Intermittent Pneumatic Compression Research Articles

Postoperative Venous Thromboembolism Following Hysterectomy in the Department of Defense.

Hysterectomy is the most common major gynecologic procedure performed in the USA. Surgical complications, such as venous thromboembolism (VTE), are known risks that can be mitigated by preoperative risk stratification and perioperative prophylaxis. Based on recent data, the current post-hysterectomy VTE rate is found to be 0.5%. Postoperative VTE significantly impacts health care costs and patients' quality of life. Additionally, for active duty personnel, it can negatively impact military readiness. We hypothesize that the incidence of post-hysterectomy VTE rates will be lower within the military beneficiary population because of the benefits of universal health care coverage. The Military Health System (MHS) Data Repository and Management Analysis and Reporting Tool was used to conduct a retrospective cohort study of postoperative VTE rates within 60 days of surgery among women who underwent a hysterectomy at a military treatment facility between October 1, 2013, and July 7, 2020. Patient demographics, Caprini risk assessment, preoperative VTE prophylaxis, and surgical details were obtained by chart review. Statistical analysis was performed using the chi-squared test and Student t-test. Among the 23,391 women who underwent a hysterectomy at a military treatment facility from October 2013 to July 2020, 79 (0.34%) women were diagnosed with VTE within 60 days of their surgery. This post-hysterectomy VTE incidence rate (0.34%) is significantly lower than the current national rate (0.5%, P < .0015). There were no significant differences in postoperative VTE rates with regard to race/ethnicity, active duty status, branch of service, or military rank. Most women with post-hysterectomy VTE had a moderate-to-high (4.29 ± 1.5) preoperative Caprini risk score; however, only 25% received preoperative VTE chemoprophylaxis. MHS beneficiaries (active duty personnel, dependents, and retirees) have full medical coverage with little to no personal financial burden for their health care. We hypothesized a lower VTE rate in the Department of Defense because of universal access to care and a presumed younger and healthier population. The postoperative VTE incidence was significantly lower in the military beneficiary population (0.34%) compared to the reported national incidence (0.5%). Additionally, despite all VTE cases having moderate-to-high preoperative Caprini risk scores, the majority (75%) received only sequential compression devices for preoperative VTE prophylaxis. Although post-hysterectomy VTE rates are low within the Department of Defense, additional prospective studies are needed to determine if stricter adherence to preoperative chemoprophylaxis can further reduce post-hysterectomy VTE rates within the MHS.

Association of early mobility with the incidence of deep-vein thrombosis and mortality among critically ill patients: a post hoc analysis of PREVENT trial

BackgroundThis study assessed the mobility levels among critically ill patients and the association of early mobility with incident proximal lower-limb deep-vein thrombosis and 90-day mortality.MethodsThis was a post hoc analysis of the multicenter PREVENT trial, which evaluated adjunctive intermittent pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis with an expected ICU stay ≥ 72 h and found no effect on the primary outcome of incident proximal lower-limb deep-vein thrombosis. Mobility levels were documented daily up to day 28 in the ICU using a tool with an 8-point ordinal scale. We categorized patients according to mobility levels within the first 3 ICU days into three groups: early mobility level 4–7 (at least active standing), 1–3 (passive transfer from bed to chair or active sitting), and 0 (passive range of motion). We evaluated the association of early mobility and incident lower-limb deep-vein thrombosis and 90-day mortality by Cox proportional models adjusting for randomization and other co-variables.ResultsOf 1708 patients, only 85 (5.0%) had early mobility level 4–7 and 356 (20.8%) level 1–3, while 1267 (74.2%) had early mobility level 0. Patients with early mobility levels 4–7 and 1–3 had less illness severity, femoral central venous catheters, and organ support compared to patients with mobility level 0. Incident proximal lower-limb deep-vein thrombosis occurred in 1/85 (1.3%) patients in the early mobility 4–7 group, 7/348 (2.0%) patients in mobility 1–3 group, and 50/1230 (4.1%) patients in mobility 0 group. Compared with early mobility group 0, mobility groups 4–7 and 1–3 were not associated with differences in incident proximal lower-limb deep-vein thrombosis (adjusted hazard ratio [aHR] 1.19, 95% confidence interval [CI] 0.16, 8.90; p = 0.87 and 0.91, 95% CI 0.39, 2.12; p = 0.83, respectively). However, early mobility groups 4–7 and 1–3 had lower 90-day mortality (aHR 0.47, 95% CI 0.22, 1.01; p = 0.052, and 0.43, 95% CI 0.30, 0.62; p < 0.0001, respectively).ConclusionsOnly a small proportion of critically ill patients with an expected ICU stay ≥ 72 h were mobilized early. Early mobility was associated with reduced mortality, but not with different incidence of deep-vein thrombosis. This association does not establish causality, and randomized controlled trials are required to assess whether and to what extent this association is modifiable.Trial registrationThe PREVENT trial is registered at ClinicalTrials.gov, ID: NCT02040103 (registered on 3 November 2013) and Current controlled trials, ID: ISRCTN44653506 (registered on 30 October 2013).

