Purpose: The purposes of this study were to determine the rate of venous thromboembolism (VTE) after discharge from the hospital in patients treated operatively with a pelvic ring or acetabular fracture and to define the main time frame in which VTE occurs within the 90-day period after hospital discharge. Methods: California and Florida State Inpatient Databases from 2005 to 2009 were used to identify patients with clinically significant VTEs within 90 days of hospital discharge. ICD-9 diagnosis codes identified patients with a pelvic ring or acetabular fracture and a VTE. Procedure codes distinguished patients having surgical fracture treatment. Deep vein thrombosis (DVT) and pulmonary embolus (PE) were included. Results: Overall, 13,589 patients had a pelvic ring or acetabular fracture and operative treatment. One hundred thirteen patients (0.83%) had a VTE within 90 days after hospital discharge: 0.51% had a DVT, 0.21% had a PE, and 0.12% had both. Twenty eight percent of DVTs and 23% of PEs occurred >35 days after discharge, being evenly distributed out to 90 days. Therefore, overall, <0.2% of patients developed a DVT and <0.1% were diagnosed with a PE (<0.01% fatal) >35 days after the index hospitalization. Conclusions: A substantial proportion of VTE events occur over 35 days after discharge; however, the overall risk is low with fatal PE being extremely low (<0.01%). Given the diminished VTE risk after 35 days, the decision to further extend antithrombotic drug therapy may be guided by patient-specific factors, such as prolonged immobility.
T-tests were used to compare times. Residents completed an 11item satisfaction evaluation.
RESULTS:Eleven residents (PGY2 to 4) participated at a single academic center. The mean (SD) times for E1, E2, E3, and E4 were 38 (4.9), 68 (14.3), 102 (12.6), and 131 (25.9) seconds, respectively. T-tests showed no differences in completion time by group. All participants strongly agreed that mastering these simulation tasks would help in the operating room. All strongly or somewhat agreed the simulator was high fidelity and feasible to use at home.
CONCLUSION:Resident perceptions of a novel model for advanced open surgical skills with video-based DP support ongoing development of this simulation method. Similarities in benchmarks across years suggests a need for increased DP.
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