Incidence Of Pulmonary Embolism Research Articles

Racial, Biological Sex, and Geographic Disparities of Venous Thromboembolism in the United States, 2016–2019

Venous thromboembolism (VTE) stands as the leading cause of preventable death within hospitals in the United States. While there have been some studies investigating incidence rates of VTE, there has yet to be a large-scale study elucidating disparities in sex, race, income, region, and seasons in patients with VTE. The goal of this study was to report the disparities in race, sex, income, region, and seasons in patients with VTE, pulmonary embolism (PE), and deep vein thrombosis (DVT), in hospitalized patients from 2016-2019. We used the United States National Inpatients Sample database to identify inpatients diagnosed with PE, DVT, and PE & DVT from 2016 to 2019. The inpatient incidence per thousand was calculated for sex and race using the weighted sample model. The regional and monthly incidence of DVT and PE per thousand inpatients and risk of incidence were calculated. Patients' characteristics including hospital type, bed size, median length of stay, median total charges, and mortality were also collected. We examined 455,111 cases of VTE, 177,410 cases of DVT, 189,271 cases of PE, and 88,430 cases of both DVT and PE combined. Over the study period, we observed a statistically significant trend among PE hospitalization incidences. There was a strong and positive correlation between DVT and PE inpatients. Black inpatients had the highest cumulative incidence of hospitalizations in all cohorts with 10.36/1000 in PE, and 9.1/1000 in DVT. Asian and Pacific Islander inpatients had the lowest cumulative incidence with 4.42/1000 in PE and 4.28/1000 in DVT. Females showed the lowest cumulative incidence with 7.47/1000 in PE and 6.53/1000 in DVT. Mountain region was the highest among PE hospitalizations with 9.62/1000. For DVT, Middle Atlantic region was the highest at 8.65/1000. The in-hospital mortality was the highest among the PE hospitalizations with 7.3%. Also, the trend analysis showed significant increases among all groups. Over the study period (2016-2019), we reported the racial, biological sex, and geographical disparities from the National Inpatient Sample database, highlighting that Black inpatients had the highest incidence of PE and DVT, while Asian / Pacific Islander inpatients had the lowest incidence of PE and DVT. Moreover, women had lower incidence compared to men. The observed regional variations indicated that the incidence of PE was highest in the Mountain region, whereas the incidence of DVT was lowest in the Middle Atlantic region. There was an increase in the mortality of inpatients diagnosed with VTE reflecting the growing burden of this condition in the U.S. healthcare system.

Incidental pulmonary embolism in abdominal CT: detection rate and characteristics with artificial intelligence

Abstract Background Abdominal CT is a mainstay in the evaluation of abdominal infections, trauma, oncology, and postoperative complications. Pulmonary embolism (PE) is a common complication, but there is a risk that these ancillary findings are overlooked. In addition, data on detection rate and characteristics of incidental PE (iPE) on abdominal CT are lacking. Purpose The current study compared the period before and after implementing an artificial intelligence (AI) algorithm for iPE detection regarding detection rate and characteristics. Material and methods A retrospective cross-sectional study was performed on abdominal CTs between 2019-08-01 and 2021-01-31 (before AI implementation, 8026 studies) and 2021-08-01 and 2023-01-31 (after AI implementation, 8765 studies). iPE cases were identified through text search and manually confirmed. Study indication and urgency were recorded for iPE patients, and the most proximal iPE level was assessed. 1000 cases after AI implementation were randomly selected and manually reviewed for AI accuracy analysis. Results 5876 patients with a mean age of 63.6 ± 17.7 years were included before AI implementation, and 6310 patients with a mean age of 63.2 ± 18.3 years after AI implementation. The iPE detection rate was higher after AI implementation, 0.57% (50/8765 studies) vs 0.12% (10/8026), p < 0.001. The most common study indications were abdominal pain (25%, 15/60 cases) and infection (30%, 18/60 cases). There were no differences in CT pulmonary angiography usage or the most proximal extent of the iPE between the periods before or after AI implementation, p > 0.05. AI identified 46/50 of the reported iPE with seven AI false positive cases for a PPV of 87% (95% confidence interval: 75-93%). In the manually reviewed randomly selected subset, iPE prevalence was 1.7% (15/874, 95% confidence interval: 1.0-2.8%) with AI having 40% sensitivity (95% confidence interval: 16-68%) and 100% specificity (95% confidence interval: 99.5-100%). Conclusion Implementing AI for iPE detection and triage increased the iPE detection rate in abdominal CT. The AI sensitivity was moderate, with very few AI false positives.