Intermittent pneumatic compression devices: time to reassess the evidence.

ANZ Journal of SurgeryEarly View PERSPECTIVE Intermittent pneumatic compression devices: time to reassess the evidence Natalie Lott MClinEpi, RN, Natalie Lott MClinEpi, RN orcid.org/0000-0001-5905-6357 Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia Hunter Surgical Clinical Research Unit, John Hunter Hospital, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Contribution: Conceptualization, Resources, Validation, Visualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorStephen Smith MS, PhD, Stephen Smith MS, PhD Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia Hunter Surgical Clinical Research Unit, John Hunter Hospital, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Department of Surgery, Calvary Mater Hospital, New South Wales, Newcastle, Australia Contribution: Conceptualization, Supervision, Validation, Visualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorJonathan Gani MBChB, MD, Jonathan Gani MBChB, MD orcid.org/0000-0003-0655-1877 Hunter Surgical Clinical Research Unit, John Hunter Hospital, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Contribution: Supervision, Validation, Visualization, Writing - review & editingSearch for more papers by this authorPenny Reeves BEc, PhD, Penny Reeves BEc, PhD School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Health Economics, Hunter Medical and Research Institute, Newcastle, New South Wales, Australia Contribution: Supervision, Validation, Visualization, Writing - review & editingSearch for more papers by this author Natalie Lott MClinEpi, RN, Natalie Lott MClinEpi, RN orcid.org/0000-0001-5905-6357 Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia Hunter Surgical Clinical Research Unit, John Hunter Hospital, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Contribution: Conceptualization, Resources, Validation, Visualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorStephen Smith MS, PhD, Stephen Smith MS, PhD Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia Hunter Surgical Clinical Research Unit, John Hunter Hospital, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Department of Surgery, Calvary Mater Hospital, New South Wales, Newcastle, Australia Contribution: Conceptualization, Supervision, Validation, Visualization, Writing - original draft, Writing - review & editingSearch for more papers by this authorJonathan Gani MBChB, MD, Jonathan Gani MBChB, MD orcid.org/0000-0003-0655-1877 Hunter Surgical Clinical Research Unit, John Hunter Hospital, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Contribution: Supervision, Validation, Visualization, Writing - review & editingSearch for more papers by this authorPenny Reeves BEc, PhD, Penny Reeves BEc, PhD School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Health Economics, Hunter Medical and Research Institute, Newcastle, New South Wales, Australia Contribution: Supervision, Validation, Visualization, Writing - review & editingSearch for more papers by this author First published: 27 February 2023 https://doi.org/10.1111/ans.18342Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Systematic review and meta-analysis of preoperative interventions to support the maturation of arteriovenous fistulae in patients with advanced kidney disease.

