Analysis of Demographics, Discharge Functional Outcomes &amp; Disposition Locations Following Inpatient-Rehabilitation in National Sample Guillain-Barre-Syndrome Patients

Kushner, David S.; Felix, Elizabeth R.; Miller, C. Dudley; Cordero, Maite K.; Thomashaw, Stacy A.

doi:10.1016/j.apmr.2020.09.311

Cited by 1 publication

(1 citation statement)

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“…with increased discharge to skilled nursing or intermediate care facilities, suggesting a common link between the significant complications found in the VTEP group. [34][35][36][37] The cause of these findings is unclear, but it is possible that patients are observed longer in the inpatient setting following VTEP due to the fear of subsequent hemorrhage, increasing the window of opportunity for additional complications. It is also possible that there was a higher rate of unspecified and unassociated complications in the VTEP group, leading to increased complications and subsequent longer LOS.…”

Section: Postoperative Complicationsmentioning

confidence: 99%

Effect of perioperative anticoagulant prophylaxis in patients with traumatic subdural hematoma and a history of anticoagulant use: a propensity-matched National Trauma Data Bank analysis

Jiang,

Hukamdad,

Gould

et al. 2023

Neurosurgical Focus

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OBJECTIVE The use of anticoagulation to prevent venous thromboembolism (VTE) is controversial in the setting of neurosurgical decompression for traumatic subdural hematoma (SDH). In these patients, there is concern that anticoagulation may cause secondary hemorrhage, increasing the risk of death and other complications. Patients with a history of anticoagulant use are at further risk of VTE, but the effect of VTE prophylaxis (VTEP) following neurosurgery for SDH has not been thoroughly investigated in this population. This study aims to investigate the differences in in-hospital outcomes in patients with SDH and preexisting anticoagulant use who received VTEP following neurosurgical intervention compared with those who did not. METHODS The National Trauma Data Bank was queried from 2017 to 2019 for all patients with preexisting anticoagulant use presenting with an SDH who subsequently underwent neurosurgical intervention. Patients who received VTEP were propensity score matched with patients who did not based on demographics, insurance type, injury severity, and comorbidities. Paired Student t-tests, Pearson’s chi-square tests, and Benjamini-Hochberg multiple comparisons correction were used to compare differences in in-hospital complications, length of stay (LOS), and mortality rate between the two groups. A logistic regression model was developed to identify risk factors for in-hospital mortality. RESULTS Two thousand seven hundred ninety-four patients matching the inclusion criteria were identified, of whom 950 received VTEP. Following one-to-one matching and multiple comparisons correction, the VTEP group had a lower mortality rate (18.53% vs 34.53%, p < 0.001) but longer LOS (14.09 vs 8.57 days, p < 0.001) and higher rates of pressure ulcers (2.11% vs 0.53%, p = 0.01), unplanned intensive care unit admission (9.05% vs 3.47%, p < 0.001), and unplanned intubation (9.47% vs 6.11%, p = 0.021). The multivariable logistic regression showed that use of unfractionated heparin (UH; OR 0.36, p < 0.001) and low-molecular-weight heparin (LMWH; OR 0.3, p < 0.001) were associated with lower odds of in-hospital mortality. CONCLUSIONS In patients with traumatic SDH and a history of anticoagulant use, perioperative VTEP was associated with increased LOS but provided a mortality benefit. LMWH and UH use were the strongest predictors of survival.

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Section: Postoperative Complicationsmentioning

confidence: 99%