Lack of extended venous thromboembolism prophylaxis in high-risk patients undergoing major orthopaedic or major cancer surgery. Electronic Assessment of VTE Prophylaxis in High-Risk Surgical Patients at Discharge from Swiss Hospitals (ESSENTIAL)

Extended pharmacological venous thromboembolism (VTE) prophylaxis beyond discharge is recommended for patients undergoing high-risk surgery. We prospectively investigated prophylaxis in 1,046 consecutive patients undergoing major orthopaedic (70%) or major cancer surgery (30%) in 14 Swiss hospitals. Appropriate in-hospital prophylaxis was used in 1,003 (96%) patients. At discharge, 638 (61%) patients received prescription for extended pharmacological prophylaxis: 564 (77%) after orthopaedic surgery, and 74 (23%) after cancer surgery (p < 0.001). Patients with knee replacement (94%), hip replacement (81%), major trauma (80%), and curative arthroscopy (73%) had the highest prescription rates for extended VTE prophylaxis; the lowest rates were found in patients undergoing major surgery for thoracic (7%), gastrointestinal (19%), and hepatobiliary (33%) cancer. The median duration of prescribed extended prophylaxis was longer in patients with orthopaedic surgery (32 days, interquartile range 14-40 days) than in patients with cancer surgery (23 days, interquartile range 11-30 days; p<0.001). Among the 278 patients with an extended prophylaxis order after hip replacement, knee replacement, or hip fracture surgery, 120 (43%) received a prescription for at least 35 days, and among the 74 patients with an extended prophylaxis order after major cancer surgery, 20 (27%) received a prescription for at least 28 days. In conclusion, approximately one quarter of the patients with major orthopaedic surgery and more than three quarters of the patients with major cancer surgery did not receive prescription for extended VTE prophylaxis. Future effort should focus on the improvement of extended VTE prophylaxis, particularly in patients undergoing major cancer surgery.

Computer technology applications in surgical implant dentistry: a systematic review

PURPOSE: To assess the literature on accuracy and clinical performance of computer technology applications in surgical implant dentistry. MATERIALS AND METHODS: Electronic and manual literature searches were conducted to collect information about (1) the accuracy and (2) clinical performance of computer-assisted implant systems. Meta-regression analysis was performed for summarizing the accuracy studies. Failure/complication rates were analyzed using random-effects Poisson regression models to obtain summary estimates of 12-month proportions. RESULTS: Twenty-nine different image guidance systems were included. From 2,827 articles, 13 clinical and 19 accuracy studies were included in this systematic review. The meta-analysis of the accuracy (19 clinical and preclinical studies) revealed a total mean error of 0.74 mm (maximum of 4.5 mm) at the entry point in the bone and 0.85 mm at the apex (maximum of 7.1 mm). For the 5 included clinical studies (total of 506 implants) using computer-assisted implant dentistry, the mean failure rate was 3.36% (0% to 8.45%) after an observation period of at least 12 months. In 4.6% of the treated cases, intraoperative complications were reported; these included limited interocclusal distances to perform guided implant placement, limited primary implant stability, or need for additional grafting procedures. CONCLUSION: Differing levels and quantity of evidence were available for computer-assisted implant placement, revealing high implant survival rates after only 12 months of observation in different indications and a reasonable level of accuracy. However, future long-term clinical data are necessary to identify clinical indications and to justify additional radiation doses, effort, and costs associated with computer-assisted implant surgery.