There is great potential to improve outcomes of arteriovenous fistulas (AVFs) by focusing more on the preoperative period of AVF creation. We aim to systematically review the evidence on safety and efficacy of various preoperative interventions that have been tried to improve AVF maturation and success rate. We searched five databases: PubMed, Embase, CINAHL, Cochrane Library and King's Fund Library. Experimental studies that investigated the effect of various preoperative interventions to improve AVF outcomes among advanced chronic kidney disease (CKD) patients were searched. The effect size for primary outcome was calculated as the weighted mean difference in the final vessel calibre, rate of AVF maturation or primary failure between the intervention and control arm. We also assessed adverse effects and dropout rates. This review was preregistered in the International Prospective Register of Systematic Reviews (CRD42020193257). Eight eligible studies were identified involving three types of intervention: hand exercise (n=6), cholecalciferol supplementation (n=1) and pneumatic compression of the arm using a Fist Assist device (n=1). The overall effect size of hand exercise on distal cephalic vein calibre was 0.24mm [95% confidence interval (CI) 0.03-0.45] on meta-analysis of hand exercise studies. On restricting analysis to two randomized controlled trials (RCTs) that had independent control groups, the effect size was higher, at 0.29mm (95% CI 0.11-0.47). Hand exercise was a well-tolerated intervention, especially when confined to the first 4weeks. Hand exercise is the predominant intervention tried in the preoperative period of AVF creation, although there is methodological heterogeneity. Intermittent pneumatic compression using a Fist Assist device is a novel intervention that has shown some promise. Well-designed prospective RCTs are needed on preoperative interventions among advanced CKD patients, aimed at improving AVF outcomes.

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

AUGS-IUGA Joint Clinical Consensus Statement on Enhanced Recovery After Urogynecologic Surgery

EXTERNAL PNEUMATIC COMPRESSION FOR PREOPERATIVE MANAGEMENT OF SWELLING FOR ANKLE FRACTURES: A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Patients awaiting resolution of swelling and oedema prior to ankle surgery can represent a significant burden on hospital beds. Our study assessed whether external pneumatic intermittent compression (EPIC) can reduce delays to surgery.Our prospective randomised controlled trial (n= 20) compared outcomes of patients treated with EPIC vs control group managed with ice and elevation. Included were patients aged &lt;18 years with isolated closed ankle fractures admitted for management of swelling prior to surgery. Excluded were open fractures, injuries to contralateral leg, diabetes, absent pulses, peripheral vascular disease, inability to consent, no requirement for admission. Eligible patients were randomised to active or control arms. All patients were managed initially with reduction and back slab application. Patients in active arm fitted with EPIC (Hydroven 3000) device over the back slab. Assessment by treating team determined the time at which patient is assessed ready for surgery.Patients in the treatment arm were assessed as ready for surgery sooner, (123 hrs vs 168hrs, T score = 1.925, P 0.035) and had a shorter time to surgery (167 hrs vs 216 hrs, T score = 1.748, P 0.047) Length of stay was reduced bud did not reach statistical significance. (259 hrs vs 269 hrs, T score 0.229, P 0.41)Our results showed a statistically and clinically significant reduction in time that patients were assessed ready for surgery and time to surgery in the treatment cohort. We conclude that although further data is needed to achieve an adequately powered study and assess the safety profile of the EPIC, incorporation of EPIC into routine clinical practice has the potential for significant cost savings.