Can Routine Investigation for Occult Pulmonary Embolism Be Justified in Patients with Deep Vein Thrombosis?

This study aims to investigate whether routine screening for silent pulmonary embolism (PE) can be justified in patients with deep vein thrombosis (DVT). We retrospectively analyzed the medical records of 201 patients with lower-extremity DVT admitted to the vascular surgery department of a single tertiary university center between 2019 and 2023. All patients underwent clinical evaluation, basic laboratory exams, a whole-leg colored duplex ultrasound, and a computed tomography pulmonary angiography (CTPA), to screen for an occult, underlying PE. The overall incidence of silent PE was 48.8%. The median admission D-dimer level was significantly higher in patients with silent PE than in those without PE (9.60 vs. 5.51 mg/L, P=0.001). A D-dimer value ≥5.14 mg/L was discriminant for predicting silent PE, with a sensitivity of 68.2% and a specificity of 59.3%. Silent PE was significantly more common on the right side, with the embolus located at the main pulmonary, lobar, segmental, and subsegmental arteries in 29.6%, 32.7%, 20.4%, and 17.3%, respectively. A higher incidence of occult PE was observed in patients with iliofemoral DVT (P=0.037), particularly when the thrombus extended to the inferior vena cava (P=0.003). Moreover, iliofemoral DVT was associated with a larger size and a more proximal location of the embolus (P=0.041). Multivariate logistic regression showed that male sex (odds ratio [OR]=2.46, 95% confidence interval [CI]: 1.39-3.53; P=0.026), cancer (OR=2.76, 95% CI: 1.45-4.07; P=0.017), previous venous thromboembolism (VTE) history (OR=2.67, 95% CI: 1.33-4.01; P=0.022), D-dimer value ≥5.14 mg/L (OR=2.24, 95% CI: 1.10-3.38; P=0.033), iliofemoral DVT (OR=2.13, 95% CI: 1.19-3.07; P=0.041), and thrombus extension to the IVC (OR=2.95, 95% CI: 1.43-4.47; P=0.009) served as independent predictors for silent PE. A high incidence of silent PE was observed in patients with lower-extremity DVT. Screening of patients with DVT who have the aforementioned predictive risk factors using CTPA for silent PE may be needed and justified for the efficient management of VTE and its long-term complications.

Epidemiology, Etiology, and Pathophysiology of Pulmonary Embolism

AbstractOver the last 20 years, there has been a progressive increase in the incidence of pulmonary embolism (PE) diagnosis in the United States, Europe, and Australia. Increased use of computed tomography pulmonary angiography has likely contributed in part to this rising incidence. However, it is pertinent to note that the burden of comorbidities associated with PE, such as malignancy, obesity, and advanced age, has also increased over the past 20 years. Time-trend analysis in North American, European, and Asian populations suggests that mortality rates associated with PE have been declining. The reported improved survival rates in PE over the past 20 years are likely, at least in part, to be the result of better adherence to guidelines, improved risk stratification, and enhanced treatment. Factors contributing to the development of venous thromboembolism (VTE) include stasis of blood, hypercoagulability, endothelial injury, and inflammation. In 70 to 80% of cases of PE, the thrombi embolizes from the proximal deep veins of the lower extremities and pelvis. Strong risk factors for VTE include lower extremity fractures and surgeries, major trauma, and hospitalization within the previous 3 months for acute myocardial infarction or heart failure with atrial fibrillation. Acute PE causes several pathophysiological responses including hypoxemia and right ventricle (RV) failure. The latter is a result of pulmonary artery occlusion and associated vasoconstriction. Hemodynamic compromise from RV failure is the principal cause of poor outcome in patients with acute PE.

Impact of hospitalized vaso-occlusive crises in the previous calendar year on mortality and complications in adults with sickle cell disease: a French population-based study

