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William W. Hope,
Marc Zerey,
Thomas M. Schmelzer,
William L. Newcomb,
B. Lauren Paton,
Jessica J. Heath,
Richard D. Peindl,
H. James Norton,
Amy E. Lincourt,
B. Todd Heniford,
Keith S. Gersin
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ABSTRACT: IntroductionThe addition of staple-line reinforcements on circular anastomoses has not been well studied. We histologically and mechanically
analyzed circular- stapled anastomoses with and without bioabsorbable staple-line reinforcement (SeamGuard®, W. L. Gore & Associates, Flagstaff, AZ) in a porcine model.
MethodsGastrojejunal anastomoses were constructed using a #25 EEA Proximate ILS® (Ethicon Endo-Surgery, Cincinnati, OH) mechanical stapling device with and without Bioabsorbable SeamGuard® (BSG). Gastrojejunal anastomoses were resected acutely and at 1week, and burst-pressure testing and histological analysis
were performed. Standardized grading systems for inflammation, collagen deposition, vascularity, and serosal inflammation
were used to compare the two anastomosis types.
ResultsAcute burst pressures were significantly higher with BSG than with staples alone (1.37 versus 0.39 psi, p=0.0075). Burst pressures at 1week were significantly lower with BSG than with staples alone (2.24 versus 3.86 psi, p=0.0353); however, both readings were above normal physiologic intestinal pressures. There was no statistical difference
in inflammation (13.4 versus 15.6, p=0.073), width of mucosa (3.2mm versus 3.2mm, p=0.974), adhesion formation (0 versus 0.5, p=0.575), number of blood vessels (0.5 versus 1.0, p=0.056), or serosal inflammation (2.0 versus 1.0, p=0.27) between the stapled anastomoses and those buttressed with BSG. Stapled-only anastomoses had statistically more collagen
(2.0 versus 1.0, p=0.005) than the anastomoses supported with BSG.
ConclusionsThe addition of BSG as a staple-line reinforcement acutely improves the burst strength of a circular anastomosis but not at
1week. At 1week, a decrease in collagen content with the BSG-buttressed stapled anastomosis was the only difference in the
histologic parameters studied with no difference in vascularity, adhesions, or inflammation. The long-term effect of BSG on
anastomotic strength or scarring is yet to be determined. The clinical implications may include decreased stricture formation
and also decreased strength at anastomoses.
Surgical Endoscopy 04/2012; 23(4):800-807. · 4.01 Impact Factor
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ABSTRACT: Despite efforts for patient stabilization before radiologic procedures, cardiopulmonary arrests still occur. The purpose of our study was to define the incidence, patient characteristics, and outcomes of patients having cardiopulmonary arrest in a radiology department. We retrospectively reviewed patients sustaining cardiopulmonary arrest in the radiology department from 2002 to 2007. Patient characteristics and outcomes were documented. Descriptive statistics were calculated. Over the 6 years of the study, 1,480,578 radiographic procedures were performed, and 27 patients sustained a cardiopulmonary arrest in the radiology department for an incidence rate of 0.002 per cent. The average patient age was 66 years (range, 35 to 88 years); 12 were male (44%). Radiological procedures were diagnostic in 15 cases and therapeutic in 12 cases. The most common locations for arrest were in the CT area (9 patients) and the vascular procedures area (8 patients). The most common preprocedural patient locations were the hospital wards (11 patients [41%]), the emergency department/trauma bay (5 patients [19%]), the intensive care unit (4 patients [15%]), and an outpatient setting (four patients [15%]). Nineteen patients (70%) survived the initial code, 14 patients (52%) survived 24 hours, and 9 patients (33%) survived until discharge. Survival to discharge was significantly impacted by body mass index (P = 0.005) and type of radiologic procedure (P = 0.04) but not by the preprocedure patient location. Cardiopulmonary arrest occurring in the radiology department is a rare but potentially lethal occurrence. Patients undergoing vascular access procedures may be an at-risk group. Further study is needed to evaluate potential risk factors for cardiopulmonary arrest occurring in the radiology department.
The American surgeon 03/2011; 77(3):273-6. · 1.28 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate two electrosurgical vessel-sealing devices in biliary surgery.
Porcine common bile ducts (CBDs) were sealed with two electrosurgical devices, an electrothermal bipolar vessel-sealing device (EBVS) and ultrasonic coagulation shears. Acute study animals underwent surgical bile duct sealing followed by immediate burst pressure testing. Chronic study animals were maintained for 1 week postoperatively and then tested.