Feasibility study of percutaneous thoracic duct embolization with lower-limb intermittent pneumatic compression devices

To demonstrate intranodal thoracic duct embolization (TDE) for treating chyle leaks following thoracic surgery and the feasibility of applying lower-limb intermittent pneumatic compression devices during TDE. Between December 2017 and October 2020, 12 consecutive TDEs for post-operative chyle leaks were performed in 11 patients using intranodal lymphangiogram (IL) with an intermittent pneumatic compressive device applied to the lower limb. The procedure's duration, technical/clinical success, and complications were retrospectively evaluated. IL was successful at imaging the thoracic duct in all procedures (100%), and TDE had an intention- to-treat success rate of 92% (11/12). No related complications were observed during follow-up, which took place at a mean of 27 days. The time from the commencement of lymphangiogram until visualization of the thoracic duct was a mean of 21.6 min, and the mean overall procedure time was 87.3 min. This study supports IL-guided TDE as a safe and effective option to treat post-thoracic surgery chyle leaks. We revealed shorter lymphangiogram times compared with previously published studies, and we postulate that the application of intermittent lower-limb pneumatic compressive devices contributed toward this study's results by expediting the return of lymph from the lower limb. This study is the first to illustrate this approach in TDE and advocates for randomized controlled studies to further evaluate the influence of intermittent pneumatic compressive devices on the procedure.

Influence of postoperative D-Dimere Evaluation and intraoperative use of Intermittent Pneumatic Vein Compression (IPC) on Detection and Development of perioperative Venous Thromboembolism in Craniotomy Patients

Influence of postoperative D-Dimere Evaluation and intraoperative use of Intermittent Pneumatic Vein Compression (IPC) on Detection and Development of perioperative Venous Thromboembolism in Craniotomy Patients

ПЕРСПЕКТИВИ ПЕРЕМІЖНОЇ ПНЕВМАТИЧНОЇ КОМПРЕСІЇ ЯК НЕЙРОТРОПНОЇ ТЕРАПІЇ

Prospects of intermittent pneumatic compression as a neurotropic therapy: ISSN 2223-6775 Ukrainian journal of occupational health Vol.18, No 4, 2022https://doi.org/10.33573/ujoh2022.04.297 Prospects of intermittent pneumatic compression as a neurotropic therapy D.V. ZaitsevShupyk National Healthcare University of Ukraine Full

Comparative Analysis of Methods of Laser Doppler Flowmetry and Doppler Ultrasound Measurement of Blood Flow during the Procedure of Intermittent Pneumatic Compression

The results of the analysis of microcirculation of the blood flow of the toe and ultrasound Doppler measurement of blood flow in the femoral artery during the intermittent pneumatic compression procedure are presented. A professional device “Doctor Life Mark 400” (South Korea) was used for the pressotherapy procedure. Microcirculation was measured using a portable laser Doppler flowmeter “LAZMA PF” (Russia). Ultrasonic Dopplerograms were obtained using the device “Edan U50” (China) with a linear sensor model L15-7b with a frequency in pulsed Doppler mode (PW) 7.2 MHz. The study involved a group of 11 subjects without identified vascular disorders, the age of the group was from 23 to 42 years. The method of calculating the average speed and volume of blood flow over the period of the cardiac cycle was used for ultrasound Dopplerograms. Arterial resistance was evaluated, which was compared with the dynamics of perfusion in the limb. In the studies, approximately half of the test subjects had an increase in perfusion of the microcirculatory bed and a decrease in resistance of arterial vessels. At the same time, with an increase in the perfusion of the microcirculatory bed, a decrease in the resistance of arterial vessels was observed.

EE414 Cost-Effectiveness of Mobile Intermittent Pneumatic Compression Devices (IPCD) Compared to Traditional IPCD for Early Postoperative Total Knee Replacement: The Hospital’s Perspectives

EE414 Cost-Effectiveness of Mobile Intermittent Pneumatic Compression Devices (IPCD) Compared to Traditional IPCD for Early Postoperative Total Knee Replacement: The Hospital’s Perspectives

Comparison of intermittent pneumatic compression device and compression stockings for workers with leg edema and pain after prolonged standing: a prospective crossover clinical trial

