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At least 775 records · Page 43Linked to original sources
PubMed2002

Implementation of sentinel lymph node biopsy for breast cancer by surgeons in the Department of Defense.

BACKGROUND: Sentinel lymph node biopsy (SLNB) for the evaluation of women with invasive breast cancer is rapidly gaining acceptance. The purpose of this study was to assess how surgeons in the Department of Defense (DOD) are incorporating SLNB into practice. METHODS: Surgeons at all DOD hospitals were telephonically surveyed regarding their current practices with SLNB. RESULTS: Of 66 DOD hospitals 23 (35%) are currently performing SLNB. Eleven hospitals (11 of 23, 48%) are academic centers, while 12 (12 of 23, 52%) are not teaching facilities. Seventeen (17 of 23, 77%) are in the learning phase of SLNB and follow SLNB with an axillary dissection. Eighteen (18 of 23, 78%) of facilities have surgeons who learned the procedure in residency/fellowship training. Sixteen (16 of 23, 70%) use a combination of isosulfan blue dye and sulfur colloid radioisotope. Surgeons performing SLNB are not aware of the method of examination of the sentinel node at their institution at 6 of 23 (26%) of hospitals. CONCLUSIONS: Increasing numbers of surgeons in the DOD Healthcare System are performing SLNB. The majority learned the procedure in residency or fellowship and are using a combination of blue dye and radioisotope for the performance of SLNB.

Axilla↗
PubMed1996

Teaching effectiveness of surgeons.

BACKGROUND: Evaluation of clinical teaching is essential for feedback to teachers, and for reliable and valid data for the purpose of promotion and tenure. METHODS: The teaching effectiveness of 43 surgeons was evaluated continuously over a 9-year period. Stability of Teaching Effectiveness Scores (TES) over the 9-year period, correlation with age, and the changes after academic promotion were analyzed. RESULTS: A total of 3,750 evaluations were completed. The average of 10 evaluations per surgeon per year gave an intraclass correlation of 0.65. The mean TES did not show any significant change over the 9 years. The majority of the "good" and "average" surgeons maintained their TES ratings, and most of the "poor" group improved their TES. The age of the surgeon was not a factor. Most surgeons had a decrease in their TES after academic promotion. CONCLUSIONS: A reliable system of teaching evaluation was achieved. Teaching scores were stable over time for good and average teachers, whereas the poor teachers tended to improve their scores.

Adult↗
PubMed1999

Comparison of the first 100 coronary bypass patients of a supervised resident with his first 100 as an attending surgeon at the same institution.

BACKGROUND: Although coronary artery bypass grafting (CABG) has been analyzed intensely for 30 years, little information is available on the characteristics and outcome of CABG patients operated upon by resident trainees or first-year attending surgeons in a public teaching hospital. METHODS: The first 100 CABG patients operated upon by a supervised resident were compared with the first 100 CABG patients under the care of the same person as an attending surgeon at the same institution. In the first group, the resident was directly supervised by one of three different staff surgeons. In the second group, the same person, as an attending, performed 60 operations and directly supervised one of two trainees in 40. RESULTS: Comparing the resident group versus the attending group, mean age (62 versus 61 years), percentage of females (37 and 37), tobacco use (74 versus 77), obesity (43 versus 55), insulin-dependent diabetes mellitus (20 versus 17), ejection fraction < or =0.5 (29 versus 35), and previous myocardial infarction (56 versus 54) were similar. Three or more coronary anastomoses were performed in 83 patients in the first group and in 74 in the second group. Early mortality (in-hospital and/or < or =30 days) occurred in 2 patients in the resident group and 3 in the attending group; each patient had a low ejection fraction and severe narrowing of all three major epicardial coronary arteries. Morbidity in the two groups was similar. CONCLUSION: If properly supervised by experienced staff surgeons, a resident trainee can achieve satisfactory results in CABG in a heterogeneous group of patients. Furthermore, the transition to attending surgeon can be achieved with a good outcome for the patients.