The seal failure rate in the acute study was 50% for both the EBVS device and shears, and 0% for the laparoscopic surgical clip device used as a control. The latter had significantly higher burst pressures (646.2 ± 281.8 mmHg; P = 0.006) than the EBVS device (97.6 ± 86.6 mmHg) and shears (71.7 ± 89.3 mmHg). No significant difference in burst pressures was noted between the EBVS device and shears (97.6 ± 86.6 mmHg vs. 71.7 ± 89.3 mmHg). In the chronic study, obvious bile leaks occurred in one of four pigs (25%) in the EBVS device subgroup and two of four pigs (50%) in the shears subgroup. The average proximal CBD pressure in seven pigs was 16.1 ± 4.1 mmHg. The average chronic burst pressure in the control subgroup was 1088.0 ± 922.6 mmHg.
Given the high rates of failure of the EBVS device and the shears in consistently sealing biliary ducts, we do not recommend their routine use in biliary surgery.
HPB 12/2010; 12(10):703-8. · 1.60 Impact Factor
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ABSTRACT: Bowel obstructions following Roux-en-Y gastric bypass (RYGB) are a significant issue often caused by internal herniation. Controversy continues as to whether mesenteric defect closure is necessary to decrease the incidence of internal hernias after RYGB. Our purpose was to evaluate the effectiveness of closing the mesenteric defect at the jejunojejunostomy in patients who underwent RYGB by examining this potential space at reoperation for any reason.
We retrospectively reviewed medical records of patients undergoing surgery after RYGB from August 1999 to October 2008 to determine the status of the mesentery at the jejunojejunostomy.
Eighteen patients underwent surgery 2 to 19 months after open (n=8) or laparoscopic (n=10) RYGB. All patients had documented suture closure of their jejunojejunostomy at the time of RYGB. Permanent (n=12) or absorbable (n=6) sutures were used for closures. Patients lost 23.6 kg to 62.1 kg before a reoperation was required for a ventral hernia (n=8), cholecystectomy (n=4), abdominal pain (n=4), or small bowel obstruction (n=2). Fifteen of the 18 patients had open mesenteric defects at the jejunojejunostomy despite previous closure; none were the cause for reoperation.
Routine suture closure of mesenteric defects after RYGB may not be an effective permanent closure likely due to the extensive fat loss and weight loss within the mesentery.
JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 01/2010; 14(2):213-6. · 0.98 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the duration and clinical significance of postoperative pneumoperitoneum (PP) after laparoscopic nephrectomy. We reviewed consecutive laparoscopic nephrectomies from 2001 to 2007. The presence and timing of free intraperitoneal air was documented. Postoperative imaging was performed in 135 of 538 patients with 55 patients (41%) noted to have free air. These included 53 hand-assisted laparoscopic nephrectomies and 2 purely laparoscopic radical nephrectomies. There was no difference between patients with and without PP with respect to age, sex, race, length of hospital stay (LOS), operating room time, earliest postoperative film with PP, presence of free air on plain film, or complication rate (P>0.05). Donor nephrectomy patients had the highest incidence of PP (P=0.01). Nineteen patients had benign PP (34.5%) at least 3 days after surgery with the longest interval postsurgery being 9 days. Postoperative free air after laparoscopic nephrectomy is common, even up to 9 days after surgery.
Surgical laparoscopy, endoscopy & percutaneous techniques 10/2009; 19(5):415-8. · 1.23 Impact Factor
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The Journal of trauma 04/2009; 66(3):931-2. · 2.48 Impact Factor
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ABSTRACT: Peritoneal macrophages play an important role in the immune response after abdominal operations. The stress response after these operations has been associated with impaired phagocytosis by peritoneal macrophages. This study examined the influence of minimally invasive techniques and preoperative corticosteroid administration on postoperative peritoneal macrophage phagocytic activity.
After IACUC approval, 66 Sprague Dawley rats were randomly divided into 7 groups: baseline animals (B), anesthesia controls (AC), open cecectomy (OC), and laparoscopic cecectomy (LC). Within the AC, OC, and LC groups, half received intraperitoneal (IP) dexamethasone (10 mg/kg) 1 hour before surgery (+S), and the other half received an equal volume of normal saline IP (-S). Animals were observed postoperatively for 24 hours and were then euthanized. Peritoneal macrophages were harvested via intraperitoneal lavage. A phagocytosis assay was performed to calculate the net phagocytosis and percent response to the effector agent. Statistical analysis was performed using analysis of variance and a Student t test between groups. A P value of <.05 was considered significant.
