Surgery
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The purpose of this study was to assess the impact of care guidelines for patients with isolated blunt splenic trauma on length of stay (LOS) and patient charges. ⋯ Implementing guidelines for the observation of blunt splenic injury decreased the overall hospital LOS and ICU LOS at our institution, but hospital charges remained the same. Trauma programs should institute splenic injury guidelines to reduce resources needed for the care of isolated splenic injuries.
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Despite routine prophylaxis, thromboembolic events (TEs) in surgical patients remain a substantial problem. Furthermore, the timing and incidence of hypercoagulability, which predisposes to these events is unknown, with institutional screening programs serving primarily to establish a diagnosis after an event has occurred. Emerging evidence suggests that point of care (POC) rapid thrombelastography (r-TEG) provides a real-time analysis of comprehensive thrombostatic function, which represents an analysis of both enzymatic and platelet components of thrombus formation. We hypothesized that r-TEG can be used as a screening tool to identify hypercoagulable states in surgical patients and would predict subsequent thromboembolic events. ⋯ These results indicate that the presence of hypercoagulability identified by r-TEG is predictive of thromboembolic events in surgical patients. Subsequent study is necessary to define optimal prophylactic treatment strategies for patients with r-TEG proven hypercoagulability.
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Traumatic diaphragmatic injuries (TDI) are uncommon but associated with substantial morbidity and mortality. We sought to analyze patients with TDI at a large trauma center and associated county coroner to identify characteristics predictive of increased mortality. ⋯ Although TDI may indicate substantive trauma burden in any patient, those with greater ISS and advanced age are at the greatest risk of death.
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Controversy exists regarding the extent of surgical treatment for paratracheal (level VI) lymph nodes in patients with papillary thyroid cancer (PTC). Local recurrence within lymph nodes in the central neck compartment after total thyroidectomy can be difficult to detect and more hazardous to treat surgically. An initial bilateral central lymph node dissection (CLND) can best minimize this risk of local recurrence, if CLND is established as reasonably safe and oncologically justified. ⋯ Lymph node metastases are present in both the ipsilateral and contralateral central lymph node basins in a significant percentage of patients with PTC. Routine bilateral CLND in patients with PTC has the potential to clear metastatic disease without significantly increasing the risk of RLN injury.
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In the trauma population, the use of retrievable inferior vena cava filters (RIVCF) is rapidly gaining acceptance in patients at high risk for venous thromboembolism. This study reports the impact of an institutional protocol on retrieval rates of RIVCF at a level I trauma center. ⋯ An institutional protocol for prospective monitoring of RIVCF significantly increases filter retrieval rate.