Adult↗
PubMed1999

Accuracy of surgeon-performed gallbladder ultrasound.

BACKGROUND: Symptomatic cholelithiasis is among the most common of general surgery referrals. With an appropriate clinical presentation, definitive diagnosis requires documentation of gallstones by ultrasonography (US). The authors evaluated the accuracy of surgeon-performed US for identifying gallstones in patients with a nonacute indication for study. METHODS: Patients referred for symptomatic cholelithiasis and who provided informed consent received an US examination by one or more of the surgical investigators. Surgeon-performed US findings were correlated with radiologist US findings and pathologic diagnoses. RESULTS: Seventy-seven patients received a total of 128 examinations by the investigators. Surgeon-performed US examination agreed with the radiologist US findings for 112 of 122 studies (92%) with a sensitivity of 100% and a specificity of 95%. Surgeon-performed US findings correlated with the pathologic diagnoses for 83 of 86 studies (97%). CONCLUSIONS: Surgeons can perform gallbladder US in the nonacute setting with a high degree of accuracy.

Cholelithiasis↗
PubMed2001

Assessment of mortality rates for congenital heart defects and surgeons' performance.

BACKGROUND: In the absence of reliable national data, we have collected results of all operations for congenital heart defects from five departments to assess mortality rates and compare them among surgeons and departments. METHODS: Data relating to all operations (2,718) carried out at the five centers during a period from April 1, 1997 through March 31, 1999. Clearly defined criteria were agreed for the classification of patients into various subgroups. RESULTS: The overall hospital mortality was 4.4% (95% confidence intervals 3.7%-5.3%). Mortality for open-operations was 12.6% in neonates, 5.1% in infants, and 3.5% in children. Mortality rates were 1.1% for coarctation, 0.4% ventricular septal defect, 4.1% atrioventricular septal defect, 2.9% Fallot, 0.9% switch, and 15.6% truncus arteriosus. Although individual surgeons' mortality rates ranged from 1.8% to 7.5%, none of the 12 surgeons' data were above 95% confidence intervals. For individual surgeons, the change in mortality rates between the 2 years ranged between -3.3% and +3.8%. CONCLUSIONS: With 2 years' data available, estimates of mortality rates are more precise as reflected by tighter confidence intervals. There were relatively small data sets for individual hospitals and surgeons, which made statistical evaluation difficult. For setting standards, data from more departments for a longer period will be required. Statistical methods alone cannot be used as a sole arbiter of what is considered acceptable performance.

Cause of Death↗
PubMed1998

Radiation exposure to the hands and the thyroid of the surgeon during intramedullary nailing.

During 41 procedures of intramedullary nailing of femoral and tibial fractures, the primary surgeon and the first assistant wore ring dosimeters on their dominant index fingers. While the average fluoroscopy time per procedure was 4.6 min, the average dose of radiation to the dominant hand of the primary surgeon was 1.27 mSv and 1.19 mSv to the first assistant. The dose limit for the extremities is 500 mSv per year, as recommended by the International Commission on Radiological Protection. Extrapolation of the mean dose of the primary surgeon and first assistant per procedure of 1.23 mSv leads to the result that the recommended dose limit of 500 mSv would only be exceeded if more than 407 intramedullary nailing procedures are carried out per year. The duration of fluoroscopy time correlated with the radiation dose to the hands of the surgeons, though it was determined by phantom measurements that the majority of radiation exposure occurred during brief exposures of the hands in the direct X-ray beam on the X-ray tube near side of the patient. In order to assess the surface doses of the thyroid gland to the primary surgeon with and without a lead shield, we performed in vitro measurements during operative procedures of the lower leg simulating different intraoperative situations under fluoroscopic control. The average registered ionizing dosage without a thyroid shield was approximately 70 times higher than with thyroid lead protection. In a previous study we found average fluoroscopy times during intramedullary nailing of the tibia and femur of 4.6 min per procedure. Extrapolation of this value leads to the result, that even when 1000 intramedullary nailings were carried out without wearing lead protection, only 13 per cent of the dose limit recommended by the International Commission on Radiological Protection for the thyroid of 300 mSv per year would be reached; by wearing the lead protection only 0.2 per cent of the recommended dose would be reached.