BackgroundDuring prolonged standing, insufficient calf muscle pumping accompanies venous stasis and hypertension in the lower legs, resulting in valve dysfunction, venous wall problems, and sub-sequent inflammation. Compression therapy, which includes medical compression stockings (MCS) and mechanical intermittent pneumatic compression (IPC), is one of the most effective therapeutic interventions for treating chronic venous diseases. This study aimed to compare the therapeutic effect among resting, IPC and MCS alone, and IPC with MCS in long-standing workers (> 8 h daily).MethodsThis crossover trial was conducted with 39 participants with complaints of leg edema and pain whose work involved standing for more than 8 h daily. Four treatment protocols were established for each visit as follows: protocol A (not wear MCS during work and rest without IPC after work), protocol B (wear MCS during work and rest without IPC after work), protocol C (not wear MCS during work and treat with IPC after work), and protocol D (wear MCS during work and treat with IPC after work). The primary outcome was the visual analogue scale (VAS) score for leg pain. The secondary outcomes were leg volume (mL), circumference (cm), extracellular fluid/total body fluid (ECF/TBF), and extracellular water/total body water (ECW/TBW) through bioelectrical impedance analysis. Outcomes were assessed before work (T0), after work (T1), and 60 min after intervention (T2).ResultsAll four protocols had significantly increased leg pain after work (T0-1) but improved 60 min after intervention (T1-2), particularly protocol C (decreased VAS by 1.9). When leg swelling was compared at T0 and T1, protocols A and C showed significant increases in leg volume and circumference, indicating significant work-induced edema, whereas protocols B and D showed no change or even a decrease. After interventions, leg volume and circumference significantly decreased in protocols A and C, although protocols B and C did not show significant improvement. The ECF/TBF and ECW/TBW of all protocols decreased after interventions.ConclusionsLeg pain and edema after prolonged standing (T1-T2) in adults were safely and effectively improved by both IPC alone and IPC with MCS. Although the use of MCS during the workday did not show improvement in leg pain immediately after work (T0-T1), both MCS with resting and MCS with IPC decreased leg pain at T1-T2 and prevented leg edema at T0-T1.Trial registrationThis trial protocol was registered at the Clinical Research Information Service (KCT0005383, the date of first registration: 08/09/2020).

Effects of different intermittent pneumatic compression stimuli on ankle dorsiflexion range of motion.

Despite substantial evidence of the effectiveness of intermittent pneumatic compression (IPC) treatments for range of motion (ROM) improvement, little evidence is available regarding how different IPC stimuli affect ankle dorsiflexion (DF) ROM. This study aimed to investigate the effects of different IPC stimuli on the ankle DF ROM. Fourteen, university intermittent team sport male athletes (age: 21 ± 1 year, height: 1.74 ± 0.05 m, body mass: 70.9 ± 7.7 kg, body fat percentage: 14.2 ± 3.6%, body mass index: 23.5 ± 2.5kg/m2; mean ± standard deviation) completed four experimental trials in a random order: 1) no compression with wearing IPC devices (SHAM), 2) the sequential compression at approximately 80mmHg (SQUEE80), 3) the uniform compression at approximately 80mmHg (BOOST80), and 4) the uniform compression at approximately 135mmHg (BOOST135). For the experimental trials, the participants were initially at rest for 10min and then assigned to either a 30-min SHAM, SQUEE80, BOOST80, or BOOST135. Participants rested for 20min after IPC treatment. The Weight-Bearing Lunge Test (WBLT), popliteal artery blood flow, pressure-to-pain threshold (PPT), muscle hardness, heart rate variability, and perceived relaxation were measured before (Pre) and immediately after IPC treatment (Post-0) and 20min after IPC treatment (Post-20), and the changes in all variables from Pre (Δ) were calculated. ΔWBLT performance, ΔPPT, and Δperceived relaxation in all IPC treatments were significantly higher than those in SHAM at Post-0 and Post-20 (p < 0.05). ΔPopliteal artery blood flow in BOOST80 and BOOST135 was significantly higher than that in SHAM and SQUEE80 at Post-0 (p < 0.05). ΔMuscle hardness and Δheart rate variability did not differ significantly between trials. In conclusion, IPC treatments, irrespective of applied pressure and mode of compression, increased ankle DF ROM. This resulted from decreased pain sensitivity (i.e., increased PPT). In addition, high inflation pressure and frequency did not provide additional benefits in increasing ankle DF ROM.