BackgroundHistorically, sickle cell disease (SCD) patients experiencing frequent hospitalized vaso-occlusive crises (HVOC) have been associated with increased mortality, yet recent data reflecting the widespread use of hydroxyurea and advancements in disease management remain limited. Our study aims to assess the association between HVOC and mortality or severe complications in patients with SCD in this new treatment landscape. MethodsThis was a retrospective observational cohort study using the French national health data system. Between 01-01-2012 and 12-31-2018, all SCD patients ≥16 years old (ICD-10 codes D57·0-2) were included and followed until 12-31-2018. HVOC was defined as a hospitalization of ≥1 night with primary diagnosis of SCD with crisis, following an emergency room visit. The association between HVOC and severe complications was assessed with a Cox proportional hazards model. FindingsIn total, 8 018 patients (56·6% females; 4 538/8 018) were included. The 2018 SCD standardized one-year period prevalence was 17·9 cases/100 000 person-years [17·4;18·3]. The mean rate was 0.84 (1·88) HVOC/person-year. In 2018, 70% (5 323/7 605), 22% (1 671/7 605), and 8% (611/7 605) of patients experienced 0, 1–2, or 3+ HVOCs, respectively. The median survival time between HVOCs was 415 days [386;439]. Overall, 312 patients died (3·9%) with a mean age of 49·8 (19·4). Compared to patients without HVOC, the hazard ratios of death in patients with 1–2 or 3+ HVOCs the year prior to death were 1·67 [1·21;2·30] and 3·70 [2·30;5·93], respectively. Incidence of acute chest syndrome, pulmonary embolism, osteonecrosis, and sepsis increased with the HVOCs category, but not stroke. In 2018, 29·5% (180 / 611) of patients with 3+ HVOCs did not take hydroxyurea. InterpretationPatients must be closely monitored during their hospitalizations to intensify treatment and check treatment compliance. Innovative therapies are also required. FundingThe study was funded by Novartis.

Trends in admissions for COVID-19 in the United States between April 2020 and December 2021 and cardiovascular events

IntroductionCoronavirus disease 2019 (COVID-19) can lead to cardiovascular complications. We aimed to understand the trends in admission for COVID-19 and the incidence of various cardiovascular events.Material and methodsThe 2020 and 2021 National Inpatient Sample (NIS) was studied for cases of COVID-19 between April 2020 and December 2021 in the United States. Linear-by-linear association helped us understand the trends of various events.ResultsThe number of cases of COVID-19 was highest in January 2021 (261,469 patients). The incidence of acute pulmonary embolism rose from 2.08% in April 2020 to 4.82% in November 2021, while deep vein thrombosis cases rose from 1.74% in April 2020 to 2.63% in December 2021. The incidence of cardiac arrest varied, with a maximum of 3.00% in August 2021. Similarly, acute ischemic stroke cases experienced their highest incidence in January 2021 (0.91%). The incidence of myocarditis was highest in April and May 2020 (0.42% each). Peak takotsubo cases were seen between October and December 2021. The highest overall all-cause mortality among COVID-19 cases was seen in April 2020 (16.74%).ConclusionsThroughout the 21 months of our analysis, various trends in COVID-19 cases and incidence of cardiac events were noticed. This could relate to the different variants of COVID-19, their direct and indirect impact on coagulation pathways and the myocardial tissues, and the protective roles of the vaccines.

Radiology: Cardiothoracic Imaging Highlights 2023.

Radiology: Cardiothoracic Imaging publishes novel research and technical developments in cardiac, thoracic, and vascular imaging. The journal published many innovative studies during 2023 and achieved an impact factor for the first time since its inaugural issue in 2019, with an impact factor of 7.0. The current review article, led by the Radiology: Cardiothoracic Imaging trainee editorial board, highlights the most impactful articles published in the journal between November 2022 and October 2023. The review encompasses various aspects of coronary CT, photon-counting detector CT, PET/MRI, cardiac MRI, congenital heart disease, vascular imaging, thoracic imaging, artificial intelligence, and health services research. Key highlights include the potential for photon-counting detector CT to reduce contrast media volumes, utility of combined PET/MRI in the evaluation of cardiac sarcoidosis, the prognostic value of left atrial late gadolinium enhancement at MRI in predicting incident atrial fibrillation, the utility of an artificial intelligence tool to optimize detection of incidental pulmonary embolism, and standardization of medical terminology for cardiac CT. Ongoing research and future directions include evaluation of novel PET tracers for assessment of myocardial fibrosis, deployment of AI tools in clinical cardiovascular imaging workflows, and growing awareness of the need to improve environmental sustainability in imaging. Keywords: Coronary CT, Photon-counting Detector CT, PET/MRI, Cardiac MRI, Congenital Heart Disease, Vascular Imaging, Thoracic Imaging, Artificial Intelligence, Health Services Research © RSNA, 2024.

In-Hospital Pulmonary Arterial Embolism after Catheter Ablation of Over 45,000 Cardiac Arrhythmias: Individualized Case Analysis of Multicentric Data.

