Background
The VTEPS Network is a consortium of five tertiary referral centers established to examine venous thromboembolism in plastic surgery patients. We report our mid-term analyses of the study’s control group to 1) evaluate the incidence of VTE in patients who receive no chemoprophylaxis and 2) validate the Caprini Risk Assessment Model (RAM) in plastic surgery patients.
Study Design
Medical record review was performed at VTEPS centers for all eligible plastic surgery patients between March 2006 and June 2009. Inclusion criteria were Caprini score ≥ 3, surgery under general anesthesia, and post-operative hospital admission. Patients who received chemoprophylaxis were excluded. Dependent variables included symptomatic DVT or PE within the first 60 post-operative days and time to DVT or PE.
Results
We identified 1126 historic control patients. The overall VTE incidence was 1.69%. Approximately one in nine (11.3%) patients with Caprini score >8 had a VTE event. Patients with Caprini score >8 were significantly more likely to develop VTE when compared to patients with Caprini score of 3–4 (OR 20.9, p<0.001), 5–6 (OR 9.9, p<0.001), or 7–8 (OR 4.6, p=0.015). Among patients with Caprini score 7–8 or Caprini score >8, VTE risk was not limited to the immediate post-operative period.
Conclusions
The Caprini RAM effectively risk-stratifies plastic and reconstructive surgery patients for VTE risk. Among patients with Caprini score >8, 11.3% have a post-operative VTE when chemoprophylaxis is not provided. In higher risk patients, there was no evidence that VTE risk is limited to the immediate post-operative period.
There is a 20.8% prevalence of postoperative doctor shopping in the orthopaedic trauma population. Patients with multiple postoperative narcotic providers had a significant increase in postoperative narcotic prescriptions, duration of narcotics, and morphine equivalent dose per day.
Situation Report-73 HIGHLIGHTS • No new countries/territories/areas reported cases of COVID-19 in the past 24 hours. Region of the Americas 216 912 confirmed (28161) 4565 deaths (1165) African Region 4702 confirmed (629) 127 deaths (36) WHO RISK ASSESSMENT Global Level Very High SUBJECT IN FOCUS: The routes of transmission from COVID-19 patients As the COVID-19 outbreak continues to evolve, we are learning more about this new virus every day. Here we summarize what has been reported about transmission of the COVID-19 virus, and provide a brief overview of available evidence on transmission from symptomatic, pre-symptomatic and asymptomatic people infected with COVID-19. Symptomatic transmission By way of definition, a symptomatic COVID-19 case is a case who has developed signs and symptoms compatible with COVID-19 virus infection. Symptomatic transmission refers to transmission from a person while they are experiencing symptoms. Data from published epidemiology and virologic studies provide evidence that COVID-19 is primarily transmitted from symptomatic people to others who are in close contact through respiratory droplets, by direct contact with infected persons, or by contact with contaminated objects and surfaces. 1-7 This is supported by detailed experiences shared by technical partners via WHO global expert networks, and reports and presentations by Ministries of Health. Data from clinical and virologic studies that have collected repeated biological samples from confirmed patients provide evidence that shedding of the COVID-19 virus is highest in upper respiratory tract (nose and throat) early in the course of the disease. 8-11 That is, within the first 3 days from onset of symptoms. 10-11 Preliminary data suggests that people may be more contagious around the time of symptom onset as compared to later on in the disease.
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