Переміжна пневматична компресія у реабілітаційній та спортивній медицині

The purpose of the study was to characterize the clinical value of intermittent pneumatic compression in sports medicine according to the scientific literature. Materials and methods. The English-language publications refereed by the PubMed electronic database, by the keyword “intermittent pneumatic compression”, concerning sports achievements, physiology of athletes, sports rehabilitation and also the treatment of injuries were analyzed. Results and discussion. Hardware for intermittent pneumatic compression develops rapidly in sports rehabilitation, while a significant number of practitioners use intermittent pneumatic compression in combination with other means, which makes it difficult to assess its effectiveness. Traumatic risk is a reality of the professional activity of athletes. In several reviews of the literature, it was shown that the use of intermittent pneumatic compression after injuries can reduce thrombus formation, swelling and duration of preoperative preparation for fractures, reduce swelling and improve joint mobility after fractures, improve wound and fracture healing. During the rehabilitation period, intermittent pneumatic compression allows to reduce limb dysfunction after sprain, increase joint mobility, and enhance the effectiveness of occupational therapy measures. Conclusion. Skeletal muscles are undoubtedly the target organ of intermittent pneumatic compression, but the optimal parameters of exposure need to be clarified. During exercise, intermittent pneumatic compression improves vascular conductivity, and during the recovery period it reduces muscle proteolysis, increases blood flow and tissue oxygenation. Intermittent pneumatic compression does not appear to affect muscle strength and performance recovery. Intermittent pneumatic compression may help reduce delayed muscle pain syndrome, but the optimal conditions for such an effect need to be investigated. In trauma, in particular sprains and fractures, the use of intermittent pneumatic compression can reduce pain and the need for narcotic analgesics, especially in the early stages. The use of intermittent pneumatic compression can reduce swelling and shorten the duration of preoperative preparation for fractures, subsequently improving joint mobility, wound and fracture healing. After surgery or removal of immobilizers, intermittent pneumatic compression reduces swelling, improves limb function, and reduces hospital stay. When using intermittent pneumatic compression in work with athletes, the practitioner must also take into account its reparative, adaptive and other general effects. Intermittent pneumatic compression is a promising sports medicine tool, but the existing data are completely insufficient to make firm recommendations

Thromboprophylaxis with unilateral pneumatic device led to less edema and blood loss compared to enoxaparin after knee arthroplasty: randomized trial