Data on incidence of in-hospital pulmonary embolisms (PE) after catheter ablation (CA) are scarce. To gain further insights, we sought to provide new findings through case-based analyses of administrative data. Incidences of PE after CA of supraventricular tachycardias (SVT), atrial fibrillation (AF), atrial flutter (AFlu), and ventricular tachycardias (VT) in three German tertiary centers between 2005 and 2020 were determined and coded by the G-DRG (German Diagnosis Related Groups System) and OPS (German Operation and Procedure Classification) systems. An administrative search was performed with a consecutive case-based analysis. Overall, 47,344 ablations were analyzed (10,037 SVT; 28,048 AF; 6,252 AFlu; 3,007 VT). PE occurred in 14 (0.03%) predominantly female (n = 9; 64.3%) patients with a mean age of 55.3 ± 16.9 years, body mass index 26.2 ± 5.1 kg/m2, and left ventricular ejection fraction of 56 ± 13.6%. PE incidences were 0.05% (n = 5) for SVT, 0.02% (n = 5) for AF, and 0.13% (n = 4) for VT ablations. No patient suffered PE after AFlu ablation. Five patients (35.7%) with PE after CA had no prior indication for oral anticoagulation (OAC). Preprocedural international normalized ratio in PE patients was 1.2 ± 0.5. Most patients with PE following CA presented with symptoms the day after the procedure (n = 9) after intraprocedural heparin application of 12,943.2 ± 5,415.5 IU. PE treatment included anticoagulation with either phenprocoumon (n = 5) or non-vitamin K-dependent OAC (n = 9). Two patients with PE died after VT/AF ablation, respectively. The remaining patients were discharged without sequels. Over a 15-year period, incidence of PE after ablation is low, particularly low in patients with ablation for AF/AFlu. This is most likely due to stricter anticoagulation management in these patients compared with those receiving SVT/VT ablation procedures and could argue for continuation of OAC prior to ablation. Optimizing periprocedural anticoagulation management should be subject of further prospective trials.

Incidence of Symptomatic Venous Thromboembolisms in Stroke Patients.

Venous thromboembolism (VTE) is a common but preventable complication observed in critically ill patients. Deep vein thrombosis (DVT) is the most common type of VTE, with clinical significance based on location and symptoms. There is an increased incidence of DVT and pulmonary embolism (PE) in ischemic stroke patients using unfractionated heparin (UFH) for VTE prophylaxis compared with those using enoxaparin. However, UFH is still used in some patients due to its perceived safety, despite conflicting literature suggesting that enoxaparin may have a protective effect. The current study aimed to determine the incidence of VTEs in patients with acute ischemic strokes on UFH versus enoxaparin for VTE prophylaxis, subclassifying the VTEs depending on their location and symptoms. It also aimed to examine the safety profile of both drugs. A total of 909 patients admitted to the Neuro-ICU with the diagnosis of acute ischemic stroke were identified, and 634 patients were enrolled in the study-170 in the enoxaparin group and 464 in the UFH group-after applying the exclusion criteria. Nineteen patients in the UFH group (4.1%) and 3 patients in the enoxaparin group (1.8%) had a VTE. The incidence of DVT in the UFH group was 12 (2.6%), all of which were symptomatic, compared with 3 (1.8%) in the enoxaparin group, wherein one case was symptomatic. Nine patients (1.9%) in the UFH group developed a PE during the study period, and all of them were symptomatic. No patients in the enoxaparin group developed PE. No statistically significant difference was found between both groups. However, 18 patients in the UFH group (3.9%) experienced intracranial hemorrhage compared with none in the enoxaparin group, and this difference was statistically significant. Enoxaparin was found to be as effective as and potentially safer than UFH when used for VTE prophylaxis in stroke patients.

Seasonal Variations of Venous Thromboembolism Incidence: A Systemic Review from Global Trends to Chinese Context

Background: Venous thromboembolism (VTE) is a significant global health concern with seasonal variations in its incidence. Understanding these patterns is crucial for effective prevention and management strategies. Methods: Utilizing the PRISMA guidelines, our literature selection process involved systematic screening of both English and Chinese articles. From 21 included studies, involving 98,877 VTE patients, we conducted a meta-analysis examining global and China-specific VTE incidence patterns. Subgroup analyses were performed for pulmonary embolism (PE) and deep vein thrombosis (DVT). Results: In the global context, VTE incidence varied across seasons, with significantly lower rates observed in summer compared to winter (relative risk (RR) = 0.90, 95% confidence interval (CI): 0.84–0.98, p = 0.010). PE incidence was lower in summer compared to autumn/winter (RR = 0.93, 95% CI: 0.89–0.97 summer/autumn; RR = 0.90, 95% CI: 0.84–0.98 summer/winter). Conversely, DVT incidence was higher in winter compared to summer (RR = 0.80, 95% CI: 0.66–0.86, p = 0.02). In China, VTE incidence was lower in spring compared to winter (RR = 0.83, 95% CI: 0.72–0.96; p = 0.010), with no significant differences between winter and summer or autumn. Conclusion: Our study underscores the importance of considering seasonal and regional factors in understanding VTE incidence. The findings contribute valuable insights for healthcare professionals and policymakers, emphasizing the need for tailored strategies in different geographical areas to address and prevent VTE effectively.

