A prospective cohort study on the effectiveness of 3500 IU versus 5000 IU bemiparin in the prophylaxis of postoperative thrombotic events in obese patients undergoing orthopedic surgery.

BACKGROUND: Postoperative thromboses are among the most feared complications in orthopedic surgery as they may cause life-threatening conditions in otherwise highly successful procedures such as total joint replacement. Body weight is an important risk factor for thromboses and is used in algorithms to determine dosages in prophylaxis. However, weight patterns among orthopedic populations have changed considerably since the introduction of these algorithms, essentially shifting towards obesity. This study asks whether present-day obese patients would benefit from higher than usual dosages of bemiparin in the prophylaxis of postoperative thrombosis. PATIENTS AND METHODS: To detect at least a 5% difference in the incidence of clinically symptomatic thrombotic events with sufficient power, 750 patients were enrolled in the study and treated with 3,500 IU or 5,000 IU bemiparin. Differences in rates were modelled in a Poisson regression including as covariates the potential confounders severity of immobilization, sex, exact weight and age. RESULTS: Overall, 723 patients were followed for a total of 66.8 person-years and analyzed by intention-to-treat. The ratio of incidence rates in the two groups of patients was 0.35 (95% CI: 0.03-2.91), thus there was no evidence for a difference in rates between groups. There was, however, a borderline significant association between incidence rates and body weight. There were no complications resulting from the higher dosages of bemiparin. CONCLUSION: Both groups of treated patients showed low incidence rates of thromboses and we did not see a significant reduction of incidence rates with higher dosages of bemiparin in this population. However, there was weak evidence that higher dosages might prove beneficial if populations gain weight even further.

Long-term experience with Chiari's osteotomy.

UNLABELLED: Fifty-six years after the introduction of Chiari's pelvic osteotomy, we report the long-term function scores and radiographic grade of osteoarthritis in 66 patients with 80 pelvic osteotomies with a minimum followup time of 27 years (average, 32 years; range, 27-48 years). These 66 patients were those who could be contacted and who returned for a followup visit from among 450 patients operated between 1961 and 1981. Thirty-two hips (40%) in 28 patients had undergone a total joint arthroplasty after an average 26 years (range, 13-41 years). Forty-eight hips in 41 patients (60%) were not replaced, their Harris hip score being a median of 82 points (range, 37-100 points). For the 22 patients for whom we had complete radiographs the average preoperative CE angle was 11.6 degrees, 48.6 degrees (range, 31 degrees-82.8 degrees) immediately postoperatively, and 41.6 degrees (range, 13.7 degrees-90 degrees) at last followup . Despite a functional hip score in most patients retaining their native hip, the degree of osteoarthritis progressed at last followup. We observed a similar mean age at the time of osteotomy in patients converted to total hip arthroplasty and those retaining their native hip. Age at time of surgery was inversely correlated (r = -0.78) with the interval between the osteotomy and THA. In this select patient group we found good functional outcome in patients who underwent Chiari pelvic osteotomy, with a conversion rate of 40% to total hip arthroplasty a mean of 32 years after the procedure. LEVEL OF EVIDENCE: Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

Feasibility of life-supporting first-aid (LSFA) training as a mandatory subject in primary schools.

BACKGROUND: Life-supporting first-aid (LFSA) training in primary schools might prove a useful means of increasing cardiac arrest survival rates. We thus studied the feasibility of introducing first-aid training to 6-7-year old primary school children. METHODS AND RESULTS: During 1 week medical students and emergency physicians provided LSFA training to 47 first- and second-year pupils, including semi-automatic defibrillation. A course assessment was made using cartoon-style questionnaires for the pupils, video tapes of the training and telephone interviews with the children's parents. Prior to training, only eight pupils (17%) were able to place in the correct sequence a series of pictures illustrating the various stages of the procedure of semi-automatic defibrillation. After training that figure rose to 24 (51%). Using a semi-automatic defibrillator, excellent performances were recorded by video camera in eight pupils. Post-training telephone interviews were conducted with 34 parents (79%), 28 (82%) of whom now considered their children capable of reacting properly in an emergency situation. The children had been given stickers displaying the European Emergency Call Number 112 together with a set of brochures. In 25 cases (74%), the children applied the stickers to their parents phones at home. CONCLUSIONS: LSFA training is a feasible proposition for 6-7-year olds who might well be in a position to save the lives of cardiac-arrest victims. Future training sessions should determine the impact of repeat courses and the findings should be used to convince politicians and administrators of the need of LSFA training as a mandatory subject in schools.