BackgroundPharmacological and mechanical thromboprophylaxis are frequently used together after total knee arthroplasty (TKA). Most studies in this context compare anticoagulants versus a combination of these drugs with an intermittent pneumatic compression device (IPCD). However, there is uncertainty about the need for the combination of both and whether a unilateral IPCD would alone affect other important clinical outcomes: edema and blood loss. We compared the effects of enoxaparin versus unilateral portable IPCD after TKA on edema and blood loss. We hypothesised that unilateral IPCD would cause the same level of edema and the same blood loss as enoxaparin.MethodsIn this open, randomized trial (1:1), adults with no history of coagulation disorders, anticoagulant use, venous thromboembolism, liver or malignant diseases underwent TKA. For 10 days, participants received the IPCD, used 24 h/day on the operated leg from the end of surgery, or 40 mg of enoxaparin, starting 12 h after surgery. All underwent the same rehabilitation and were encouraged to walk on the same day of surgery. We measured edema (thigh, leg and ankle circumference) before and on the third postoperative day. Blood loss (volume accumulated in the suction drain and drop of hemoglobin and hematocrit in 48 h) was a secondary outcome.ResultsWe randomized 150 patients and lost 3 to follow-up with enoxaparin and 2 with IPCD. There was no case of symptomatic venous thromboembolism. Four patients needed transfusions (three receiving enoxaparin), one had infection and one hemarthrosis (both in the enoxaparin group). Leg circumference increased by approximately 2 cm for enoxaparin group and 1.5 cm in IPCD (p < 0.001). The increase in ankle circumference was about 1.5 cm in the enoxaparin group (p < 0.001), and almost zero in IPCD (p = 0.447). Enoxaparin group lost 566.1 ml (standard deviation, SD, 174.5) of blood in the first 48 h, versus 420.8 ml (SD 142.5) in the IPCD.ConclusionsExclusively mechanical prophylaxis after TKA with portable IPCD only on the operated leg reduces leg and ankle swelling and post-operative blood loss compared to exclusively pharmacological prophylaxis with enoxaparin. Portable devices that can prevent deep vein thrombosis and pulmonary embolism without increasing blood loss or other risks should be further investigated.Trial registrationREBEC RBR-8k2vpx. Registration date: 06/04/2019.

Optimisation of intermittent pneumatic compression in patients with lymphoedema of the legs

Intermittent pneumatic compression (IPC) has established itself as a cornerstone in the combined decongestive therapy (CDT) of leg oedema, however, there is little evidence on the degree of volume shifts. We performed continuous volume measurements during CDT to quantify volume shifts in a controlled trial. In addition, "wrapping/underpadding" and medical compression stockings were evaluated regarding decongestion and leg oedema, respectively. The volume reduction of CDT in patients with lymphoedema of the legs was measured. The additive decongesting effect of a padding surrounding the leg under the lymph cuff (IPC +) was evaluated. The efficacy of compression stockings in the maintenance phase was analysed. Volume reductions were observed on the thigh (2%) and lower leg (5%) utilising IPC. Further significant volume reduction of the thigh (6%, p < 0.001) and lower leg (8%, p = 0.002) was observed with IPC +. Considering the thigh volume, patients with thigh-length compression stockings in the maintenance phase showed a significantly less pronounced increase in volume than patients with below-knee compression stockings (98% vs. 101% after six weeks; p < 0.05). The additional padding of the leg during an IPC session induces significantly more pronounced volume reduction. Medical compression stockings help to prevent volume increase in the maintenance phase.

8778 Laparoscopic Low Anterior Resection of Endometriosis Pelvic Mass with Side-to-End Colorectal Anastomosis

<h3>Study Objective</h3> To perform resection of a recto-vaginal endometriosis mass and end-to-side bowel resection with minimally invasive surgery. <h3>Design</h3> Case study. <h3>Setting</h3> General endotracheal anesthesia. Foley catheter in place. Patient in modified lithotomy with both arms tucked, all pressure points padded and all extremities in neutral position. The patient received preoperative antibiotics and sequential compression devices were placed. The abdomen was prepped and draped in the usual sterile fashion. <h3>Patients or Participants</h3> Patient with endometriosis involving the rectum and vagina desiring minimally invasive surgery. <h3>Interventions</h3> Laparoscopic low anterior resection with side-to-end colorectal anastomosis, trachelectomy, bilateral oophorectomy, lysis of adhesion, flexible sigmoidoscopy, cystoscopy. <h3>Measurements and Main Results</h3> surgery performed without complications; patient recovery was uncomplicated. <h3>Conclusion</h3> We show in this surgical video the possibility to resect a recto-vaginal endometriosis mass and to perform end-to-side bowel resection using minimally invasive surgery without intra-operative or post-operative complications.

Efficacy of intermittent compression devices for thromboembolic prophylaxis in major abdominal surgery: a systematic review and meta-analysis.