Relationship Between the Incidence of Pulmonary Embolism and the Quantitative Level of Air Pollution (NO2, SO2, CO, O3, and PM10) in Patients Referred to Mashhad Hospitals in 2019

Background: Air pollution is known to be associated with increased levels of inflammatory markers, vascular endothelial damage, and alterations in blood coagulation factors. It represents one of the most significant environmental hazards in urban areas, with adverse effects on the health of the population. Objectives: This study aimed to investigate the relationship between the incidence of pulmonary embolism (PE) and the quantitative levels of various air pollution parameters. Methods: In this descriptive-analytical (cross-sectional) study, we examined all patients diagnosed with PE who were referred to Ghaem and Imam Reza (AS) Hospitals in Mashhad during the year 2019. Daily data on each air pollutant, including NO2, SO2, CO, O3, and PM10, were obtained from the Meteorological Center. For each patient's assessment, we considered the average pollution levels over the past 30 days. The collected data were subsequently analyzed using independent samples t-tests and the Mann-Whitney U test in SPSS 22. Results: The findings of this study revealed a statistically significant association between elevated levels of PM10 and O3 and the occurrence of PE. However, no such relationship was observed for NO2 and CO in relation to the risk of PE. Conclusions: It can be concluded that increased levels of PM10 and O3 are linked to a higher risk of developing PE, while other pollutants showed no evidence of association in this study.

Risk of Venous Thromboembolism With Tofacitinib Versus Tumor Necrosis Factor Inhibitors in Cardiovascular Risk-Enriched Rheumatoid Arthritis Patients.

The ORAL Surveillance trial found a dose-dependent increase in venous thromboembolism (VTE) and pulmonary embolism (PE) events with tofacitinib versus tumor necrosis factor inhibitors (TNFi). We aimed to assess VTE incidence over time and explore risk factors of VTE, including disease activity, in ORAL Surveillance. Patients with rheumatoid arthritis (RA) aged 50 years or older with at least one additional cardiovascular risk factor received tofacitinib 5 or 10 mg twice daily (BID) or TNFi. Post hoc, cumulative probabilities and incidence rates (patients with first events/100 patient-years) by 6-month intervals were estimated for adjudicated VTE, deep vein thrombosis, and PE. Cox regression models identified risk factors. Clinical Disease Activity Index leading up to the event was explored in patients with VTE. Cumulative probabilities for VTE and PE were higher with tofacitinib 10 mg BID, but not 5 mg BID, versus TNFi. Incidence rates were consistent across 6-month intervals within treatments. Across treatments, risk factors for VTE included prior VTE, body mass index greater than or equal to 35 kg/m2, older age, and history of chronic lung disease. At the time of the event, most patients with VTE had active disease as defined by Clinical Disease Activity Index. Incidences of VTE and PE were higher with tofacitinib (10 > 5 mg BID) versus TNFi and were generally consistent over time. Across treatments, VTE risk factors were aligned with previous studies in the general RA population. These data highlight the importance of assessing VTE risk factors, including age, body mass index, and VTE history, when considering initiation of tofacitinib or TNFi in patients with active RA.

Anticoagulation in the Management of Acute Pulmonary Embolism—A Review

AbstractVenous thromboembolism (VTE) is a very frequent cardiovascular entity that encompasses deep vein thrombosis and pulmonary embolism (PE). This last entity represents a major cause of cardiovascular morbidity and mortality. The incidence of PE and the rate of PE-related morbidity significantly increase with age, race, and underlying medical conditions, such as malignancy. Given the recent advances in diagnostic strategies and algorithms, patients can be risk assessed and treated promptly to avoid disease progression. Anticoagulation is the mainstay of treatment for acute PE that is not hemodynamically unstable. Direct oral anticoagulants, such as apixaban, rivaroxaban, or edoxaban, are currently the preferred agents for the treatment of patients who present with acute PE or for long-term treatment. Treatment duration should be continued for at least 3 months, and all patients should be assessed for extended duration of therapy based on the precipitating factors that led to the development of the VTE. Novel anticoagulant agents targeting factor XI/XIa are currently being investigated in phases 2 and 3 clinical trials, representing an attractive option in anticoagulation therapies in patients with VTE. For hemodynamically unstable patients, systemic thrombolysis is the treatment of choice, and it may also be of benefit—in reduced dose—for patients with intermediate to high risk who are at risk of hemodynamic collapse.

