Publications by authors named "Visakha Suresh"

15 Publications

  • Page 1 of 1

The utility of initial staging PET-CT as a baseline scan for surveillance imaging in stage II and III melanoma.

Surg Oncol 2020 Dec 2;35:533-539. Epub 2020 Nov 2.

Department of Surgery, Duke University Medical Center, Durham, NC, USA. Electronic address:

Background: This study evaluates the utility of whole-body PET-CT for the initial staging and subsequent surveillance imaging of patients with completely resected stage II and stage III melanoma.

Methods: A single-center, retrospective review of patients who received perioperative whole-body PET-CT from January 1, 2005 to December 1, 2019 within three months of initial melanoma diagnosis was performed.

Results: Of 258 total patients with completely resected melanoma who had a PET-CT within 3 months after their melanoma diagnosis, 113 had stage II and 145 had stage III melanoma. PET-CT detected distant metastasis in 3 (2.7%) of 113 stage II patients and 7 (4.8%) of 145 stage III patients. 179 of 258 patients had adequate follow-up time to determine whether they received surveillance cross-sectional imaging and whether they had a melanoma recurrence. 143 (79.9%) received subsequent surveillance imaging, 74 of whom developed a recurrence. In 64 (86.5%) of 74 cases, recurrence was detected by routine surveillance. 26 (34.2%) of 76 stage II and 65 (63.1%) of 103 stage III patients developed a recurrence. The median time to recurrence among the 179 patients for stage II and III was 16.3 and 13.0 months, respectively.

Conclusions: These findings indicate that baseline staging with whole-body PET-CT rarely provides information that changes initial management. Rather, the value of the initial PET-CT is as a baseline for subsequent surveillance scans. Therefore, it may be premature to discourage cross-sectional imaging for patients with stage II and III melanoma without supportive evidence or a reliable biomarker of recurrent disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.suronc.2020.10.018DOI Listing
December 2020

Which Surgical Specialties Provide Craniomaxillofacial Trauma Services at American College of Surgeons Level I Trauma Centers.

J Oral Maxillofac Surg 2020 11 17;78(11):1883-1885. Epub 2020 Jul 17.

Resident, Department of Plastic Surgery, Johns Hopkins Medical Institute; Baltimore, MD, Formerly Medical Student; Duke University Medical School, Durham, NC.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.joms.2020.06.039DOI Listing
November 2020

Volumetric Symmetry after Unilateral Autologous Breast Reconstruction: A Reasonable Goal.

Plast Reconstr Surg Glob Open 2019 Sep 30;7(9):e2362. Epub 2019 Sep 30.

Division of Plastic, Maxillofacial & Oral Surgery, Duke University Medical Center, Durham, N.C.

With growing concerns about the overuse of contralateral prophylactic mastectomy, optimizing unilateral mastectomy reconstruction outcomes becomes a priority. However, there remains a paucity of objective data that describe volumetric symmetry between a natural and autologous-reconstructed breast.

Methods: We evaluated patients who underwent unilateral mastectomy reconstruction with free-flap abdominal tissue transfer from 04/2006 to 01/2015, and had at least 2 postoperative magnetic resonance images (MRIs; n = 28). Using these MRI data, volumetric measurements of the reconstructed and natural breast were performed at the first postoperative MRI (after all revisions were complete) and the most recent MRI. Relationships were analyzed using Spearman correlation coefficients. A symmetry score (SS) was calculated such that values closer to 1.0 reflected volumetric symmetry.

Results: The mean age (years) and BMI of the patients was 44.8 and 26.8, respectively. The mean interval time between the MRIs was 3.03 years (range 0.43-6.6). After surgical revisions were complete, volumetric symmetry between reconstructed and nonreconstructed breasts was typically achieved (mean SS 0.92). This symmetry was also retained at the end of follow-up (mean SS 0.96), despite a mean change in BMI of 3.9% (range 1.1-7.7). Additionally, the mean number of flap revisions was 0.75 (range 0-2), and 39% of patients had a procedure performed on the natural breast.

