliation(s)
- Eric Swanson
- Dr Swanson is a plastic surgeon in private practice in Leawood, KS
| |
Collapse
|
26
|
Kenkel JM, Shaikh MA, Lysikowski J. Response to "Why Risk Assessment Models are Ineffective in Predicting Venous Thromboembolism in Plastic Surgery Patients". Aesthet Surg J 2016; 36:NP235-6. [PMID: 27241365 DOI: 10.1093/asj/sjw091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jeffrey M Kenkel
- Mr Shaikh is a medical student and Dr Kenkel is a Professor and Chairman, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Kenkel is also the Associate Editor of Aesthetic Surgery Journal. Dr Lysikowski is a Statistician, Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mohammad-Ali Shaikh
- Mr Shaikh is a medical student and Dr Kenkel is a Professor and Chairman, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Kenkel is also the Associate Editor of Aesthetic Surgery Journal. Dr Lysikowski is a Statistician, Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jerzy Lysikowski
- Mr Shaikh is a medical student and Dr Kenkel is a Professor and Chairman, Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Dr Kenkel is also the Associate Editor of Aesthetic Surgery Journal. Dr Lysikowski is a Statistician, Office of Quality Improvement and Safety, University of Texas Southwestern Medical Center, Dallas, TX
| |
Collapse
|
27
|
Swanson E. Why Risk Assessment Models are Ineffective in Predicting Venous Thromboembolism in Plastic Surgery Patients. Aesthet Surg J 2016; 36:NP233-4. [PMID: 27241364 DOI: 10.1093/asj/sjv272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eric Swanson
- Dr Swanson is a plastic surgeon in private practice in Leawood, KS
| |
Collapse
|
28
|
Davison SP, Hayes KD. Commentary on: Analysis of the American Society of Anesthesiologists Physical Status Classification System and Caprini Risk Assessment Model in Predicting Venous Thromboembolic Outcomes in Plastic Surgery Patients. Aesthet Surg J 2016; 36:506-7. [PMID: 26961990 DOI: 10.1093/asj/sjv245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Steven P Davison
- Dr Davison is an Associate Professor of Otolaryngology, Georgetown University Hospital, Washington, DC. Ms Hayes is the patient care coordinator at a private plastic surgery practice in Washington, DC
| | - Kylie D Hayes
- Dr Davison is an Associate Professor of Otolaryngology, Georgetown University Hospital, Washington, DC. Ms Hayes is the patient care coordinator at a private plastic surgery practice in Washington, DC
| |
Collapse
|