Therapeutic efficacy of tranexamic acid on traumatic brain injury: a systematic review and meta-analysis

ObjectiveTranexamic acid (TXA) demonstrates therapeutic efficacy in the management of traumatic brain injury (TBI). The objective of this systematic review and meta-analysis was to evaluate the safety and effectiveness of TXA in patients with TBI.MethodsThe databases, namely PubMed, Embase, Web of Science, and Cochrane Library databases, were systematically searched to retrieve randomized controlled trials (RCTs) investigating the efficacy of TXA for TBI from January 2000 to November 2023.ResultsThe present meta-analysis incorporates ten RCTs. Compared to the placebo group, administration of TXA in patients with TBI resulted in a significant reduction in mortality (P = 0.05), hemorrhage growth (P = 0.03), and volume of hemorrhage growth (P = 0.003). However, no significant impact was observed on neurosurgery outcomes (P = 0.25), seizure occurrence (P = 0.78), or pulmonary embolism incidence (P = 0.52).ConclusionThe administration of TXA is significantly associated with reduced mortality and hemorrhage growth in patients suffering from TBI, while the need of neurosurgery, seizures, and incidence of pulmonary embolism remains comparable to that observed with placebo.

Considerations for instituting pediatric pulmonary embolism response teams: A tool kit

The incidence of pediatric pulmonary embolism (PE) has increased by 200 % in the last decade, but at a single center, it is still infrequent. Given the unique epidemiologic features of pediatric PE, diagnosis is often delayed, and the management is empiric, based on individual physician experience or preference. Thus, there is a strong need for center-specific uniform management of pediatric PE patients. In adults, the development of pulmonary embolism response teams (PERTs) or PE critical care pathways has shortened the time to diagnosis and the initiation of definitive management. Evidence to support an improvement in PE outcomes after the development of PERTs does not exist in children. Nonetheless, we have summarized the practical practice guidelines that physicians and institutions can adopt to establish their institutional PERTs or critical pathways. We also provide strategies for resource-challenged institutions for partnering with centers with expertise in the management of pediatric PE.

Gluteal Fat Grafting Technique and Mortality Update Among Surveyed ABCS Surgeons

Background: The demand for gluteal fat grafting (colloquially known as Brazilian butt lift [BBL]) has seen a dramatic increase in the past decade. Brazilian butt lift has been the fastest-growing cosmetic procedure in the United States for several years. During this time, the incidence of pulmonary fat embolisms (PFEs) associated with this procedure has raised safety concerns. Several professional organizations have responded to these concerns with investigational reports to identify the causes and provide recommendations to decrease the mortality associated with this popular cosmetic procedure. Awareness and implementation of these safety recommendations have been a cornerstone to decreasing the mortality rate associated with gluteal fat grafting. Objectives: To provide a comparison of current technical approaches and a mortality update on gluteal fat grafting among surgical members from the American Board of Cosmetic Surgeons (ABCS) within the last 6 years. Also, to determine if specific technical changes in the manner this procedure is performed are improving safety. Methods: An online (emailed) survey regarding perioperative gluteal fat grafting techniques and postoperative outcomes performed by ABCS surgeons within the previous 3 years was collected in 2 different 3-year time frames. Initial data were collected in 2019 for the preceding 3 years 2016-2019. The survey was again repeated in 2022 to collect similar data as before from ABCS member years 2019-2021. The data, which included the total # of BBLs performed, incidence of major infection or fat emboli, cannula size, and injection methods details was compared for each 3-year period. Both sequential studies provided a comparison of the techniques employed as well as morbidity and mortality outcomes. Results: Sixty-four ABCS surgeons who reported performing BBLs responded to the survey in 2019 and reported performing a total of 22 800 (BBLs) gluteal fat grafting cases in a previous 3-year window from 2016 to 2018. More surgeons used a closed system peristaltic pump in the second part of the study as compared to the first (51% vs 22%) ( P < .01). Two cases required in-hospital treatment of infection in the first survey while zero cases were reported for the second survey period ( P = .07). Twenty-five of 64 (39%) reported injecting fat at least into superficial gluteal muscle during this earlier time frame. In this earliest study, there were 3 total cases of PFE reported (2 fatal PFEs and 1 nonfatal PFEs). In 2022, 85 ABCS surgeons who reported performing BBLs responded to the survey. Around 12 172 gluteal fat grafting cases were reported in the second 3-year study from 2019 to 2021 compared to 22 800 in the first study ( P < .01). There was a total of 34 972 BBLs during the entire 6-year study. Most surgeons (82 of the 85) in the second-phase 3-year study reported injecting fat “exclusively” above the muscle ( P < .01). There were no fatal and non-fatal PFEs reported in the follow-up 3-year study in 2022 of ABCS member data from 2019 to 2021 ( P = .03). Conclusions: The mortality report associated with gluteal fat grafting from this survey among surgical members of the ABCS suggests using the current safety recommendations proposed, including injection of fat in the subcutaneous layer only, have led to a decreased risk of PFEs associated with gluteal fat grafting. The mortality rate was zero (0 out of 12 800) when 96% were injecting above muscle only compared to a mortality rate of 1:11 400 (2 of 22 800 cases) when 39% of 22 800 BBLs performed had fat injected into muscle. While there were more BBLs performed during the earlier 3-year study ( P = .07). The mortality rate significantly decreased in the years when only a small minority of cases had fat injected into the muscle. This study adds to other existing literature from professional organizations’ reports on the safety of gluteal fat grafting using the proper safety measure and recommendations.

