Adherence to Inpatient Venous Thromboembolism Prophylaxis: A Single Institution's Concurrent Review.

Hospital-acquired venous thromboembolism (VTE) affects morbidity and mortality and increases health care costs. Poor adherence to recommended prophylaxis may be a potential cause of ongoing events. This study aims to identify institutional adherence rates and barriers to optimal VTE prophylaxis. The authors performed patient and nurse interviews and a concurrent review of clinical documentation, utilizing a cloud-based, HIPAA-compliant tool, on a convenience sample of hospitalized patients. Adherence and agreement between different assessment modalities were calculated. Seventy-six patients consented for participation. Nurse documented adherence was 66% (29/44), 44% (27/61), and 89% (50/56) for mechanical, ambulatory, and chemoprophylactic prophylaxis, respectively. Patient report and nurse documentation showed moderate agreement for mechanical and no agreement for ambulatory adherence (κ = 0.51 and 0.07, respectively). Concurrent review using a cloud-based tool can provide robust, timely, and relevant information on adherence to recommended VTE prophylaxis. Iterative concurrent reviews can guide efforts to improve adherence and reduce rates of hospital-acquired VTE.

René Gerónimo Favaloro (1923-2000): A Man Who Struggled with Matters of the Heart.

René Gerónimo Favaloro prided himself on being a "simple country doctor." Born in La Plata, Argentina, Dr. Favaloro had an interest in Argentina's sociopolitical and healthcare systems beginning at a young age. He began his medical education at La Universidad Nacional de La Plata, graduating in 1949 with plans to continue his medical education in the field of surgery; however, in 1950, Dr. Favaloro temporarily resigned from his position as a surgeon to work as a country doctor in a small province of La Pampa, Argentina. It was during this time that Dr. Favaloro became acutely aware of the overwhelmingly poor state of the healthcare system in Argentina. In 1962, Dr. Favaloro redirected his focus back to his surgical interests and moved to the United States to work at the Cleveland Clinic, where he discovered the use of the saphenous vein graft for revascularization of the coronary arteries. Despite a productive medical career in the United States, Dr. Favaloro eventually brought his work back to Argentina, where his heart had always remained. Throughout the incredible milestones of his life, Dr. René Gerónimo Favaloro consistently remained a humble, gracious, and simple country doctor.

Outcomes in Children Undergoing Surgery for Congenital Pulmonary Airway Malformations in the First Year of Life.

BACKGROUND: Treatment of congenital pulmonary airway malformations (CPAMs) is generally surgical resection; however, there is controversy regarding the optimal timing of surgical intervention, especially in asymptomatic patients. STUDY DESIGN: Using the American College of Surgeons National Surgical Quality Improvement Program-Pediatric Participant Use Files from 2012 to 2015, children who underwent lung resection for CPAMs were identified. Outcomes in children who underwent lung resection during the neonatal period were compared with those who underwent resection beyond the neonatal period, but during the first year of life (non-neonates). RESULTS: A total of 541 patients (20.7% neonates and 79.3% non-neonates) were identified. Neonates had higher rates of preoperative comorbidities and worse postoperative outcomes when compared with non-neonates (morbidity 19.6% vs 5.4%, p < 0.0001). On multivariable regression analysis, the presence of preoperative symptoms (defined as oxygen dependence or ventilatory support) was independently associated with increased morbidity (odds ratio 3.91 [range 1.6 to 9.57], p = 0.003). In a subgroup analysis of asymptomatic neonates compared with asymptomatic non-neonates, there was no difference in overall morbidity (7.4% vs 4.4%, p = 0.33). CONCLUSIONS: These data suggest that lung resection for CPAMs in the neonatal period in asymptomatic children are not associated with increased 30-day morbidity. The presence of preoperative symptoms was independently associated with increased morbidity in a multivariable regression model. More data are needed to better understand the long-term outcomes and better define the optimal timing of surgery in this patient population.

Predicting the Risk of Postoperative Respiratory Failure in Elective Abdominal and Vascular Operations Using the National Surgical Quality Improvement Program (NSQIP) Participant Use Data File.

OBJECTIVE: This study aims to develop a Respiratory Failure Risk Score (RFRS) with good predictability for elective abdominal and vascular patients to be used in the outpatient setting for risk stratification and to guide preoperative pulmonary optimization. SUMMARY BACKGROUND DATA: Postoperative respiratory failure (RF), defined as ventilator dependency for more than 48 hours or unplanned reintubation within 30 days, is associated with increased mortality and hospital costs. Many tools have been previously described for risk stratification, but few target elective surgical candidates. METHODS: Our training sample included patients undergoing inpatient, nonemergent general and vascular procedures sampled for the American College of Surgeon National Surgical Quality Improvement Program 2012 Participant Use File. Multivariable logistic regression identified independent preoperative risk factors associated with RF, used to derive a weighted RFRS. We then determined goodness-of-fit and optimal cutoff values through receiver operator characteristic analysis and Youden indices to evaluate internal and external validity with a retrospective institutional validation sample (2013 and 2014). RESULTS: Multivariable analysis of 151,700 patients from the National Surgical Quality Improvement Program Participant Use File identified 12 variables independently associated with RF. The RFRS showed good external prediction in the validation sample with a c-statistic of 0.73 (95% confidence interval, 0.68-0.79). With the highest Youden index, 30 was determined to be the optimal cutoff value with a sensitivity 0.62 and specificity of 0.75. Additional cutoff values of 15 and 40 optimized sensitivity (>0.80) and specificity (>0.80), respectively. CONCLUSIONS: In the preoperative setting, the RFRS can effectively stratify patients into low (<15), moderate low (15-29), moderate high (30-39), and high risk (>39) to assist in patient counseling and guide application of perioperative pulmonary optimization measures.