Femoral Fractures↗
PubMed1996

Who should treat pyloric stenosis: the general or specialist pediatric surgeon?

Recent reports suggest that children under 3 years of age are best operated on by a specialist pediatric surgeon. In the United Kingdom, hypertrophic pyloric stenosis traditionally has been treated by adult general surgeons. Should this change? In 1991, a retrospective review of 10 years' experience with pyloric stenosis, managed by general surgeons in a large district general hospital, was published. In 1969, an accredited pediatric surgeon, who largely took over the management of pyloric stenosis, was appointed to the staff. His results with 70 children over a 5-year period (series 2) were reviewed retrospectively and compared with the previously published general surgical series of 170 children (series 1). There was no significant difference in the gender, age, or weight distribution between the two series. There was a marked difference in the rates of wound infection (15.5% in series 1; 2.8% in series 2; P < .05), wound dehiscence (6.7% in series 1; 0% in series 2; P < .05), and breach of the duodenal mucosa (12.8% in series 1; 0% in series 2; P < .01). The lower morbidity rate resulted in a shorter hospital stay, with emotional and financial savings. This supports the recommendation that children with this condition should be managed by a pediatric surgeon.

Child, Preschool↗
PubMed1998

Validation of surgeon-performed emergency abdominal ultrasonography in pediatric trauma patients.

BACKGROUND/PURPOSE: The focused assessment for the sonographic evaluation of trauma patients (FAST) in adults is effective in detecting intraperitoneal and intrapericardial fluid and can be performed quickly by surgeons in the emergency department (ED). The authors sought to validate the accuracy of FAST performed by surgeons during ED resuscitation of pediatric trauma patients. METHODS: Patients were assigned to one of three groups based on standard clinical criteria: immediate surgery, abdominal computed tomography (CT), or observation alone. FAST was then performed in the ED by a surgery resident (postgraduate year 3 or higher) or an attending trauma surgeon. Four views were used to assess the possible presence of fluid in the pericardial, subphrenic, subhepatic, and pelvic spaces. Time needed to conduct FAST was noted. Presence of peritoneal or pericardial fluid by FAST was compared with that determined by CT or surgery. Sensitivity, specificity, and predictive values were calculated. For those who did not undergo CT or surgery, FAST findings were compared with the clinical course. RESULTS: Technically adequate studies could be performed on 192 of 196 eligible children. Their ages ranged from 3 months to 14 years (mean, 6.9 years); 119 were boys (62%), and 188 (98%) had sustained a blunt injury. FAST was performed in a mean time of 3.9 minutes (range, 1-17 minutes). All FAST examinations were reviewed by our senior surgeon-sonographer (GSR). Interrater agreement between the performing and reviewing surgeon-sonographer was 100%. Sixty (31%) patients underwent either abdominal CT (n = 56; mean Injury Severity Score (ISS), 9.6) or immediate operation (n = 4; mean ISS, 18.8). Of the 10 patients with verified presence of intraperitoneal fluid, eight had positive and two had false-negative FAST examination results. Of the 50 patients with verified absence of intraperitoneal fluid, none had a positive FAST (ie, no false-positives); sensitivity was 80%; specificity, 100%; predictive value positive, 100%; predictive value negative, 96%. None of the 132 patients followed up clinically without CT or surgery (mean ISS, 4.5) had fluid documented by FAST, and all did well. CONCLUSIONS: The focused assessment for the sonographic evaluation of pediatric blunt trauma patients performed by surgical residents and attendings in the ED rapidly and accurately predicted the presence or absence of intraperitoneal fluid. The FAST is a potentially valuable tool to rapidly prioritize the need for laparotomy in the child with multiple injuries and extraabdominal sources of bleeding.