Significant differences were observed between groups. The B group had a response rate of 94.2% +/- 56.7%, which was not different from the AC groups (-S, P = .28; +S, P = .16) or the LC-S group (P = .9). The lowest phagocytic activity rate was in the OC-S group with a response rate of 33.8% +/- 28.5%. The highest phagocytic response rates occurred in the AC +S (145.2% +/- 60.2%) and LC +S (198.1% +/- 103.5%). These were not significantly different from each other (P = .3). The LC +S group had a significantly higher percent response than all of the other groups. The phagocytic response rate of the OC +S group was not different from either the AC-S group (P = .07) or the LC-S group (P = .8); however, it was less than the AC +S group (P = .02) and the LC +S group (P = .003).
Open cecectomy resulted in greater impairment of the phagocytic activity of peritoneal macrophages than laparoscopic cecectomy. The addition of preoperative corticosteroids improved phagocytic activity back to baseline function. The combination of minimally invasive surgical technique and preoperative corticosteroid administration resulted in the greatest postoperative phagocytic function of peritoneal macrophages in a rat model.
American journal of surgery 01/2009; 196(6):920-4; discussion 924-5. · 2.36 Impact Factor
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ABSTRACT: BackgroundBipolar electrosurgical devices and ultrasonic devices are routinely used in open and advanced laparoscopic surgery for hemostasis.
New electrosurgical and ultrasonic instruments demonstrate improved quality and efficiency in blood vessel sealing.
MethodsThe 5-mm laparoscopic Gyrus PKS™ Cutting Forceps (PK), Gyrus Plasma Trissector™ (GP), Harmonic Scalpel® (HS), EnSeal™ Tissue Sealing and Hemostasis System (RX), LigaSure™ V with LigaSure™ Vessel Sealing Generator (LS), LigaSure™
V with Force Triad™ Generator (FT), and Ligamax™ 5 Endoscopic Multiple Clip Applier (LM) were tested to compare burst pressure,
sealing time, and failure rate. Each device was used to seal 13 small (2–3mm diameter), 13 medium (4–5mm diameter), and
13 large (6–7mm diameter) arteries from euthanized pigs. A p value <0.05 was considered statistically significant.
ResultsMean burst pressures were not statistically different for 2–3mm or 6–7mm vessels. For 4–5mm vessels, LS had the highest
mean burst pressure recorded. Mean seal times were shorter for every vessel size when FT was compared with LS (p<0.05). The shortest sealing times for 2–3mm vessels were recorded for GP. The shortest sealing times for medium and large
vessels were observed with FT. The highest percentage failure rate for each vessel size occurred with GP. For 4–5mm diameter
vessels, the failure rate was 48% for GP, 41% for PK, and 22% for HS. For 6–7mm diameter vessels, the failure rate was 92%
for GP, 41% for PK, and 8% for HS. LM and FT had no recorded failures.
ConclusionAmong the new 5-mm laparoscopic electrosurgical and ultrasonic instruments available for testing, RX, LS, and FT produced
the highest mean burst pressures. FT had the shortest mean seal times for medium and large vessels. Minimal or no seal failures
occurred with HS, RX, LS, LM, and FT.
Surgical Endoscopy 12/2008; 23(1):90-96. · 4.01 Impact Factor
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Journal of the American College of Surgeons 11/2008; 207(4):614-5. · 4.55 Impact Factor
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ABSTRACT: The aim of this study was to compare quality-of-life outcomes in patients with symptomatic hernias who were undergoing laparoscopic and open repairs.
Clinical data for patients undergoing ventral hernia repair were reviewed with quality-of-life surveys administered before and at least 6 months following surgery.
