Clinical presentation and time-course of postoperative venous thromboembolism: Results from the RIETE Registry

There is little literature about the clinical presentation and time-course of postoperative venous thromboembolism (VTE) in different surgical procedures. RIETE is an ongoing, prospective registry of consecutive patients with objectively confirmed, symptomatic acute VTE. In this analysis, we analysed the baseline characteristics, thromboprophylaxis and therapeutic patterns, time-course, and three-month outcome of all patients with postoperative VTE. As of January 2006, there were 1,602 patients with postoperative VTE in RIETE: 393 (25%) after major orthopaedic surgery (145 elective hip arthroplasty, 126 knee arthroplasty, 122 hip fracture); 207 (13%) after cancer surgery; 1,002 (63%) after other procedures. The percentage of patients presenting with clinically overt pulmonary embolism (PE) (48%, 48%, and 50% respectively), the average time elapsed from surgery to VTE (22 +/- 16, 24 +/- 16, and 21 +/- 15 days, respectively), and the three-month incidence of fatal PE (1.3%, 1.4%, and 0.8%, respectively), fatal bleeding (0.8%, 1.0%, and 0.2%, respectively), or major bleeding (2.3%, 2.9%, and 2.8%, respectively) were similar in the three groups. However, the percentage of patients who had received thromboprophylaxis (96%, 76% and 52%, respectively), the duration of prophylaxis (17 +/- 9.6, 13 +/- 8.9, and 12 +/- 11 days, respectively) and the mean daily doses of low-molecular-weight heparin (4,252 +/- 1,016, 3,260 +/- 1,141, and 3,769 +/- 1,650 IU, respectively), were significantly lower in those undergoing cancer surgery or other procedures. In conclusion, the clinical presentation, time-course, and three-month outcome of VTE was similar among the different subgroups of patients, but the use of prophylaxis in patients undergoing cancer surgery or other procedures was suboptimal.

El implante de condrocitos autólogos en la red sanitaria pública de Andalucía. Resultados tras 6 años de circuito asistencial.

Objective: To asses the results of Autologous Chondrocyte Implantation (ACI) whith periosteal patch and To propagate the care circuits existing about in Andalusia. Material and Methods: From its of ficial licence in 2005, the tissue bank and the Virgen de la Victoria Hospital from Málaga, performed the ACI in the Andalusian public health system. 16 patients has been operated between 2006-2013, whith medium follow-up 47,6 months (6 months-6 years), from public hos- pitals throughout Andalucia, managed by hospital admission source and destination. Physiologically younger patients were selected (<50 años), with singles, > 2cm2 symptomatics chondral lesions, in stables and well aligned knees. ACI was used as res- cue procedure after microfracture ́s failure except osteochondritis dissecans. To assess the results the Concinnati score and the Short Form 36 (SF-36) score were used. A descriptive analysis was performed and non-parametric tests were used to establish correlations and compare results. Results: In 15 patients with more than one year of follow-up: 14 men(87.5%) and 2women (14.5%), medium age 28.2 years old (min 17 max 43), the lesion was located into de femoral condyle, mostly in the internal one (81,2%) with medium size 2,7cm2(2-4,2). We founded significant improvement (p<0,001), both daily activities ( 89,3% preop. limitatión - 9% postop), as in the sports (90,2% preop limitatión - 38% postop) and the exploration of the knee (67,7% hpatological findings preop- 13,3%postop). The SF-36 score improved in all categories, over all in mental health (p> 0,01). The patient satisfaction was high or very high in 12 of the 15 patients ( 80%), and low in 3 patients. Conclusions: ACI improve quality of life and knee function in femoral condyle chondral lesions. The case ́s selection and the collaboration with Tissue Bank, allows us to create care circuits for treatment of patients from other provinces in the Public Sanitary Health System in Andalucia. It is necessary to increase the experience with this type of therapy, consolidating multicenter workgroups that provide strength to the conclusions.