Neurologic sequelae of penetrating cervical trauma.

STUDY DESIGN: Multicenter, retrospective chart analysis was performed using data housed in the trauma registries of 2 independent American College of Surgeons verified, Level I Trauma centers. The trauma registries were queried for all cases of penetrating cervical trauma. Abstracted data included age, sex, race, mechanism of injury, Glasgow Coma Scale (GCS) level on arrival, neurologic findings on arrival, zone of injury, associated injuries, imaging studies and results, operations performed, neurologic sequelae, disposition from the hospital and the presence or absence of neurologic injury, cervical spine fracture, and cervical spine immobilization. OBJECTIVE: The purpose of this study was to determine the relationship between cervical spine immobilization and neurologic sequelae in penetrating cervical trauma. SUMMARY OF BACKGROUND DATA: Current recommendations for cervical spine immobilization in penetrating cervical trauma developed by empiric extension of blunt trauma protocols without evidentiary support. No evidence exists to support cervical spine immobilization as a means of preventing neurologic injury progression in cases of penetrating cervical injury. METHODS: Abstracted data were organized, entered into a database, and compared statistically. Significance was accepted for P<0.05. RESULTS: A total of 196 patient charts formed the study cohort. Neurologic injuries either improved or remained static. No patient could be determined to have benefited from cervical spine immobilization in this study as the only 2 patients presenting with unstable cervical spine fractures were completely neurologically devastated at the time of injury. Prehospital cervical spine immobilization may have negatively affected patients with vascular and airway injuries. Decreased cervical spine immobilization rates at one institution did not affect neurologic outcome. CONCLUSION: Cervical spine immobilization does not appear to prevent progression of neurologic injury in cases of penetrating cervical trauma. Comorbid penetrating injuries may be negatively impacted by prehospital cervical spine immobilization.

Efficacy of prophylactic inferior vena cava filter placement in bariatric surgery.

BACKGROUND: To determine whether prophylactic placement of an inferior vena cava (IVC) filter in bariatric patients deemed to be at high risk is effective in reducing their risk of pulmonary embolism. The study was performed at a bariatric center in a community hospital. METHODS: This was a retrospective study of all patients in the Hurley Bariatric Center database who had undergone surgery from April 2000 to June 2006. We compared the incidence of deep venous thrombosis (DVT), pulmonary embolism (PE), and all-cause perioperative mortality in patients who received prophylactic IVC filters and those who did not. Patients received prophylactic filters for risk factors identified in their preoperative evaluation. The charts and electronic medical records were reviewed retrospectively for any DVTs, PEs, and deaths within 30 days. RESULTS: A total of 1851 patients were identified as low risk and did not receive an IVC filter. Among these patients, 12 DVTs, 11 PEs, and 4 deaths occurred. Of the 248 high-risk patients who received IVC filters, 3 DVTs, 2 PEs, and 2 deaths occurred. The difference in the rates of PE was not significant (P = 0.69). CONCLUSION: The incidence of PE in the high-risk group was not significantly different from that of the low-risk group. Thus, the use of prophylactic IVC filters reduces the risk of PE in high-risk patients, a group known to have a much greater incidence of morbidity and mortality, to a rate comparable to the baseline risk of a low-risk group. Additional study is necessary to better define the risk groups.

Practice patterns and outcomes of retrievable vena cava filters in trauma patients: an AAST multicenter study.

BACKGROUND: The purpose of this study is to describe practice patterns and outcomes of posttraumatic retrievable inferior vena caval filters (R-IVCF). METHODS: A retrospective review of R-IVCFs placed during 2004 at 21 participating centers with follow up to July 1, 2005 was performed. Primary outcomes included major complications (migration, pulmonary embolism [PE], and symptomatic caval occlusion) and reasons for failure to retrieve. RESULTS: Of 446 patients (69% male, 92% blunt trauma) receiving R-IVCFs, 76% for prophylactic indications and 79% were placed by interventional radiology. Excluding 33 deaths, 152 were Gunter-Tulip (G-T), 224 Recovery (R), and 37 Optease (Opt). Placement occurred 6 +/- 8 days after admission and retrieval at 50 +/- 61 days. Follow up after discharge (5.7 +/- 4.3 months) was reported in 51%. Only 22% of R-IVCFs were retrieved. Of 115 patients in whom retrieval was attempted, retrieval failed as a result of technical issues in 15 patients (10% of G-T, 14% of R, 27% of Opt) and because of significant residual thrombus within the filter in 10 patients (6% of G-T, 4% of R, 46% Opt). The primary reason R-IVCFs were not removed was because of loss to follow up (31%), which was sixfold higher (6% to 44%, p = 0.001) when the service placing the R-IVCF was not directly responsible for follow up. Complications did not correlate with mechanism, injury severity, service placing the R-IVCF, trauma volume, use of anticoagulation, age, or sex. Three cases of migration were recorded (all among R, 1.3%), two breakthrough PE (G-T 0.6% and R 0.4%) and six symptomatic caval occlusions (G-T 0, R 1%, Opt 11%) (p < 0.05 Opt versus both G-T and R). CONCLUSION: Most R-IVCFs are not retrieved. The service placing the R-IVCF should be responsible for follow up. The Optease was associated with the greatest incidence of residual thrombus and symptomatic caval occlusion. The practice patterns of R-IVCF placement and retrieval should be re-examined.

Open Roux-en-Y gastric bypass in 925 patients without mortality.

BACKGROUND: Open Roux-en-Y gastric bypass has become the gold standard for bariatric surgery. Safety has always been a concern with this elective surgery, especially among the general public. With increasing numbers of bariatric surgeries being performed, the public eye is once again focused on safety and outcomes for these patients. METHODS: Nine hundred twenty-five consecutive open Roux-en-Y gastric bypass patients were reviewed. Charts were retrospectively reviewed for early complications, late complications, and resolution of medical comorbidities. RESULTS: There were no deaths in this study group. The average body mass index (BMI) was 51. Eight leaks at the anastomosis occurred with no reoperations. Hypertension resolved in 70% and diabetes mellitus resolved in 58% of patients. CONCLUSIONS: Open Roux-en-Y gastric bypass is a safe operation, even with increasing numbers of surgeries being performed. Major complications are low and improvement of medical comorbidities is significant. A multidisciplinary team approach helps to improve care and clinical outcomes.