The study included 56 symptomatic patients. Forty-one patients (73%) underwent laparoscopic repair, and 15 patients (27%) underwent open repair. There was no difference in preoperative quality-of-life scores on the SF-36 Health Survey between patients having laparoscopic or open repairs. Postoperative quality-of-life scores on the SF-36 survey were significantly improved in the laparoscopic group, compared with the open group, in general health (46% vs. 37%; P=0.0217), vitality (53% vs. 45%; P=0.0491), role-emotional (45% vs. 35%; P=0.0480), and mental health (49% vs. 39%; P=0.0381). Postoperative quality-of-life scores on the Carolinas Comfort Scale (CCS) were significantly improved in the laparoscopic group, compared with the open group, in bending over (3.15 vs. 5.87, P=0.0158), sitting up (2.51 vs. 5.13; P=0.0211), activities of daily living (2.48 vs. 5.75; P=0.0139), coughing or deep breathing (2.95 vs. 5.75; P=0.0314), walking (2.36 vs. 4.62; P=0.0427), exercising (3.19 vs. 6.14; P=0.0222), and total comfort scale (17.62 vs. 40.23; P=0.0084).
Laparoscopic ventral hernia repair provides improved quality-of-life, compared with open repair, 6 months postoperatively. Nearly all physical variables measured by the CCS were significantly better when ventral hernias were repaired laparoscopically.
Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2008; 18(4):567-71. · 1.40 Impact Factor
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The Journal of trauma 09/2008; 65(2):499-500. · 2.48 Impact Factor
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ABSTRACT: The electrothermal bipolar vessel sealer (EBVS) was developed as an alternative to sutures, clips, and the ultrasonic scalpel for haemostasis during open and laparoscopic surgery. The purpose of this prospective clinical study was to objectively evaluate the performance of the EBVS during trauma surgery. Data from trauma cases, in which the EBVS was used, was collected prospectively for 19 consecutive months. Data collected included: total number of EBVS applications, need for additional haemostatic devices after application, calculated time savings or loss, and hemorrhagic complications. The EBVS was used in 23 trauma cases consisting of 13 small bowel resections, 4 ileocolectomies, 2 left hemicolectomies, 1 transverse colectomy, 1 right hemicolectomy with roux-en-Y gastrojejunostomy and duodenostomy, 1 Hartmann's procedure, and 1 splenorrhaphy with omental injury repair. A total of 631 applications of the device were used, averaging 27.4 applications per case. An additional suture ligature or clip placed for an inadequate EBVS seal (failure) was needed in only 1.5% of the total EBVS applications. All of these (10) occurred in one patient undergoing Hartmann's procedure for massive colonic injury. An additional 45 sutures or clips for non-EBVS failure were used in 5 cases due to proximity of bleeding to critical vascular, biliary, or bowel structures. In 17 trauma cases (74%) with intestinal resection no other means of hemostasis (sutures or clips) was required except the EBVS. The mean calculated time savings using the EBVS was 26.8 min (range 9.8-48) per case. There were no haemorrhagic complications. The EBVS is safe and effective for intestinal resections and haemostasis in trauma surgery. This novel energy source reliably seals major mesenteric vessels with little need for sutures or clips. Using the EBVS can substantially shorten operative time.
Injury 06/2008; 40(5):564-6. · 1.98 Impact Factor
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ABSTRACT: With the use of mesh shown to considerably reduce recurrence rates for hernia repair and the subsequent improvement in clinical outcomes, focus has now been placed on quality-of-life outcomes in patients undergoing these repairs, specifically, as they relate to the mesh prosthesis. Traditionally, quality of life after hernia surgery, like many other medical conditions, has been tested using the generic SF-36 survey. The SF-36 quality-of-life survey, although well studied and validated, may not be ideal for patients undergoing hernia repairs. We propose a new quality-of-life survey, the Carolinas Comfort Scale (CCS), pertaining specifically to patients undergoing hernia repair with mesh; our goal was to test the validity and reliability of this survey.
The CCS questionnaire was mailed to 1,048 patients to assess its acceptability, responsiveness, and psychometric properties. The survey sample included patients who were at least 6 months out after hernia repair with mesh. Patients were asked to fill out the CCS and the generic SF-36 questionnaires, four questions comparing the two surveys, and their overall satisfaction relating to their hernia repair and mesh.
The reliability of the CCS was confirmed by Cronbach's alpha coefficient (0.97). Test-retest validity was supported by the correlation found between two different administrations of the CCS; both Spearman's correlation coefficient and the kappa coefficient were important for each question of the CCS. Assessment of its discriminant validity showed that both the mean and median scores for satisfied patients were considerably lower than those for dissatisfied patients. Concurrent validity was demonstrated by the marked correlations found between the CCS and SF-36 questionnaire scales. When comparing the two surveys, 72% of patients preferred the CCS questionnaire, 80% believed it was easier to understand, 66% thought it was more reflective of their condition, and 69% said they would rather fill it out over the SF-36.
