Outcomes of Protocol-Driven Venous Thromboembolic Chemo-Prophylaxis in Trauma Patients: A Trauma Quality Improvement Project Analysis.

INTRODUCTION: Low molecular weight heparin (LMWH) is the standard for venous thromboembolic (VTE) chemo-prophylaxis in trauma patients; however, inconsistencies in the use of LMWH exist. The objective of this study was to assess VTE outcomes in response to a chemo-prophylaxis protocol guided by patient physiology (eg, creatinine clearance) and comorbidities. METHODS: ACS TQIP Benchmark Reports at a level 1 trauma center using a patient physiology and comorbidity directed VTE chemo-prophylaxis protocol were analyzed for Spring 2019 to Fall 2021. Patient demographics, VTE rates and pharmacologic VTE prophylaxis type were collected for "All Patients" and "Elderly" (TQIP: age ≥ 55 years) cohorts. RESULTS: Data was analyzed for 1919183 "All Hospitals" (AH) and 5843 patients single institution (SI) using the physiologic and comorbidity guided VTE chemo-prophylaxis protocol. Elderly subgroup had 701965 (AH) and 2939 (SI) patients. Use of non-LMWH chemo-prophylaxis was significantly higher at SI: All patients = 62.6% SI vs 22.1% (P < .01); Elderly = 68.8% SI vs 28.1% AH (P < .01). VTE, DVT, and PE rates for All Patients and Elderly subgroup were significantly reduced at SI, except Elderly PE which was statistically equivalent. CONCLUSIONS: Protocol-driven VTE chemo-prophylaxis was associated with significantly lower LMWH use accompanied by significant reductions in All VTE, DVT, PE, and Elderly VTE and DVT with no difference in Elderly PE rates. These results may imply that adherence to a physiologic and comorbidity directed chemo-prophylaxis protocol, rather than LMWH, reduces VTE events in trauma patients. Further investigation to elucidate best practice is warranted.

Understanding the Effect of Bias on the Experience of Women Surgeons: A Qualitative Study.

BACKGROUND: Exploring the lived experiences of surgeons is necessary to understand the changing culture of surgery and the unique challenges of being a woman in surgery. Surgeons have significant experiences and observations best discovered through qualitative study. The purpose of this study is to identify the similarities and differences between the experiences of men and women surgeons after initiation of mandatory microaggression training. STUDY DESIGN: Qualitative semi-structured interviews with female and male surgeons and residents were done following a year-long series of training sessions on the detrimental effects of microaggression. Participants were selected using a convenience sampling method. MAXQDA coding software (Verbi) was used to evaluate interview transcripts with thematic analysis. RESULTS: Nineteen surgeons and surgical residents were interviewed. The participants were of equal gender identification, with the majority being attending surgeons. Multiple themes highlighted similarities and differences between male and female participants. Differences were noted in identification of a sensitive personality, family planning considerations, and experiences of bias. Similarities were related to the personality traits required to be successful in surgery, the sacrifice inherent to a surgical career, and the war rhetoric used to describe the comradery of residency. CONCLUSION: The challenges and rewards of surgery are similar for women and men, but women have additional stressors, including gender-based bias, microaggression, and family planning. These stressors take up energy, decreasing the mental space available for additional roles and affecting the work environment. Microaggression education can incite necessary discussions of bias and provide women with an opportunity to reflect on and share their experiences.