Conclusion: In patients undergoing unilateral abdominal-based breast reconstruction, volumetric symmetry is attainable; however, it can require flap revisions and procedures to natural breast. Interestingly, this study does show that initial symmetry is retained postoperatively, regardless of changes in BMI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/GOX.0000000000002362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6908390PMC
September 2019

The Hybrid Arch Bar Is a Cost-Beneficial Alternative in the Open Treatment of Mandibular Fractures.

Craniomaxillofac Trauma Reconstr 2019 Jun 12;12(2):128-133. Epub 2018 Apr 12.

Division of Oral & Maxillofacial Surgery, Mount Sinai Beth Israel Hospital, New York, New York.

Obtaining maxillomandibular fixation (MMF) to achieve fracture reduction and functional occlusion is essential in the management of maxillofacial trauma. The aims of this retrospective review were to compare the total time spent in the operating room (OR) when using the Erich arch bar (EAB) versus the bone anchored hybrid arch bar (HAB) as well as performing a cost-benefit analysis (CBA). The study sample comprised patients older than 18 years who underwent open reduction internal fixation of mandible fractures at two separate institutions over a 5-year period. The primary outcome variable was total surgical time in minutes, defined as the time from incision to the completion of closure. Average operative time was significantly longer for the EAB than for the HAB (186.74 ± 70.73 vs. 135.98 ± 2.69 minutes,  < 0.001). A significant amount of time was saved by using the HAB for unilateral (37.17 ± 13.19 minutes;  = 0.007) and bilateral fractures (55.83 ± 18.89 minutes;  = 0.005). In-depth CBA showed that, for average OR fees of $60 per minute, the HAB produced savings of at least 4.01 and 11.63% of the total cost of surgery for unilateral and bilateral fractures. These results support the hypothesis that the HAB is a time-saving maneuver in the open treatment of mandible fractures. The HAB saves more time in bilateral fracture cases despite the longer overall operative times. This study shows the differential time-saving effect of the HAB regardless of fracture laterality as well as its cost minimization benefit compared with the EAB.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0038-1639351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506252PMC
June 2019

The Utilization of Video Technology in Surgical Education: A Systematic Review.

J Surg Res 2019 03 26;235:171-180. Epub 2018 Oct 26.

Pediatric Plastic & Craniofacial Surgery, Division of Plastic, Maxillofacial & Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.

Background: The use of surgical video has great potential to enhance surgical education, but there exists limited information about how to effectively use surgical videos. We performed a systematic review of video technology in surgical training and provided evidence-based recommendations for its effective use.

Materials And Methods: A systematic review of literature on surgical video in residency education was conducted. All articles meeting inclusion criteria were evaluated for technical characteristics pertaining to video usage. Included studies were critically appraised using a quality-scoring system. Recommendations were provided for the effective implementation of video in surgical education based on associations with improved training outcomes.

Results: Twenty articles met inclusion criteria. In these studies, the source of video acquisition was primarily laparoscopy (40.0% of papers), and the main perspective of video was endoscopy (45.0%). Features of videos included supplementation with other educational tools (55.0%), schematic diagrams or images (50.0%), audio (40.0%), and narration (25.0%). Videos were primarily viewed preoperatively (60.0%) or postoperatively (50.0%). The intended viewer for videos was usually residents (70.0%) but also included attendings/faculty (30.0%). When compared with a nonvideo training group, video training was associated with improved resident knowledge (100%), improved operative performance (81.3%), and greater participant satisfaction (100%).

Conclusions: Based on this review, we recommend that surgical training programs incorporate schematics and imaging into video, supplement video with other education tools, and utilize audio in video. For video review, we recommend that residents review video preoperatively and postoperatively for learning and that attendings review video postoperatively for assessment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jss.2018.09.015DOI Listing
March 2019

Validation of the American College of Surgeons National Surgical Quality Improvement Program Risk Model for Patients Undergoing Panniculectomy.

Ann Plast Surg 2019 07;83(1):94-98

Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, and.

Panniculectomy procedures have been reported to significantly improve quality of life, increase mobility, and improve hygiene in patients with a significant pannus formation. The primary aims of this study were to determine which preoperative risk factors may be used to differentiate postoperative complication rate among patient cohorts and to validate utilization of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) risk calculator in patients undergoing panniculectomies.