Impact of COVID-19 on cardiac surgery outcomes.

This study aimed to assess the impact of COVID-19 infection on cardiac surgery outcomes in patients who contracted COVID-19 peri-operatively or had recently recovered from COVID-19. The study prospectively enrolled 95 patients scheduled for cardiac surgery who had recently recovered from COVID-19. This formed the post-COVID-19 group. The other group consisted of 25 patients who contracted COVID-19 peri-operatively. Patients were followed for all-cause mortality as the primary endpoint and postoperative course complications as the secondary endpoint. Data were compared to a historical cohort of 280 non-COVID-19 patients. The peri-operative COVID-19 group exhibited a significantly higher prevalence of primary outcome all-cause mortality (28%), compared with 4.3% in the controls (p < 0.01), as well as the secondary composite endpoint (stroke, peri-operative myocardial infarction and pneumonia) (52 vs 13.9%, p < 0.01). The post-COVID-19 group had a higher incidence of acute pulmonary embolism (3.2 vs 0%, p < 0.01) and atrial fibrillation (23.4 vs 11.4%, p < 0.01). Patients who contracted COVID-19 peri-operatively had an increased rate of mortality and postoperative complications, while cardiac surgery in the recently recovered COVID-19 group was associated with a higher incidence of pulmonary embolism and atrial fibrillation.

Features of various options for anticoagulant therapy for a new coronavirus infection against the background of obesity

BACKGROUND: When treating a new coronavirus infection, the prevention of venous thromboembolic complications in obese patients is of particular importance.&#x0D; AIM: To analyze various options for anticoagulant therapy in obese and non-obese patients in the treatment of a new coronavirus infection.&#x0D; MATERIAL AND METHODS: The patients were divided into two groups: the first group — obese patients — 151 (40.8%) people [average age 63 (56–69) years], the second group without obesity — 219 (59.2%) people [average age 63 (51.5–71.0) years], p=0.998. According to the prescribed anticoagulant and the presence of obesity, patients were divided into subgroups: subgroup 1 — non-obese + low-molecular-weight heparin (n=114), subgroup 2 — non-obese + unfractionated heparin (n=58), subgroup 3 — obesity + low-molecular-weight heparin (n=76), subgroup 4 — obesity + unfractionated heparin (n=66). Venous thrombotic complications and bleeding rates were assessed. Analysis of qualitative indicators was performed using Pearson χ2 and Fisher tests. The distribution of quantitative indicators was assessed using the Kolmogorov–Smirnov and Shapiro–Wilk tests (p 0.05). Due to the non-normal distribution of indicators, mean values were presented as median (Me) and interquartile range (Q1–Q3), and analysis was carried out using Wilcoxon, Mann–Whitney and Kruskal–Wallis tests.&#x0D; RESULTS: In nonobese patients, a comparable incidence of deep vein thrombosis was noted on low molecular weight heparin and unfractionated heparin — 1 (0.9%) case versus 3 (5.2%) cases (p=0.102). At the same time, there was a statistically significant difference in the frequency of pulmonary embolism without a source according to autopsy data — 2 (1.8%) versus 4 (6.9%) cases (p=0.004). In obese patients receiving unfractionated heparin, the incidence of this complication was higher and amounted to 9 (13.6%), and in patients receiving low molecular weight heparin — 2 (2.6%) cases (p=0.004). A higher incidence of bleeding was observed in patients with obesity compared to patients without it (10.6 vs 4.7% of cases, p=0.045). When analyzing hemorrhagic complications, it was found that the incidence of major and significant bleeding was higher in patients receiving unfractionated heparin rather than low molecular weight heparin (16.7 vs 5.3% of cases, p 0.001).&#x0D; CONCLUSION: The use of low molecular weight heparin in obese patients with new coronavirus infection was associated with a low incidence of pulmonary embolism and bleeding compared with patients receiving unfractionated heparin.