Abdominal Injuries↗
PubMed1999

The market for pediatric surgeons: a survey of recent graduates.

PURPOSE: The aim of this study was to identify the demand for pediatric surgeons as perceived and experienced by recent graduates of North American training programs. METHODS: A survey questionnaire was mailed to every pediatric surgeon who had completed a certified training program in the United States or Canada between 1992 and 1997; 84% of the 165 responded. The data were then analyzed using univariate and bivariate statistics and content analysis. RESULTS: The number trained has risen since 1992 from 21 to 35 per year, exceeding previous definitions of need. However, recently trained pediatric surgeons found positions, and their first-year incomes had risen oven the 6-year period. In contrast, just 54% found first positions in the type of hospital desired, and the percent working in a children's hospital dropped from 65% in 1992 to 32% in 1997; 34% cover between four and ten hospitals. The majority of those in practice for more than 2 years expressed the perception of a decline in market demand with just 30% of those 1996 to 1997 graduates perceiving a strong market. The clinical scope of practice was less than that for which they were trained. Three specified complex cases were managed by fewer than 30% of recent graduates during practice despite more than 60% having had fellowship experience. The scope of practice, as measured by variables of index procedures, was strongly associated with hospital type (children's or general) and by practice region. Although satisfaction with practice is lower for each successive class, 96% of the graduates were satisfied with their training programs, and 98% believed they had been well prepared, although 46% indicated they desired some additional training. Sixty-one percent believed the role of pediatric surgeons will change over the next 5 years. CONCLUSIONS: The market demand was strong as measured by employment and income. This was in contrast to the striking recent changes in the market for new pediatric surgeons, including a migration of practice from children's to general hospitals, a reduced scope of practice, a more negative perception of the pediatric surgery market, and concerns for narrowing of the specialty.

Canada↗
PubMed1995

Effectiveness of joint consultation sessions of general practitioners and orthopaedic surgeons for locomotor-system disorders.

Joint consultation sessions between general practitioners (GPs) and specialists to examine patients for whom decisions about referral are difficult are thought to be helpful, but their effects have not been evaluated. In a randomised, controlled trial we studied the effects of joint sessions of GPs and orthopaedic surgeons on referral and intervention rates. During 1.5 years, 12 GPs (in groups of three) held monthly joint consultation sessions with four participating orthopaedic surgeons: patients were seen by one orthopaedic surgeon in the presence of three GPs. Patients were included in the trial if the GP was uncertain about the diagnostic or therapeutic management and if referral was considered; and excluded if referral was urgently necessary or if there was some other clear indication for referral. By a randomised consent design, patients were assigned to joint consultation sessions (n = 144) or a usual-care control group (n = 128). A year later the patients were examined by an independent orthopaedic surgeon. There were significantly fewer referrals (51/144 [35%] vs 87/128 [68%], p < 0.01) and diagnostic actions in the intervention group than in the control group, without negative effects on health or functional status. More patients in the intervention group were symptom-free at 1 year (35% vs 24%, p < 0.05). Joint consultation sessions of GPs and orthopaedic surgeons within the framework of general practice resulted in more efficient care, with better targeted examination, treatment, and referrals.

Family Practice↗
PubMed2000

Determination of surgeon's absorbed dose in iodine 125 and ruthenium 106 ophthalmic plaque surgery.

OBJECTIVE: Validation of dosimetry and exposition time to an ophthalmic surgeon during radioactive plaque operations. DESIGN: Experimental study in which videotaped operations and dosimetric measurements were used to model dosimetry. METHODS: We used thermoluminescence detectors for high sensitivity readings in radiation fields. Typical intersurgical mobility was videotaped and distances to the plaque was evaluated. MAIN OUTCOME MEASURE: Estimated radiation received by surgeons. RESULTS: All simulated plaque operations have a maximum dose rate of 6 mGy per minute (value in the inner eyeball). Mean dose rate is 2 mGy per minute (average of approximately all measurements). The surgeon's fingers receive a dose from 2 to 6 mSv from plaque operation. CONCLUSIONS: Results suggest that radioactive plaque operations are safe for the surgeon but that the time for plaque handling should be minimized. A surgeon should not exceed 100 to 200 operations per year.