Methods: This retrospective study included all patients who underwent a panniculectomy procedure at our institution from 2005 to 2016. Baseline characteristics, preoperative risk factors, medical comorbidities, and postoperative complications were collected via retrospective chart review.

Results: Two hundred sixty-four patients who underwent a panniculectomy were identified. The odds ratios of any postoperative complication were 8.26, 7.76, and 16.6 for patients with classes 1, 2, and 3 obesity, respectively (P < 0.05). Statistical modeling was utilized to evaluate the predictive performance of the ACS-NSQIP Surgical Risk Calculator. We calculated the C-statistic for the ACS-NSQIP model to be only 0.61, indicating that although the model is associated with the risk of complication, it does not have a strong predictive value for this particular procedure.

Discussion: This study is one of the first to characterize postoperative complication rate based on extremum of body mass index for panniculectomy patients. Our results show that the utilization of the ACS-NSQIP Risk Calculator in this particular patient population underestimates the complication risk as a whole, which may necessitate the future development of a separate risk assessment model for this procedure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SAP.0000000000001759DOI Listing
July 2019

Outcomes of Laparoscopic Cholecystectomy in Patients Supported with a Left Ventricular Assist Device.

J Laparoendosc Adv Surg Tech A 2019 Apr 16;29(4):441-444. Epub 2018 Nov 16.

5 Division of Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.

Background: An increasing number of end-stage heart failure patients are supported with left ventricular assist device (LVAD) implantation and must be maintained on consistent anticoagulation. These patients are experiencing prolonged survival and, in some, there is development of new biliary disease. However, safety and outcomes of this procedure in this unique patient group is not well reported.

Methods: This was a retrospective single-center review. All adult patients supported on an implanted, continuous flow LVAD from 2007 to 2016 were screened. Baseline characteristics, laboratory values, and operative details were collected through retrospective chart review and an institutional LVAD registry.

Results: Of the 798 patients screened, 5 (0.63%) underwent laparoscopic cholecystectomy after LVAD implantation. In 4 patients (80%), the indication for surgery was symptomatic cholelithiasis and 1 patient (20%) had symptomatic acalculous cholecystitis. The average time from LVAD implantation to laparoscopic cholecystectomy was 254 ± 158 days. Average (corrected) preoperative international normalized ratio (INR) was 1.34 ± 0.30. Average preoperative hemoglobin was 11.28 ± 2.41 g/dL. All patients were on warfarin preoperatively and admitted before their operations for bridging with a heparin drip. Average postoperative change in hemoglobin was -1.16 ± 1.97 g/dL. The only major postoperative complication in this cohort was the development of an abdominal wall hematoma in 1 patient requiring operative evacuation. The average length of stay was 13.2 ± 4.6 days. Three patients (60%) took an average of 12 days to reach therapeutic INR.

Conclusions: Laparoscopic cholecystectomies can be performed safely in LVAD patients. Prolonged hospital stay is mainly owing to time required to reach a therapeutic INR postoperatively.

Level Of Evidence: II, prognostic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/lap.2018.0431DOI Listing
April 2019

A Novel Approach for the Management and Prevention of Self-Induced Masticatory Lingual Trauma in the Neurologically Injured Patient.

Craniomaxillofac Trauma Reconstr 2018 Sep 19;11(3):242-248. Epub 2017 Sep 19.

Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.

Self-induced masticatory trauma is an unfortunate complication of a variety of neurologic disorders, including epileptic seizures, cerebral palsy, mental retardation, psychiatric disease, and brain trauma, in addition to other described etiologies. While single or occasional occurrences of tongue biting are relatively benign, recurrent self-injury can pose major issues and predispose a patient to chronic, severe complications. To prevent the complications associated with ongoing trauma to the tongue, steps must be taken to protect individuals from chronic self-injurious behavior. Often, these interventions cause significant morbidity to the patient, such as elective removal of the dentition or complications in gaining access to the oral cavity/airway associated with maxillomandibular fixation. In the neurologically impaired patient, immobilization of the jaws is frequently associated with higher rates of agitation, aspiration, or development of complicating infections of the gingival tissues. We report a case of self-induced masticatory trauma managed with the fabrication of a custom-fabricated oral appliance. This treatment modality successfully prevents the recurrence or incidence of self-induced masticatory trauma to the tongue. The benefits of this modality are that it allows access to the oral cavity, prevents immobilization of the jaws, has minimal to no morbidity, and is completely reversible.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0037-1606300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6078703PMC
September 2018

The Utility of Polyether-Ether-Ketone Implants Adjacent to Sinus Cavities After Craniofacial Trauma.

