Use Of Perioperative Prophylaxis Research Articles

Acute vena cava thrombosis after placement of retrievable inferior vena cava filter before laparoscopic gastric bypass

Roux-en-Y gastric bypass has been established as an effective safe surgical procedure for morbid obesity. The overall mortality rate is low at ≤1% in many series, in which pulmonary embolism and anastomostic leak are the number 1 and 2 causes of death [1,2]. Despite widespread use of perioperative prophylaxis for venous thromboembolism (VTE) with sequential compression devices, antiembolic stockings, anticoagulation, and early ambulation, the incidence of symptomatic pulmonary embolism remains at 0.3–2.4% [1,3].

Low-Dose-Heparin versus niedermolekulares Heparin zur Thromboseprophylaxe in der operativen gynäkologischen Onkologie

In a prospective double-blind randomised study the efficacy and safety of a low mo-lecular Weight Heparin in Gynaecological Oncology: In a prospective double-blind randomised study the efficacy and safety of a low molecular weight heparin (LMWH) and unfractionated heparin (UFH) were compared in the use of perioperative prophylaxis for thrombosis in gynaecological patients undergoing major gynaecological cancer surgery. Three hundred and thirty patients were randomly allocated to the two prophylactic groups; 6 of these were dropouts of the study. Of the remaining 324 patients 160 received 3000 IU of low molecular weight heparin and 164 received subcutaneously 5000 IU unfractionated heparin 3 times a day (low dose heparin). Treatment was initiated 2 h preoperatively and continued for 7 days. The occurrence of deep vein thrombosis (DVT) was determind by impedance plethysmography (IPG) and phlebography. DVT was diagnosed in 10 of 160 patients (6.3%) treated with low molecular weight heparin and in 10 of 164 patients (6.1%) treated with low-dose heparin. DVT of proximal veins (including poplitea area) was detected in 4 patients of the LMWH group and in seven patients of the UFH group. During the observation (until 10 th postoperative day) 7 pulmonary embolism - 1 fatal and 6 unfatal - occurred in patients receiving prophylaxis with LMWH and 4 pulmonary embolisms (all unfatal) occurred in the UFH group. The incidence of wound haematoma (p = 0.01) and blood transfusions (p=0.0005) were statistically significantly increased in the UFH group. The results of this trial demon- strate that the low molecular weight heparin is as effective and safe as low dose heparin preventing DVT, but the incidences of bleeding complications were higher in the group with unfractionated heparin.

Clostridium difficile Disease in a Department of Surgery

A clustering of Clostridium difficile-associated disease in a department of surgery prompted a program of infection control and the evaluation of contributing factors. Fifty patients had diarrhea and positive assays for C difficile cytotoxin during the study period. Twenty-one of the 36 cases that developed among patients admitted to the surgical services occurred on two adjacent general surgery wards that shared attending surgeons and house staff. Perioperative prophylactic antibiotics predated C difficile-associated disease in 20 patients, 12 of whom had short courses (less than 24 hours). Symptoms were typically nonspecific and early diagnosis may be difficult. Incidence remained high, despite infection control measures, until the coincidental closure of two surgical wards. Clostridium difficile-associated disease is a nosocomial infection that can be associated with short courses of prophylactic antibiotics. Recommendations regarding the use of perioperative prophylaxis should recognize C difficile-associated disease as a significant potential complication.