Purpose To review the evidence surrounding appropriate prophylaxis for venous thromboembolism (VTE) in patients undergoing surgery. Principal findings Appropriate prophylactic strategies for surgical patients have been defined in major society guidelines. We review the evidence behind these guidelines in a case-based format, including patients with a high risk of bleeding, history of heparin-induced thrombocytopenia, obesity, and cancer. Selecting the most suitable means for VTE prophylaxis includes evaluating patient, anesthetic, and surgical factors. Nevertheless, pharmacologic VTE prophylaxis will be appropriate for the vast majority of inpatients undergoing surgery.

IntroductionPatients with severe acute kidney injury (AKI) who are hospitalized at centers that do not provide renal replacement therapy (RRT) are frequently subjected to inter-hospital transfer for the provision of RRT. It is unclear whether such transfers are associated with worse patient outcomes as compared with the receipt of initial care in a center that provides RRT. This study examined the relationship between inter-hospital transfer and 30-day mortality among critically ill patients with AKI who received RRT.MethodsWe conducted a retrospective cohort study of all critically ill patients who commenced RRT for AKI at two academic hospitals in Toronto, Canada. The exposure of interest was inter-hospital transfer for the administration of RRT. We evaluated the relationship between transfer status and 30-day mortality (primary outcome) and RRT dependence at 30 days following RRT initiation (secondary outcome), by using multivariate logistic regression with adjustment for patient demographics, clinical factors, biochemical indices, and severity of illness.ResultsOf 370 patients who underwent RRT for AKI, 82 (22.2%) were transferred for this purpose from another hospital. Compared with non-transferred patients who started RRT, transferred patients were younger (61 ± 15 versus 65 ± 15 years, P = 0.03) and had a higher serum creatinine concentration at RRT initiation (474 ± 295 versus 365 ± 169 μmol/L, P = 0.002). Inter-hospital transfer was not associated with mortality (adjusted odds ratio 0.61, 95% confidence interval 0.33 to 1.12) or RRT-dependence (adjusted odds ratio 1.64, 95% confidence interval 0.70 to 3.81) at 30 days.ConclusionsWithin the limitations of this observational study and the potential for residual confounding, inter-hospital transfer of critically ill patients with AKI was not associated with a higher risk of death or dialysis dependence 30 days after the initiation of acute RRT.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0513-1) contains supplementary material, which is available to authorized users.

No abstract