ABSTRACT
BACKGROUND: Venous thromboembolism (VTE), including Portomesenteric vein thrombosis (PMVT), is a major complication of sleeve gastrectomy (SG). We changed our practice in July 2021 to routinely discharge all SG patients postoperatively with extended chemoprophylaxis for 30 days. OBJECTIVES: Evaluate the efficacy and safety of routine extended chemoprophylaxis compared to 2 prior timeframes using selective extended chemoprophylaxis. SETTING: University Hospital. METHODS: Between 2012-2018, SG patients were discharged on extended chemoprophylaxis for patients deemed "high-risk" for VTE, including patients with body mass index (BMI) >50, and previous VTE. Between 2018-2021, extended chemoprophylaxis was broadened to include patients with positive preoperative thrombophilia panels (including Factor VIII). After 2021, all SG were routinely discharged on extended chemoprophylaxis. The typical regimen was 30 days Lovenox BID (40-mg twice daily for BMI> 40, 60-mg twice daily for BMI >60). Outcomes evaluated were rate of VTE/PMVT and postoperative bleed, including delayed bleed. RESULTS: A total of 8864 patients underwent SG. Average age and BMI were 37.5 years and 43.0 kg/m2, respectively. The overall incidence of PMVT was 33/8864 (.37%). Converting from selective extended chemoprophylaxis (Group 1) to routine extended chemoprophylaxis (Group 3) decreased the rate of PMVT from .55% to .21% (P = .13). There was a significantly higher overall bleeding rate (.85%), including delayed bleeds (.34%) in the routine extended chemoprophylaxis patients (P < .05). These bleeds were mainly managed nonoperatively. CONCLUSIONS: Routine extended (30 day) chemoprophylaxis for all SG may reduce PMVT rate but lead to a higher bleeding rate post-operatively. The vast majority of the increased bleeds are delayed and can be managed non-operatively.
Subject(s)
Chemoprevention , Gastrectomy , Laparoscopy , Portal Vein , Postoperative Complications , Venous Thrombosis , Humans , Female , Male , Gastrectomy/adverse effects , Gastrectomy/methods , Adult , Middle Aged , Laparoscopy/adverse effects , Venous Thrombosis/prevention & control , Venous Thrombosis/etiology , Chemoprevention/methods , Postoperative Complications/prevention & control , Postoperative Complications/etiology , Mesenteric Veins , Rivaroxaban/administration & dosage , Obesity, Morbid/surgery , Venous Thromboembolism/prevention & control , Venous Thromboembolism/etiology , Retrospective Studies , Anticoagulants/administration & dosage , Anticoagulants/therapeutic use , Postoperative Hemorrhage/prevention & control , Postoperative Hemorrhage/etiologyABSTRACT
The study examined public perception of Nigeria Center of Disease Control's (NCDC) radio campaign messages in managing the Covid-19 pandemic in three selected states in the south-western part of the country. A survey research design was adopted with a questionnaire as a data collection instrument. A sample size of 400 respondents was chosen through the multistage approach. The study revealed that the residents in selected states in South-Western Nigeria reported exposure to radio campaign messages on COVID-19 preventive measures and perceived that the messages influenced the awareness and adoption of COVID-19 preventive measures. It was recommended that behavioral change communication experts and public health officers at all levels should leverage the reliability and spread of radio among the populace to disseminate public health issues.