The CCS better assesses quality of life and satisfaction of patients who have undergone surgical hernia repair than the generic SF-36.
Journal of the American College of Surgeons 05/2008; 206(4):638-44. · 4.55 Impact Factor
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ABSTRACT: Microwave technology provides an emerging thermal ablation technique for solid organ tumors. We propose guidelines and recommend optimal time and power for use.
Microwave ablations using a VivaWave Microwave Ablation System (Valleylab, Boulder, CO) were performed in vivo in a porcine kidney model. The independent variables were power (20, 30, 40, 45, 50, 60 W) and time (2, 4, 6, 8, 10, 15, 20 min) with the outcome variable diameter of ablation. Following ablations, kidneys were procured for gross and histological evaluation. Analysis of variance (ANOVA) was used followed by Tukey tests when appropriate. A P value of <0.05 was considered statistically significant.
In 308 total ablations, a minimum of 7 ablations were performed in 35 of 42 power and time variables (83%). The outcome variable, ablation diameter, was affected significantly by time, power, and time/power interaction (P < 0.0001). For each time point, a one-way ANOVA showed an overall significant difference in ablation size X wattage (P < 0.0001). Tukey tests showed that, at each time point, ablation sizes at 45, 50, and 60 W were not significantly different. After determining that 45 W was optimal, a one-way ANOVA showed an overall significant difference in ablation sizes for time points at 45 W (P < 0.0001). Tukey tests showed that, at 45 W, ablation sizes at 10 min were significantly larger than ablation sizes at 8, 6, 4, and 2 min.
We propose guidelines for use of a novel microwave ablation system and recommend use at 45 W for 10 min.
Journal of Surgical Research 04/2008; 153(2):263-7. · 2.25 Impact Factor
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ABSTRACT: The purpose of this study is to examine demographic and treatment variables because they relate to 5-year survival in colon cancer. The study design is analysis of 174 471 patients with colon and rectosigmoid cancer as reported to the American College of Surgeons National Cancer Data Base. Factors associated with a reduced risk of mortality included female gender (hazard ratio = 0.89; 95% confidence interval, 0.87-0.90), education status (hazard ratio = 0.87; 95% confidence interval, 0.85-0.89), increased number of lymph nodes resected (compared with <8, 8-12: hazard ratio = 0.90; 95% confidence interval, 0.89-0.92; >12: hazard ratio = 0.79; 95% confidence interval, 0.77-0.80), and addition of chemotherapy (hazard ratio = 0.69; 95% CI, 0.68-0.71). African American race (hazard ratio = 1.14; 95% confidence interval, 1.11-1.18) and increasing age correlated with an increased hazard risk (61-75 years: hazard ratio = 1.26; 95% confidence interval, 1.23-1.29; >or=76 years: hazard ratio = 2.15; 95% confidence interval, 2.09-2.21, compared with age <60 years). Survival in colon cancer is significantly impacted by patient's age, race, gender, and education status but not by income or area of residence.
Surgical Innovation 03/2008; 15(1):17-25. · 2.13 Impact Factor
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ABSTRACT: The purpose of our study was to provide guidelines for the use of a novel microwave ablation system. Microwave ablations using a 915-MHz system were evaluated in a porcine liver. The independent variables were power and time, with the outcome variable being diameter of ablation. After ablations, livers were procured for measurement and histologic evaluation. Our study consisted of 420 ablations. The outcome variable, ablation diameter, was affected significantly by time, power, and time/power interaction (p<0.0001). For each time point, a one-way analysis of variance (ANOVA) showed an overall significant difference in ablation size X wattage (p<0.0001). Tukey tests at each time point showed ablation sizes at 45, 50, and 60 W were not significantly different. After it was determined that 45 W was optimal, a one-way ANOVA showed an overall significant difference in ablation sizes for time points at 45 W (p<0.0001). Tukey tests revealed that at 45 W, ablation sizes at 10, 15, and 20 min were not statistically different. We propose guidelines for diameters based on different time and power variables and recommend 45 W for 10 min to achieve optimal diameters at the shortest time and lowest wattage.
