The Caprini VTE risk assessment model is valid. This study supports the use of individual risk assessment in critically ill surgical patients.

author's patients other than EVAR over the time period studied. These include more rapid control of hemorrhage, permissive hypotension, use of decompressive laparotomy, better blood product resuscitation with potentially more use of fresh frozen plasma. This type of study, therefore, has multiple potential confounders despite best efforts to control for them. It actually cannot be used as justification for an endovascular first approach for rAAA when they are randomized trials where nonselective use of EVAR for rAAA does not yield a survival advantage (Improve trial investigators. BMJ 2014; 348:F7661). Overall, EVAR for treatment of rAAA should be considered another tool in the toolbox of the surgeon treating a rAAA but is not necessarily the only tool and may not be the best tool for all patients.

No abstract

The infraspinatus fascia is a tough sheet of connective tissue that covers the infraspinatus fossa of the scapula and the muscle within. Muscle fibers originate from the fossa and fascia and then travel laterally to insert on the greater tubercle of the humerus. Frequently the infraspinatus fascia is quickly removed to appreciate the underlying muscle, but the fascia is an interesting and complex structure in its own right. Despite having a characteristic set of fascial bundles, no contemporary anatomy texts or atlases describe the fascia in detail. The infraspinatus fascia was dissected in detail in 11 shoulders, to characterize the fascial bundles and connections that contribute to it. Thereafter, 70 shoulders were dissected to tabulate the variability of the fascial bundles and connections. Six characteristic features of the infraspinatus fascia were noted: a medial band, an inferior-lateral band, and superior-lateral band of fascia, insertion of the posterior deltoid into the infraspinatus fascia, a transverse connection from the posterior deltoid muscle to the infraspinatus fascia, and a retinacular sheet deep to the deltoid and superficial to the infraspinatus and teres minor muscles. Although other structures of the shoulder are more frequently injured, the infraspinatus fascia is involved in compartment syndromes and the fascial bundles of this structure are certain to impact the biomechanical function of the muscles of the posterior shoulder.

Objectives: To assess trends over a decade in utilization of Inferior Vena Cava (IVC) filters in the U.S by indication, hospital and patient demographics. Methods: Retrospective cross-sectional study utilizing the Nationwide Inpatient Sample Database, 2000-2009. IVC filter placement was identified with ICD-9 codes. Survey-weighting, bivariate and multivariate analysis was performed. Results: The number of IVC filters placed in the US increased by 234% over a decade, from 56,380 in 2000 to 132,049 in 2009 (Fig). 84.7% of patients had a PE or DVT. 94.6% of IVC filters were placed in urban hospitals. The largest number of IVC filters was placed in the South, followed by the Northeast, Midwest, and Western regions (38.7%, 25.8%, 22.4%, and 13%, respectively). Adjusting for other patient and hospital factors, independent predictors of IVC filter placement were year, hospital size, location, teaching status, patient age group 50-79 years, insurance status, and urgency of admission. Conclusions: The use of IVC filters has dramatically increased over the last decade in the USA, with the largest utilization of filters among patients aged 50-79 years, Medicare recipients and the Southern region of the US. The majority of patients receiving IVC filters have an appropriate indication (PE or DVT). Future studies are required to understand differences in utilization and to optimize selection of patients for IVC filter placement.