Is routine postoperative chest x-ray necessary after fluoroscopic-guided subclavian central venous port placement?

BACKGROUND: Two uncommon but serious complications after subclavian central venous port (SCVP) placement are pneumothorax (PNX) and malposition of the catheter. Chest x-rays (CXR) are commonly obtained after SCVP placement to identify these complications, but their use is controversial. STUDY DESIGN: We performed a retrospective review of SCVP placements to establish the incidence of PNX or catheter malposition identified exclusively by postprocedure CXR. RESULTS: Between July 1, 2001, and June 30, 2006, 205 patients underwent elective SCVP placement. Although 4 patients (2%) sustained a PNX, none was identified by routine postprocedure CXR. Postprocedure clinical symptoms (3 to 72 hours later) prompted repeat CXR, which identified the PNX. Five patients (2.4%) had catheter malposition recognized by intraoperative fluoroscopy and corrected intraoperatively. No malpositioned catheters were identified on postprocedure CXR. CONCLUSIONS: In our study, incidence of PNX after SCVP placement was low, and PNX was not detected by intraoperative fluoroscopy or by routine postprocedure CXR. We conclude that the practice of routine postprocedure CXR after SCVP placement is not necessary and should be replaced with diagnostic chest radiography only if symptoms develop.

Does obesity influence lymph node harvest among patients undergoing colectomy for colon cancer?

Adequate lymph node harvest among patients undergoing colectomy for cancer is critical for staging and therapy. Obesity is prevalent in the American population. We investigated whether lymph node harvest was compromised in obese patients undergoing colectomy for cancer. Medical records of patients who had undergone colectomy for colon cancer were reviewed. We correlated the number of lymph nodes with body mass index (BMI) and compared the number of lymph nodes among patients with BMI less than 30 kg/m2 to those with BMI of 30 kg/m2 or greater ("obese"). Among all 191 patients, the correlation coefficient was 0.04 (P > 0.2). The mean number of nodes harvested from 122 nonobese patients was 12.4 +/- 6 and that for 69 obese patients 12.8 +/- 6 (P > 0.2). Among 130 patients undergoing right colectomy and 35 patients undergoing sigmoid colectomy, the correlation coefficients were 0.02 (P > 0.2) and 0.16 (P > 0.2), respectively. There was not a statistically significant difference in lymph node harvest between obese and nonobese patients (14.1 +/- 7 vs. 13.8 +/- 6, P > 0.2; and 11.8 +/- 6 vs. 8.6 +/- 5, P > 0.2), respectively. Obesity did not compromise the number of lymph nodes harvested from patients undergoing colectomy for colon cancer.

Cervical spine fractures in patients 65 years or older: a 3-year experience at a level I trauma center.

BACKGROUND: Cervical spine fractures in the elderly carry a mortality as high as 26%. We reviewed our experience to define the level of injury, prevalence of neurologic deficits, treatments employed, and the correlation between patients' pre- and posthospital residences. Also, we correlated the prevalence of advanced directives with length of stay. METHODS: We queried the data collected prospectively at an American College of Surgeons verified Level I hospital (National TRACS, American College of Surgeons) regarding patients aged 65 years or older presenting with cervical spine fractures (International Classification of Diseases-9 code 805.X) in calendar years 2000 through 2003. RESULTS: We identified 58 patients (ages 65-94). Mortality was 24%. Twelve patients had quadriplegia or paraplegia and seven of these patients died. Respiratory failure was the primary cause of death. Application of rigid collars and a halo brace were the most commonly employed therapies. Mortality rates for halo stabilization and rigid collar and halo stabilization were similar (23% vs. 29%). Despite having a higher mean Injury Severity Score, the 16 patients with advanced directives had an intensive care unit length of stay similar to that of patients without advanced directives but a statistically significant shorter overall length of stay (13 vs. 6.9 days). Eighteen of 45 patients living at home at the time of injury returned home. CONCLUSIONS: Cervical spine injury in the elderly does not inevitably relegate patients to a setting of more acute nursing care. The health and social factors that allowed many to return to living at home warrant investigation, as support of these factors may assist others with this injury.