Postoperative venous thromboembolism and mortality in patients with pancreatic surgery.

BACKGROUND AND OBJECTIVES: Pancreatic cancer is strongly associated with thrombosis. We investigated early postoperative venous thromboembolism (PVTE) mortality among patients with pancreatic surgery and compared outcomes in adenocarcinoma pancreatic cancer (ACPC) to non-adenocarcinoma pancreatic neoplasm (NACPN). METHODS: We analyzed a prospectively collected database of patients who underwent pancreatic cancer or neoplasm-related surgery. As NACPN is underrepresented in other studies, we selected NACPN patients and a random sample of ACPC patients. PVTE was defined as VTE occurring within 3 months of surgical intervention. Statistical analysis was performed using Cox proportional hazards regression. RESULTS: A total of 441 pancreatic surgery patients were included, with 331 ACPC and 110 NACPN. Median follow-up was 449 days during which 90 (20.4%) patients developed VTE. PVTE occurred in 53 (12.0%) patients, including 41 (12.4%) ACPC patients and 12 (10.9%) NACPN patients. Those with PVTE had 60% higher mortality rate. A multivariable analysis found that PVTE is an independent predictor of increased mortality (HR Adj, 1.6; 95% CI, 1.1-2.2; P < .01). The mortality impact was not consistent between ACPC (HR, 3.2; 95% CI, 1.3-7.9) and NACPN groups (HR, 1.3; 95% CI, 0.9-1.8). CONCLUSIONS: Postoperative venous thromboembolism is an independent predictor of increased mortality in pancreatic surgery, specifically in adenocarcinoma pancreatic cancer surgery.

Training Pulmonary Critical Care Medicine Fellows in Thoracentesis Using a Head-Mounted Video Camera.

BACKGROUND: Determination of competence to perform procedures during pulmonary critical care medicine fellowship training has traditionally been based on subjective faculty opinion and numerical requirements. OBJECTIVE: To describe an objective means of assessing competence of fellows to perform thoracentesis using a head-mounted video camera with offline scoring of the thoracentesis performed on an actual patient. METHODS: To test competence in performance of thoracentesis after a multimodality training program, a total of eight first-year fellows performed a thoracentesis on an actual patient while recording the procedure with a lightweight head-mounted video camera in 2017 and 2018. The recordings were scored offline by two faculty members using a 30-point checklist. The percentage agreement between scorers was measured, as was the opinion of the fellows and the scorers on the testing process. If a fellow failed completion of all checklist items, they were provided with further training and retested to assure competence. As part of their training, fellows reviewed the video record of their procedures. RESULTS: Eight first-year fellows were tested, of whom seven successfully completed key checklist items as determined by the video scorers. One failing fellow passed after further training and testing. The percentage agreement between the scorers was high, and fellows indicated that the video device was useful for training. CONCLUSION: This study supports the use of video-based testing for assessment of competence and for training in performance of thoracentesis by fellows.