J Oral Maxillofac Surg 2018 11 10;76(11):2361-2369. Epub 2018 May 10.

Associate Professor, Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University, Durham, NC. Electronic address:

Purpose: Polyether-ether-ketone (PEEK) implants have become increasingly popular for use in reconstructive procedures. It is imperative to understand the consequences of using this biomaterial in anatomic sites that can pose a risk of infection. Specifically, the use of PEEK in paranasal sinus cavity reconstruction is not well documented. This study examined postoperative complications, namely surgical site infection and implant loss, in patients who underwent paranasal sinus cavity reconstruction using PEEK implants.

Materials And Methods: This study is a single-center case series. Patients who underwent craniomaxillofacial reconstruction with a custom-made PEEK implant in intimate contact with a functional paranasal sinus from June 2013 to May 2017 were included. Baseline characteristics and preoperative and postoperative variables were collected by retrospective chart review.

Results: Eight patients were included in this study. Average patient age was 45.75 ± 19.36 years. Average follow-up duration was 300 ± 263 days. Mean operative time for PEEK implantation was 214.13 ± 66.03 minutes. Implant size ranged from 5 to nearly 100 cm. No patients were diagnosed with acute or chronic sinusitis postoperatively. One patient underwent explantation of his PEEK implant secondary to breakdown of overlying skin that separated from the site of the frontal sinus because of coagulase-negative Staphylococcus epidermis infection.

Conclusions: Literature review indicates that this is the largest case series reported to date documenting the use of PEEK implants in reconstruction of the region of the paranasal sinuses. Specific biologic, or alloplastic, barriers outside the formation of native scar tissue or regional fasciocutaneous tissues at the sites of reconstruction were not used in these reconstructions, although consideration for placement of these barriers can be at the discretion of the operative surgeon. The authors conclude that PEEK implants can be used in complex craniomaxillofacial reconstructive procedures to achieve near anatomic reconstruction not easily attainable through conventional means. Defects that involve the paranasal sinus cavities with a functional ostium or obliterated sinus cavity can be reconstructed with PEEK implants without increasing the risk of infection and need for explantation. Long-term follow-up and continued outcome results of this treatment modality will be necessary to verify its clinical usefulness in the future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.joms.2018.05.002DOI Listing
November 2018

Scabies and Pruritus-A Historical Review.

JAMA Dermatol 2018 05;154(5):536

Duke University School of Medicine, Durham, North Carolina.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamadermatol.2018.0147DOI Listing
May 2018

The Role of Reconstructive Surgery After Skeletal and Soft Tissue Sarcoma Resection.

Ann Plast Surg 2018 06;80(6S Suppl 6):S372-S376

Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.

Background: Skeletal and soft tissue reconstruction after sarcoma resection remains challenging. The use of advanced reconstructive techniques has been shown to improve function and increase rates of limb salvage. This study aims to analyze the utilization of plastic surgery within a multidisciplinary team approach after sarcoma resection at Duke University Medical Center from 2001 to 2014.

Methods: Medical records were reviewed to determine procedure type, postoperative complications, and tumor recurrence. Observations were stratified by oncologic diagnosis, anatomic location, and procedure type. Patients were excluded if final pathology was not indicative of sarcoma, if resection or reconstruction was not performed at our institution, if resection preceded reconstruction by greater than 60 days, or if no follow-up was recorded within 3 months.

Results: Of the 747 patients who met the inclusion criteria, 116 underwent reconstructive surgery. Tumor location was associated with a need for surgical reconstruction. Patients with upper (P = 0.0073) or lower (P = 0.0265) extremity tumors had a higher occurrence of plastic surgery involvement. Patients with a history of operative interventions had a higher likelihood of reconstructive surgery after oncologic resection (odds ratio, 1.649; P = 0.019). Neoadjuvant radiotherapy was associated with an increased likelihood of reconstructive plastic surgery after sarcoma resection (odds ratio, 2.131; P = 0.0004).