The benefits of mechanical prophylaxis for the prevention of venous thromboembolism (VTE) in abdominal and pelvic surgery are uncertain, with different guidelines stating that graduated compression stockings (GCS) and intermittent pneumatic compression devices (IPCDs) can be used either alone or in combination. To review the efficacy of IPCDs in preventing VTE following abdominal and pelvic surgery. A systematic review was conducted, identifying relevant literature reporting clinical trials conducted in abdominopelvic surgery, comparing the effect of IPCDs alone or in combination with no prophylaxis, GCS and chemical prophylaxis. The review identified studies reported from 1966 to 2022 in Medline, Embase, PubMed and Cochrane databases for randomized controlled trials. Thirteen RCTs involving 1914 participants were identified. IPCDs were superior to placebo (OR VTE 0.39; 95% CI 0.20-0.76) but not superior to other forms of prophylaxis (OR 0.83; 95% CI 0.30-2.27) or to GCS alone (OR 0.9; 95% CI 0.24-3.36). The addition of IPCDs to GCS compared with GCS alone was beneficial (OR 0.45; 95% CI 0.23-0.91) as was the addition of IPCDs to standard perioperative chemoprophylaxis (OR 0.25; 95% CI 0.09-0.74). The overall quality and reliability of trials were low, with high risk of bias. IPCDs are more effective than placebo in reducing VTE rates but are not more effective than other forms of thrombo-prophylaxis (chemical or mechanical) following abdominal and pelvic surgery. There is poor quality evidence to suggest that they might have a role as additional prophylaxis when combined with GCS and chemical prophylaxis.

AAOS Management of Hip Fractures in Older Adults Evidence-based Clinical Practice Guideline.

AAOS Management of Hip Fractures in Older Adults Evidence-based Clinical Practice Guideline.

Efficacy of Cryo-compression on Shin Splints in Female Amateur Marathon Runners

Background: Medial tibial stress syndrome (MTSS) or Shin splints is exercise-induced lower leg pain along the distal posterior-medial aspect of tibia caused by repetitive loading stress during running and jumping. It is one of the most common lower leg sports injury. Cryotherapy is the most commonly used treatment during immediate care of athletic injuries and acute soft tissue injuries and is also included as part of RICE (rest, ice, compression and elevation). Cryotherapy is helpful in reducing swelling as well as it exerts analgesic effect. The external compression is also used during immediate care phase and it helps in decrease tissue temperature and prevent oedema formation. Cryotherapy in combination with intermittent pneumatic compression hypothetically help in reducing the physiologic effects of traumatic tissue damage which is based on the models of cryotherapy and static compression therapy. This study aims to establish the efficacy of cryo-compression on shin splints in female amateur marathon runners. Methods: A total 30 subjects diagnosed with shin splints were selected for study. Subjects received cryo-compression for reducing pain and swelling and exercises to strengthen the muscles. Each session was conducted for 45 minutes duration, 5 days per week for 4 weeks. Outcome measure used was Numerical Pain Rating Scale (NPRS), Goniometry for ROM and Manual muscle testing (MMT). Results: According to statistical analysis, the results of the study demonstrate that there was a significant effect of the use of cryo-compression on numerical pain rating scale (p&lt;0.0001), range of motion (ankle plantarflexion, dorsiflexion, eversion and inversion) (p&lt;0.0001), manual muscle testing – ankle plantarflexors (p=0.0028) and ankle dorsiflexors (p&lt;0.0001) during the pre and post intervention assessment. Conclusion: The conducted study shows that efficacy of cryo-compression on shin splints in female amateur marathon runners is very effective in reducing pain, increasing range of motion (ROM) and strength of muscles along with other treatment program. KEYWORDS: Cryo-compression, shin splints, numerical pain rating scale (NPRS), range of motion, ankle plantarflexion, ankle dorsiflexion, ankle eversion, ankle inversion, manual muscle testing, ankle plantarflexors, ankle dorsiflexors.