RESUMEN
BACKGROUND: Bleeding and venous thromboembolic disease are considered important sources of postoperative morbidity and mortality. Clinically, treatment of these 2 disorders is often competing. We sought to better understand the relative contributions of bleeding and venous thromboembolic disease to postoperative attributable mortality in a national cohort. METHODS: A retrospective analysis of the 2006-2017 American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database was performed to assess the adjusted odds ratio and attributable mortality for postoperative bleeding and venous thromboembolism, adjusted by year. RESULTS: After adjustment for confounding variables, bleeding exhibited a high postoperative attributable mortality in every year studied. Venous thromboembolism appeared to contribute minimal attributable mortality. CONCLUSIONS: Bleeding complications are a consistent source of attributable mortality in surgical patients, while the contribution of venous thromboembolic disease appears to be minimal in this analysis. Further studies are warranted to better understand the etiology of this disparity.
Asunto(s)
Hemorragia Posoperatoria/mortalidad , Mejoramiento de la Calidad/tendencias , Tromboembolia Venosa/mortalidad , Adulto , Anciano , Bases de Datos Factuales/tendencias , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/mortalidad , Hemorragia Posoperatoria/diagnóstico , Estudios Prospectivos , Estudios Retrospectivos , Tromboembolia Venosa/diagnósticoAsunto(s)
Ácido Láctico , Insuficiencia Multiorgánica , Humanos , Hiperglucemia , Heridas no PenetrantesRESUMEN
Acute lower extremity ischemia from septic emboli is a surgical emergency. Timely diagnosis and management are critical to improve patient outcome. However, traditional diagnostic modalities such as intraoperative angiogram are time-consuming, require special equipment and personnel, and introduce contrast exposure for critically ill patients. There are limited reports of utilization of point-of-care ultrasound to detect peripheral septic emboli. We present a case where femoral occlusive septic emboli were identified by point-of-care ultrasound after mitral valve replacement. This facilitated early surgical embolectomy and limb salvage. We suggest that perioperative point-of-care ultrasonography should be used as a first-line screening test in patients with acute lower extremity ischemia.