Conclusions: Understanding the factors that necessitate reconstructive plastic surgery after sarcoma resection can enhance coordination of care within a multidisciplinary sarcoma center and leading to improved patient outcomes, including rates of limb salvage, as well as functionality and esthetic results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SAP.0000000000001419DOI Listing
June 2018

Management of Patients With Left Ventricular Assist Devices Requiring Teeth Extraction: Is Halting Anticoagulation Appropriate?

J Oral Maxillofac Surg 2018 09 31;76(9):1859-1863. Epub 2017 Oct 31.

Associate Professor, Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University, Durham, NC.

Purpose: An increasing number of patients with end-stage heart failure are supported with left ventricular assist device (LVAD) implantation and must be maintained on a consistent anticoagulation regimen. Pre-emptive extraction of carious teeth in these patients is necessary to prevent seeding of the implanted device and endocarditis. Thus, the objective of this study was to evaluate bleeding complications after minor oral surgery, specifically teeth extractions, in this unique patient population requiring long-term anticoagulation.

Materials And Methods: This study was a retrospective single-center review. Adult patients supported on an implanted continuous-flow LVAD from January 1, 2007 to December 31, 2016 were included. Baseline characteristics were collected by retrospective chart review and the institutional LVAD registry. All extractions were performed in the operating room under local anesthesia with moderate sedation or general anesthesia with nasal intubation, and LVAD settings were monitored by a trained perfusionist. Preoperative and postoperative hematology laboratory values, such as hemoglobin and international normalized ratio (INR), were collected by chart review. Continuous variables were presented as mean ± standard deviation and compared using the Student t test. Categorical variables were presented as proportion and percentage and compared using the χ test or Fisher exact test as appropriate. Statistical significance was established at a P value less than .05.

Results: After screening 798 patients, 32 (4%) were found to have undergone dental extractions after LVAD implantation. The sample was composed of 32 patients with a mean age of 60.13 years and 81.25% were men. The average time from LVAD implantation to extraction was 445.19 ± 1,108.53 days. Average preoperative INR was 1.76 ± 0.47. Preoperative fresh frozen plasma was not administered to any patients. Twenty-eight patients (87.5%) were on Coumadin (warfarin) preoperatively. In 11 of these 28 patients (39.3%), Coumadin was held preoperatively. The average postoperative change in hemoglobin level was -0.79 ± 1.45. Only 1 patient (3%) required postoperative blood transfusion for a hemoglobin level of 7.6 that responded appropriately. There were no reoperations for bleeding.

Conclusions: Minor oral surgical procedures can be performed safely for patients being supported on LVAD therapy. With primary closure of the gingiva at the site of extraction, dental extractions can be performed without the full reversal of anticoagulation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.joms.2017.10.022DOI Listing
September 2018

Independent predictors of mortality following spine surgery.

J Clin Neurosci 2016 Jul 28;29:100-5. Epub 2016 Feb 28.

Department of Neurosurgery, Duke University Medical Center, Box 3807, Durham, NC 27710, USA. Electronic address:

We investigated the effect of preoperative patient demographics and operative factors on mortality in the 30day postoperative period after spine surgery. Postoperative mortality from surgical interventions has significantly decreased with progressive improvement in surgical techniques and patient selection. Well-studied preoperative risk factors include age, obesity, emphysema, clotting disorders, renal failure, and cardiovascular disease. However, the prognostic implications of such risk factors after spine surgery specifically remain unknown. The medical records of all consecutive patients undergoing spine surgery from 2008-2010 at our institution were reviewed. Patient demographics, comorbidities, indication for operation, surgical details, postoperative complications, and mortalities were collected. The association between preoperative demographics or surgical details and postoperative mortality was assessed via logistic regression analysis. All 1344 consecutive patients (1153 elective, 191 emergency) met inclusion criteria for the study; 19 (1.4%) patients died in the 30days following surgery. Multivariable logistic regression found several predictive factors of mortality for all spine surgery patients: operation in the cervical area (odds ratio [OR]: 7.279, 95% confidence interval [CI]: 1.37-42.83, p=0.02), postoperative sepsis (OR: 5.75, 95% CI: 1.16-26.38, p=0.03), operation for neoplastic (OR: 7.68, 95% CI: 1.53-42.71, p=0.01) or traumatic (OR: 13.76, 95% CI: 2.40-88.68, p=0.03) etiology, and age as defined as a continuous variable (OR: 1.05, 95% CI: 1.01-1.10, p=0.03). This study demonstrates predictive factors to help identify and evaluate patients who are at higher risk for mortality from spinal surgery, and potentially devise methods to reduce this risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocn.2015.12.012DOI Listing
July 2016

