-risk pediatric patients, occurring in up to 10% of individuals when focusing on severely injured cohorts in a critical care setting. 5 , 6 Known risk factors for VTE in the trauma population include older age, high Injury Severity Score (ISS), and head injury. 7 , 8 In addition, the associated morbidity and mortality of this condition are substantial. 9 Therefore, pharmacological prophylaxis to reduce VTE in the pediatric population is an important consideration in management decisions. The current standard of care for VTE prophylaxis in adults is the administration of
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Inge A. van Erp, Apostolos Gaitanidis, Mohamad El Moheb, Haytham M. A. Kaafarani, Noelle Saillant, Ann-Christine Duhaime, and April E. Mendoza
J. Bridger Cox, Kristin J. Weaver, Daniel W. Neal, R. Patrick Jacob, and Daniel J. Hoh
postoperative formation of EDH with significant neurological sequelae. Unfortunately, little evidence exists in the literature to guide management specifically for patients undergoing spine surgery. The American College of Chest Physicians 20 , 21 , 25 and the North American Spine Society 4 have published guidelines for VTE prevention, but neither provides universal or specific recommendations on which to base treatment decisions. As a result, the Department of Neurosurgery at the University of Florida implemented a standardized VTE-prophylaxis protocol for all patients
Kurtis I. Auguste, Alfredo Quinones-Hinojosa, Chirag Gadkary, Gabriel Zada, Kathleen R. Lamborn, and Mitchel S. Berger
benefit for patients undergoing craniotomy for tumor. 49, 55 Compression stockings have also been shown to reduce the incidence of thromboembolism as effectively as EPC devices. 17 The use of these devices and compression stockings in combination provides a relatively risk-free form of prophylaxis for patients undergoing neurosurgery. Cases in which intraoperative cortical motor mapping is required present an added challenge to VTE prophylaxis. Stimulation of cortical and subcortical areas allows for radical tumor resection with the least possible impairment of
Ahmad Khaldi, Naseem Helo, Michael J. Schneck, and Thomas C. Origitano
sensitivity is approximately 67%. 22 Additionally, neurosurgical specific rates are poorly defined in the literature. In this study we describe the overall VTE rate in a neurosurgical population. Furthermore, we describe our experience with a subgroup of this neurosurgical patient population at our institution following a systemwide quality improvement project to reduce the rates of VTE in postsurgical patients by using pharmacological VTE prophylaxis postoperatively in combination with mechanical prophylaxis. The overall VTE, DVT, PE, and surgical site hemorrhage rates in
Omar Tanweer, Akwasi Boah, and Paul P. Huang
consideration is clinical hesitation in starting chemical prophylaxis for VTEs in a patient with intracranial hemorrhage. Several randomized controlled trials 3 , 6 have shown that chemical prophylaxis decreases the rate of VTE development; however, no published studies describe the risks for bleeding associated with EVD placement in patients receiving VTE prophylaxis. Furthermore, the array of intracranial pathology in patients requiring EVDs is wide, so no clear consensus on the timing of chemical prophylaxis exists. The risk for hypercoagulability is highest within
Debraj Mukherjee and Chirag G. Patil
particular postoperative day may have reduced potential heterogeneity in the data set analyzed. Finally, the authors noted that all patients were treated with mechanical VTE prophylaxis. However, VTE prophylaxis may consist of a wide range of therapies, including compression stockings, below-knee sequential compression devices (SCDs), above-knee SCDs, physical therapy, and general mobility. As evidenced by the CLOTS (Clots in Legs or Stockings After Stroke) Trial 2, a prospective trial demonstrating the greater efficacy of above-knee SCDs over below-knee devices in
Alberto Aiolfi, Desmond Khor, Jayun Cho, Elizabeth Benjamin, Kenji Inaba, and Demetrios Demetriades
.7%) 41 (3.4%) 28 (2.1%) 0.036 Procedures Craniotomy/craniectomy w/in 24 hrs of admission 801 (31.3%) 374 (31.1%) 427 (31.4%) 0.836 ICP monitoring w/in 6 hrs of admission * 843 (66.4%) 601 (69.6%) 242 (59.6%) <0.001 VTE prophylaxis † 1396 (56.0%) 675 (57.9%) 721 (54.2%) 0.068 AVP = automobile versus pedestrian; CVA = cerebrovascular accident; ED = emergency department; HR = heart rate; IQR = interquartile range; MCC = motorcycle collision; MVC = motor vehicle collision; SAH = subarachnoid hemorrhage; SBP = systolic blood pressure. Boldface type indicates statistical
Zach Pennington, Ethan Cottrill, Daniel Lubelski, Jeff Ehresman, Nicholas Theodore, and Daniel M. Sciubba
studies); 27 , 28 , 30 goal-directed fluid replacement intraoperatively (2 studies); 18 , 27 urinary catheter discontinuation within 24–48 hours postoperatively (4 studies); 18 , 27 , 28 , 30 early drain removal (2 studies); 18 , 31 mechanical venous thromboembolism (VTE) prophylaxis (2 studies); 27 , 31 early resumption of enteral feeding (2 studies); 18 , 30 and early postoperative mobilization (4 studies). 17 , 18 , 29 , 31 Seven studies 8 , 19 , 27–31 directly compared patients treated under ERAS protocols with historical controls treated under conventional
Keaton Piper, Hanna Algattas, Ian A. DeAndrea-Lazarus, Kristopher T. Kimmell, Yan Michael Li, Kevin A. Walter, Howard J. Silberstein, and G. Edward Vates
pulmonary embolism (PE) and deep venous thromboembolism (DVT). Although effective VTE chemoprophylaxis exists, the decision to medicate is complicated by the associated increased risk of hemorrhage. 5 To create an evidence-based approach to VTE prophylaxis, the risk factors that predispose patients to the development of VTE need to be explored further for each type of surgery. When planning neurosurgical procedures, knowing a patient's VTE risk is of particular importance, because chemoprophylaxis has been associated with intracranial hemorrhage and epidural hematoma