Brachytherapy↗
PubMed1999

Risk of hepatitis C virus transmission to surgeons and nurses from infected patients: model-based estimates in France.

BACKGROUND/AIM: The aim of this study was to estimate the annual number of cases of hepatitis C virus transmission from infected patients to uninfected surgeons or nurses due to percutaneous injury during invasive procedures. METHODS: The risk of transmission was estimated using a model involving three probabilities: A, that a health care worker sustains at least one percutaneous injury during a procedure; B, that 1 to 10% of patients are seropositive for hepatitis C virus; and C, that infection by this virus is transmitted to the Health Care Worker after such exposure. Probability A was estimated from the results of 2 French multicentric prospective trials. Probability C was estimated from the results of 9 international prospective studies. A ten-fold decreased risk was assumed for surgeons who wear gloves and use solid-bore suture needles. RESULTS: During a single procedure, the estimated probability of hepatitis C virus transmission from an infected patient to an uninfected surgeon ranged from 4.2x10(-5)% to 4.2x10(-4)%, and from 2.98x10(-6)% to 2.98x10(-5)% to an uninfected nurse. For surgeons, the estimated annual cumulative risk of occupational infection ranged from 0.01% to 0.1% (1 in 10000 to 1 in 1000), and for nurses from 0.0054% to 0.054% (1 in 18700 to 1 in 1900). CONCLUSIONS: Between 2 and 21 surgeons out of a total 20000 are estimated to acquire occupationally-related hepatitis C virus infection, and between 16 and 167 nurses out of a total 300000. These estimates strongly justify introducing preventive measures to protect health care workers from bloodborne infection.

France↗
PubMedDate not supplied

How surgeon age affects posttreatment surveillance strategies for upper aerodigestive tract cancer patients.

PURPOSE: Strategies for the surveillance of patients with upper aerodigestive tract (UADT) epidermoid cancer after potentially curative treatment are not uniform, and the most suitable regimen remains unknown. We investigated the effect of surgeon age on follow-up strategy. MATERIALS AND METHODS: The 824 members of the Society of Head and Neck Surgeons (SHNS) and the 522 members of the American Society for Head and Neck Surgery (ASHNS) who were not members of the SHNS were surveyed using a custom-designed questionnaire to measure how these surgical experts performed follow-up on patients with UADT cancer. Subjects were asked how often they used 14 specific follow-up modalities for patients with resectable UADT cancer during years 1 to 5 after potentially curative primary treatment. Repeated-measures analysis of variance was used to compare practice patterns by surgeon age, as well as by tumor, node, metastasis (TNM) stage and year postsurgery. RESULTS: Responses from 199 SHNS members (24%) and 221 ASHNS members (42%) were considered assessable. Strategies were highly correlated across TNM stages and years postsurgery for most of the 14 modalities. Mean follow-up intensity differed significantly by surgeon age only for bone scan and liver function tests. Although statistically significant, the differences in surveillance strategies among age groups were clinically small. CONCLUSION: Surveillance practice patterns of surgeons caring for patients after treatment for UADT cancer do not vary substantially with practitioner age. Postgraduate education is a plausible mechanism for this homogenization of practitioner behavior.

Adult↗
PubMed1999

Practice differences between male and female oral and maxillofacial surgeons: survey results and analysis.

