ABSTRACT
BACKGROUND AND OBJECTIVES: Venous thromboembolism (VTE) remains a major cause of perioperative morbidity and mortality despite implementation of prophylaxis guidelines. We sought to identify risk factors for occult deep venous thrombosis (DVT) following abdominal surgery for cancer and measure the clinical impact of a prospectively implemented standardized postoperative DVT screening protocol. METHODS: Patients undergoing abdominal surgery for malignant indication were screened with early postoperative lower extremity duplex to identify DVT. Clinical and pathologic factors associated with DVT were identified. RESULTS: Among 255 patients meeting study criteria, 25 (9.8%) had occult lower extremity DVT on routine postoperative screening. Prior history of VTE and lower preoperative hemoglobin were independently associated with DVT (OR, 9.05; P = 0.004; and OR, 1.27; P = 0.025, respectively). Preoperative chemotherapy within 1 year and thrombocytopenia were associated with DVT in univariate analyses only. Five patients developed postoperative pulmonary emboli (2.0%); three following negative duplex and two following positive duplex for distal DVT for which the patients were not therapeutically anticoagulated due to a contraindication. There were no pulmonary emboli in duplex-positive patients who were anticoagulated or who had vena cava filter placed. CONCLUSION: Despite prophylaxis, the prevalence of occult DVT in abdominal oncologic surgery patients is considerable. Postoperative screening duplex can identify these events to guide management.
Subject(s)
Abdominal Neoplasms/surgery , Health Plan Implementation , Mass Screening/standards , Postoperative Complications , Surgical Procedures, Operative/adverse effects , Venous Thrombosis/diagnosis , Abdominal Neoplasms/pathology , Aged , Female , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Philadelphia/epidemiology , Prognosis , Prospective Studies , Venous Thrombosis/epidemiology , Venous Thrombosis/etiologyABSTRACT
BACKGROUND: No consensus exists on whether patient-provider race, gender, and language concordance provides benefits to surgical patients. We report a systematic review of the association between patient-provider concordance and patient preferences and outcomes in surgery. METHODS: A systematic review of the literature was performed in Medline and PubMed using defined search terms to identify studies related to patient-provider concordance in surgical patients. We included studies with full manuscripts published in English within the United States (1998 to July 2018). RESULTS: Out of 253 titles screened, 16 studies met inclusion criteria. Five studies had level 4 evidence and 11 studies had level 3 evidence. The majority of patients preferred providers with a similar background (n = 4/6). Race, gender, and language-concordance had no effect on adherence to provider recommendations (n = 3/3). No effect of race concordance on the quality of care was seen (n = 2/3). Gender concordance was associated with improved quality of care (n = 2/3). There were mixed effects of concordance on the effectiveness of communication (n = 2). CONCLUSION: Few studies examine patient-provider concordance. Most patients prioritize culturally, technically, and clinically competent providers over concordance. Future research is needed regarding the influence of concordance on patient outcomes in surgery within specific patient populations and clinical settings.