Trends in Deep Vein Thrombosis Prophylaxis After Total Knee Arthroplasty: 2016 to 2021

BackgroundIn 2011, the American Academy of Orthopaedic Surgeons released a consensus recommending venous thromboembolism (VTE) prophylaxis after total knee arthroplasty (TKA). The purpose of our study was to examine (1) incidences of postoperative complications, including pulmonary embolism (PE), deep vein thrombosis (DVT), and transfusion rates; (2) trends from 2016 to 2021 in VTE prophylaxis; and (3) independent risk factors for 90-day total complications following TKA between aspirin, enoxaparin, rivaroxaban, and warfarin. MethodsUsing a national, all-payer database from 2016 to 2021, we identified all patients who underwent primary TKA. Exclusions included all patients who had prescribed anticoagulants within 1 year prior to TKA, hypercoagulable states, and cancer. Data were collected on baseline demographics, including age, sex, diabetes, and a comorbidity index, in each of the VTE prophylaxis cohorts. Postoperative outcomes included rates of PE, DVT, and transfusion. Multivariable regressions were performed to determine independent risk factors for total complications at 90 days following TKA. ResultsFrom 2016 to 2021, aspirin was the most used anticoagulant (n = 62,054), followed by rivaroxaban (n = 26,426), enoxaparin (n = 20,980), and warfarin (n = 13,305). The cohort using warfarin had the highest incidences of PE (1.8%) and DVT (5.7%), while the cohort using aspirin had the lowest incidences of PE (0.6%) and DVT (1.6%). The rates of aspirin use increased the most from 2016 to 2021 (32.1% to 70.8%), while the rates of warfarin decreased the most (19.3% to 3.0%). Enoxaparin, rivaroxaban, and warfarin were independent risk factors for total complications at 90 days. ConclusionsAn epidemiological analysis of VTE prophylaxis use from 2016 to 2021 shows an increase in aspirin following TKA compared to other anticoagulant cohorts in a nationally representative population. This approach provides more insight and a better understanding of anticoagulation trends over this time period in a nationally representative sample.

Prognostic Effect of Incidental Pulmonary Embolism on Long-Term Mortality in Cancer Patients.

The effect of incidental pulmonary embolism (PE) on long-term prognosis in cancer patients is unclear. This study assessed the characteristics of cancer and venous thromboembolism (VTE) and the effect of incidental PE identified by oncologists on long-term survival of patients with cancer.Methods and Results:This single-center, retrospective, cohort study used hospital-based cancer registry data from the Osaka International Cancer Institute linked with electronic medical records and administrative data from Japan's Diagnosis Procedure Combination Per-diem Payment System. Overall, 15,689 cancer patients underwent contrast-enhanced thoracic computed tomography during 2010-2018. After excluding patients with missing data, symptomatic patients, or patients with suspected PE, 174 with incidental PE (PE+ group) and 13,197 with no PE (PE- group) were identified. The total incidence of incidental PE was 1.3%. No deaths from thrombotic events were identified in the PE+ group. Both groups were adjusted for cancer- and VTE-related characteristics using inverse probability weighting. After adjusting for immortal time bias in the PE+ group, Kaplan-Meier analysis revealed that all-cause mortality was higher in the PE+ group (hazard ratio, 2.26; 95% confidence interval, 1.53-3.33). A Cox proportional hazard model revealed that metastatic cancer and a history of curative treatment were significant prognostic factors, whereas central PE and residual proximal deep vein thrombosis were not. Incidental PE in cancer patients indicates poorer prognosis. Cancer-related but not thrombosis-related factors determine prognosis.