Health Insurance Status as a Barrier to Ideal Cardiovascular Health for U.S. Adults: Data from the National Health and Nutrition Examination Survey (NHANES).

PLoS One 2015 4;10(11):e0141534. Epub 2015 Nov 4.

Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America.

Background: Little is known about the association between cardiovascular (CV) health and health insurance status. We hypothesized that U.S. adults without health insurance coverage would have a lower likelihood of ideal cardiovascular health.

Methods And Results: Using National Health and Nutrition Examination Survey (NHANES) data from 2007-2010, we examined the relationship between health insurance status and ideal CV health in U.S. adults aged ≥19 years and <65 (N = 3304). Ideal CV health was defined by the American Heart Association (AHA) as the absence of clinically manifested CV disease and the simultaneous presence of 6-7 "ideal" CV health factors and behaviors. Logistic regression modeling was used to determine the relationship between health insurance status and the odds of ideal CV health. Of the U.S. adult population, 5.4% attained ideal CV health, and 23.5% were without health insurance coverage. Those without health insurance coverage were more likely to be young (p<0.0001), male (p<0.0001), non-white (p<0.0001), with less than a high school degree (p<0.0001), have a poverty-to-income ratio less than 1 (p<0.0001) and unemployed (p<0.0001) compared to those with coverage. Lack of health insurance coverage was associated with a lower likelihood of ideal CV health; however, this relationship was attenuated by socioeconomic status.

Conclusions: U.S. adults without health insurance coverage are less likely to have ideal CV health. Population-based strategies and interventions directed at the community-level may be one way to improve overall CV health and reach this at-risk group.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0141534PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4633202PMC
June 2016

Independent Predictors of 30-Day Perioperative Deep Vein Thrombosis in 1346 Consecutive Patients After Spine Surgery.

World Neurosurg 2015 Dec 11;84(6):1605-12. Epub 2015 Jul 11.

Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA. Electronic address:

Background: Deep vein thrombosis (DVT) is a morbid postsurgical complication. Identifying the perioperative DVT risk profile will improve surgeons' ability to assess patients for surgical candidacy. In addition, these data will help to identify patients who would benefit from DVT chemoprophylaxis.

Methods: We evaluated all medical records for 1346 consecutive patients who underwent spinal surgery at Duke University for incidence of DVT within 30 days of surgery and documented all demographic, preoperative, operative, and postoperative variables. DVT treatment and long-term outcomes were also documented. Associations between postoperative DVT and individual risk factors in all patients were determined using adjusted logistic regression analysis. Patients were stratified into emergent and elective groups and a similar analysis was performed.

Results: Overall, 15 patients (1.1%) had a DVT in the 30 days after surgery, 7 patients (0.6%) after elective surgery and 8 patients (4.2%) after emergent surgery (P = 0.03). Overall, multivariate logistic regression determined that previous DVT, postoperative urinary tract infection, and creatinine level >2.0 mg/dL were identified as positive predictors. When stratified by emergent surgery, we found packed red blood cell transfusion, surgical blood loss >2.0 L, and deep surgical site infection to be independently associated with increased risk of postoperative DVT. When stratified by elective surgery, we found that coronary artery disease and atrial fibrillation were associated with increased risk of DVT. No patients died in the 30-day perioperative period and 5 (33.3%) patients died within 1 year.

Conclusions: This study identifies patient factors predictive of postoperative DVT. Postoperative DVT prophylaxis may be warranted for patients undergoing emergent spine surgery because these patients have significantly higher risk of developing postoperative DVT.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2015.07.008DOI Listing
December 2015