Journal of Gastrointestinal Surgery 03/2008; 12(3):463-7. · 2.83 Impact Factor
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ABSTRACT: Many treatment strategies have been proposed for pyogenic liver abscesses; however, the indications for liver resection for treatment have not been studied in a systematic manner. The purpose of our study was to evaluate the role of surgical treatment in pyogenic abscesses and to determine an optimal treatment algorithm. We retrospectively reviewed the medical records of all patients who had a pyogenic liver abscess at Rhode Island Hospital between 1995 and 2002. Abscesses and treatment strategies were classified into three groups each. The abscess groups included Abscess Type I (small <3 cm), Abscess Type II (large >3 cm, unilocular), and Abscess Type III (large >3 cm, complex multilocular). The treatment strategy groups included Treatment Group A (antibiotics alone), Treatment Group B (percutaneous drainage plus antibiotics), and Treatment Group C (primary surgical therapy). Descriptive statistics were calculated and chi2 used for comparison with a P < 0.05 considered significant. Our study consisted of 107 patients with pyogenic liver abscess. The success rate for small abscesses treated with antibiotics was 100 per cent. The success rate with antibiotics and percutaneous drainage for large, unilocular abscesses was 83 per cent and for large, multiloculated abscesses was 33 per cent. None of the 27 patients who had surgical therapy for large, multiloculated abscesses had recurrences. Surgical treatment for large (>3 cm), multiloculated abscesses had a significantly higher success rate than percutaneous drainage plus antibiotic therapy (33% versus 100%, P < or = 0.01). The mortality rate for the percutaneous drainage plus antibiotic group was not significantly different from the primary surgical group (4.2% versus 7.4%, P = 0.40). We propose a treatment algorithm with small abscesses being treated with antibiotics alone; large, uniloculated abscess with percutaneous drainage plus antibiotics; and large, multiloculated abscessed treated with surgical therapy.
The American surgeon 02/2008; 74(2):178-82. · 1.28 Impact Factor
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The American surgeon 02/2008; 74(1):95-6. · 1.28 Impact Factor
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ABSTRACT: Abdominal wall hernias are a frequent and formidable challenge for general surgeons. Several different surgical techniques and types of mesh prosthetics are available for repair. We evaluated outcomes of an open ventral hernia repair using a synthetic composite mesh.
We prospectively collected data on consecutive patients undergoing open ventral hernia repair using a synthetic composite mesh from January 1, 2000 to December 31, 2005 at four large medical centers. Four surgeons used a standardized surgical procedure for all patients.
The study consisted of 455 patients with an average age of 56 years; 54% were men. Sixty-nine percent of the patients underwent repairs for recurrent hernias. Mean defect size was 44 cm(2), and mean mesh size was 213 cm(2). Average length of hospital stay was 1.1 days. Thirty-one patients had 33 early complications (7%), and 3 patients (0.7%) required reoperation (one each for seroma, bowel injury, and wound breakdown). Early infection occurred in four patients (0.9%), and one patient required reoperation and graft removal. Late complications occurred in nine patients (2%), with two patients requiring reoperation. Late infections occurred in two patients (0.4%); both required antibiotic treatment. Recurrent hernias were observed in 6 patients (1%; 6 of 450 because of 5 patients with unknown recurrence) at a mean followup of 29.3 months.
In this large multicenter series, open ventral hernia repair using a composite mesh resulted in a short hospital stay, moderate complication rate, low infection rate, and low recurrence rate.
Journal of the American College of Surgeons 02/2008; 206(1):83-8. · 4.55 Impact Factor
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ABSTRACT: Postoperative pulmonary embolism (PE) remains a major health concern. The purpose of our study was to evaluate our experience with postoperative PE.
We retrospectively reviewed the medical records of patients who had a postoperative PE at our institution.
Our study included 115 patients. Prophylaxis was administered preoperatively in 31% of patients and postoperatively in 56% of patients. The diagnosis was obtained by computed tomography scan in 74 patients (64%), ventilation-perfusion scan in 24 patients (21%), angiogram in 8 patients (7%), and other modalities in 9 patients (8%). The time elapsed between surgery and the diagnosis of PE varied significantly by patient age (<40 y: 3 d, compared with 40-60 y: 11 d; P = .02). The majority of patients with PE were treated with anticoagulation (83%). Morbidity and mortality rates both were 9%.
Age has a significant impact on the timing of postoperative PE, with the majority of cases being diagnosed with a computed tomography scan, and treated with anticoagulation.
American journal of surgery 12/2007; 194(6):814-8; discussion 818-9. · 2.36 Impact Factor