PURPOSE: This study describes the personal and practice characteristics of oral and maxillofacial surgeons, with an emphasis on gender differences. Potential explanations for differences found are offered. MATERIALS AND METHODS: A 39-item questionnaire was designed to address areas of suspected differences between male and female oral and maxillofacial surgeons. It included items regarding training, certification, practice type and location, time spent working, practice composition, and personal characteristics. Identical questionnaires were sent to all of the 130 female oral and maxillofacial surgeons (OMSs) registered with AAOMS, as well as to 264 randomly sampled male OMSs. RESULTS: Of the 192 responses received, 109 were from male surgeons, and 83 were from females, 56.8% versus 43.2% of the total. For men, the response rate was 41.3%, whereas the rate was 68.3% for the women; overall, 48.7% of the 394 oral surgeons responded. Profiles of the "average" male and female OMS showed similarities with regard to race, training, and reasons for choosing an OMS career. Age, marital status, number of children, physical characteristics, and use of time outside of work indicated some significant personal differences, as did practice characteristics, including income, number of years in practice, hours spent working, and number of patients seen. Clear gender-based trends were found regarding opinions of physical and mechanical disadvantages, with women more strongly denying such problems. A variety of both positive and negative viewpoints were elicited by the free comment section. CONCLUSIONS: Although male and female OMSs are similar with regard to most variables investigated, some significant differences do exist.

Adult↗
PubMed1996

A program of operative angioplasty: endovascular intervention and the vascular surgeon.

PURPOSE: Vascular surgeons are ideally suited to select and perform endovascular interventions either as primary therapy or as an adjunct to bypass surgery. Attaining proficiency in endovascular techniques is an important goal in the training of vascular surgeons. We report our initial experience with a program of endovascular intervention performed in the operating room by vascular surgeons. METHODS: During the previous three years, we performed 109 angioplasty procedures, 60 aortoiliac (55%), 32 femoropopliteal (29%), and 17 popliteal/tibial (16%), using guidewires and angioplasty balloons directed by intraoperative digital subtraction C-arm arteriography with road-mapping capabilities. Indications for angioplasty included disabling claudication in 59 patients (54%), rest pain in 18 (17%), and tissue loss in 32 (29%). Angioplasty was accompanied by stent placement in 39 of 60 aortoiliac procedures (65%) and in two of 32 femoral procedures (6%). In 16 cases (15%), the endovascular procedure was performed in conjunction with a bypass procedure. In selected cases (15, 14%), duplex scanning was the sole diagnostic method used before surgery to identify the lesion, eliminating the need for preoperative arteriographic scans. Segmental pressure measurements, duplex ultrasound scans, and treadmill exercise testing as indicated were performed before and after surgery. The efficacy of the endovascular intervention was assessed at 3-month intervals during the first year and at 6-month intervals thereafter. RESULTS: A successful results was defined using criteria recommended by the Ad Hoc Subcommittee on Reporting Standards for Endovascular Procedures from the Society for Vascular Surgery/International Society for Cardiovascular Surgery. This included the combination of symptomatic improvement, obtaining an anatomically successful result with < 30% residual lumen stenosis, and elimination of the translesion gradient with an improvement in high thigh-brachial index or ankle-brachial index greater than 0.15. Initial success was achieved in 55 of 60 aortoiliac (92%), 28 of 32 femoropopliteal (88%), and 16 of 17 popliteal/tibial (94%) angioplasty procedures. Clinical follow-up has been achieved in all cases, with continued clinical success rates of 80%, 75%, and 82% for aortoiliac, femoropopliteal, and popliteal/tibial angioplasty procedures, respectively, with a mean follow-up of 15.7 months. CONCLUSION: These results confirm the value of a program in which C-arm technology was used by vascular surgeons in the performance of angioplasty and stenting procedures in the operating room. This experience in therapeutic endovascular intervention will facilitate the credentialing process for future vascular surgeons.

Aged↗
PubMed1997

Vascular surgeons' resource use at a university hospital related to diagnostic-related group and source of admission.

