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Reducing Post-Op VTE Complications

Reducing Post-Op VTE Complications

At Boston Medical Center, researchers learned in 2009 that their institution was a high outlier for postoperative venous thromboembolism (VTE). Their data were derived from the American College of Surgeons’ National Surgical Quality Improvement Pro­gram (ACS NSQIP) database. “After recognizing this fact,” says David McAneny, MD, “we implemented a standardized intervention for reducing postoperative VTE complications.” The intervention used standardized electronic physician orders to specify early postoperative mobilization and to mandate individualized VTE risk stratification for all patients. Patients must get out of bed and ideally walk at least three times daily, starting on the day of the operation when possible. Electronic order sets require VTE risk calculation before and after operations, and risk-stratified prophylaxis recommendations are automatically generated. The system also provided reminders upon discharge for high-risk patients who warrant extended out-patient prophylactic anticoagulation. In-patient prophylaxis measures consisted of compression boots and/or heparin-based therapy, and out-patient low molecular weight heparin (LMWH) was administered to the two highest risk groups. The program also educated patients about the importance of VTE prevention. Before & After Dr. McAneny and colleagues conducted a trial, published in the Journal of the American College of Surgeons, in which VTE outcomes were compared for periods 2 years before and after implementing the program for patients undergoing general surgery or vascular operations. The frequency of DVTs was reduced by 84% at 2 years after the prevention efforts began when compared with baseline data. There were also 55% fewer cases of pulmonary emboli. Notably, risk-adjusted VTE outcomes steadily declined from an odds ratio of 3.41 to 0.94. In addition, the study found that surgeon adherence to ordering...
The Etiquette of Help

The Etiquette of Help

“Any surgeon to OR 6 STAT. Any surgeon to OR 6 STAT.” No surgeon wants to hear or respond to a call like that. It means someone is in deep kimchee and needs help right away. I was in the locker room, just about to strip off my scrubs and dress to go out with my wife for the evening. We had finished a full day of routine surgery—two gallbladders and a colon resection—and had plans for dinner. Our older son was home from college and had offered to watch his younger brother for us. I closed my locker and walked back out to the OR control desk. Michele, my wife and first assistant, was already there. A glance at the control board showed me that Dr. S was in room 6. She was a gynecologist, and according to the board, was doing a routine diagnostic laparoscopy. The bustle of technicians and nurses running in and out of the room indicated that it was anything but routine. We made our way to the room, and I stuck my head in. My friend Jon was the anesthesiologist. He was squeezing a bag of packed red blood cells to make them run into the IV faster. “We could use some help,” he said, calmly as ever. But he rolled his eyes toward the table. Dr S. stood there, blood coating her arms and chest, her eyes looking at me but somehow also looking far away, the thousand yard stare of someone out of their depth and very afraid. “Hey, Lou,” I said, using her first name as I stepped into the...
Anesthesiology 2014

Anesthesiology 2014

New research is being presented at Anesthesiology 2014, the annual meeting of the American Society of Anesthesiologists, from October 11 to 15 in New Orleans.   Meeting Highlights Trends in Postoperative Pain Severity Anesthesiologist-Led Care for TKA Patients Declining Rates of Adverse Events During Anesthesia Comparing Anesthesia Types for Colectomy Comparing Anesthesia Types for Hip Fracture Surgery   News From Anesthesiology 2014 Chronic Pain Malpractice Claims on the Rise Extreme PTSD Responds to Stellate Ganglion Block Don’t Blame Epidural Analgesia for Inpatient Falls   More From Anesthesiology 2014 Welcome Register Preliminary Brochure Schedule-at-a-Glance Session Search Featured Lectures E-Posters Abstracts CME Information Educational Grids Non-CME Events FAQs Welcome Reception Connection Center Online Community Run For the Warriors Residents and Medical Student Offerings Subspecialty Meetings Ancillary Meeting and Event Space Exhibit Get to Know New Orleans Housing Tours...
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