PURPOSE: To determine whether differences in the conduct of individual practices of attending vascular surgeons account for variations in resource use at a university hospital. METHODS: The practice patterns of six attending vascular surgeons at the University of Michigan Hospital were assessed for patient length of stay (LOS), ancillary service use, and the number of nursing hours required. Included in the study were 1930 hospitalized patients who had one of the 10 most frequently encountered diagnostic related groups (DRGs). Statistical analyses of variables that were thought likely to affect resource use included multiple regression models. RESULTS: Patient age, sex, insurance, source of admission (direct admission or transfer admission), surgeon, and DRG category together accounted for 22% of LOS variation, 27.7% of variation in ancillary service use, and 29.4% of variation in nursing hours. In no model did the individual surgeon's practice significantly effect the LOS, ancillary use, or nursing hours. Patients transferred from other hospitals had increased resource use in all models. The DRG category alone explained 20.9% of the variance in LOS, 25.2% of the variation in ancillary service use, and 21.2% of the variance in nursing hours. CONCLUSION: Differences in the conduct of individual vascular surgeons' practices accounted for less than 1% variation in hospital resource use. The most important influences on resource use were the DRG category and the source of patient admission. Modification of the frequency and manner of accepting transfer patients to vascular surgery services of a university hospital may have a major impact on hospital resource use.

Diagnosis-Related Groups↗
PubMed1994

Heparin and protamine use in peripheral vascular surgery: a comparison between surgeons of the Society for Vascular Surgery and the European Society for Vascular Surgery.

It was the intent of this study to document, in general, the patterns and complications of heparin and protamine usage during carotid endarterectomy, aortic and femoral-popliteal-tibial reconstructions for occlusive disease, elective and emergent abdominal aortic aneurysmectomy, thromboembolectomy, and dialysis arteriovenous (AV) fistula placement by surgeons from North America and Europe. All vascular surgeons from the Society for Vascular Surgery (SVS) and the European Society for Vascular Surgery (ESVS) were surveyed by a voluntary, self-reported questionnaire. Six hundred and forty-six completed questionnaires (284 from SVS and 362 from ESVS), representing a 62% response rate, were returned for evaluation. Systemic and regional administration of heparin was common during vascular procedures performed by both SVS and ESVS surgeons. Use of protamine to reverse heparin anticoagulation varied among SVS and ESVS surgeons, respectively, during: carotid endarterectomy (54% vs. 26%, p < 0.01), elective aortic reconstruction for occlusive disease (58% vs. 23%, p < 0.001), elective aortic reconstruction for abdominal aortic aneurysm (63% vs. 27%, p < 0.001), and femoral-popliteal-tibial reconstruction (44% vs. 15%, p < 0.001). Adverse reactions to protamine among the 25,219 and 12,902 cases reported from SVS and ESVS surgeons, respectively, included: hypotension (1209 and 495 cases), pulmonary artery hypertension (65 and eight cases), anaphylaxis (52 and 10 cases), and death (seven and two cases). These adverse responses accounted for 5.3% and 4.0% of the SVS and ESVS cases, respectively. Although this study is subject to the known limitations of a retrospective survey, it is clear that heparin use is common. Protamine reversal of heparin anticoagulation is more common in North America.(ABSTRACT TRUNCATED AT 250 WORDS)

Data Collection↗
PubMed1989

Anticoagulation in abdominal aortic aneurysm surgery: the approach of vascular surgeons in Great Britain and Ireland.

A questionnaire was sent to 283 vascular surgeons in Great Britain and Ireland regarding their use of heparin in elective abdominal aortic aneurysm surgery. The answers form the basis of this study and show that there is great variation. The majority of surgeons routinely anticoagulate their patients peroperatively. Heparin is usually given intravenously--most giving the drug 2 to 3 min prior to cross clamping the aorta. Approximately half of the respondents use the same dose in all patients, whilst the remainder vary the dose, usually on the basis of weight or "size". Most surgeons use 5000 units but the range of dose varies from 400 to 20,000 units. Just under a quarter of surgeons continue to anticoagulate their patients postoperatively, almost all of these using subcutaneous heparin for prophylaxis against deep vein thrombosis. Only approximately 10% of surgeons routinely reverse the heparin with protamine.

Aorta, Abdominal↗