The incidence of perioperative cerebrovascular accidents (CVAs) was 4.4% for PC, 0.8% for PTFE-PC, and 0% for vein patch closure (PC vs vein patch, p = 0.0165; PC vs all patching [vein and PTFE], p = 0.007). The perioperative CVA and reversible ischemic neurologic deficit (RIND) combined rates for all patching were superior to PC (1.5% vs 5.2%; p = 0.04). These combined rates were also superior for vein patch closure when compared with PC (0.8% vs 5.2%; p = 0.037). The mean diameter of the internal carotid artery was similar in patients who had perioperative neurologic deficits and those who did not. After 1 month of follow-up, 11.9% of the PC arteries were narrowed 50% or more in contrast to 2.3% for PTFE-PC, 3.1% for SVP, and 10.3% for JVP.

Objective: To determine the odds of cesarean, operative vaginal delivery and vaginal birth after cesarean after successful external cephalic version (ECV) compared with singleton pregnancies eligible for a trial of labor.Study Design: A matched case-control study was performed using the Memorial Care OBStat Database from 1 January 1998 to 31 July 2006. We identified 197 participants who underwent a successful ECV (study group) and compared them with the next two women presenting for labor management, matched for parity, gestational age, delivery history (previous cesarean delivery) and type of labor (spontaneous or induced).Result: There was no significant difference in the adjusted matched odds of cesarean delivery between the study group and control group overall (16.8 vs 11.9%; odds ratio (OR) 1.70; 95% confidence interval (CI) 0.98 to 2.97), even when subanalyzed according to parity. There was also no significant difference in adjusted matched odds of operative vaginal delivery for the study group and control group, 15.9 vs 8.9% (OR 1.06; 95% CI 0.32 to 3.51). Among patients with a prior cesarean, those who underwent successful ECV had a cesarean delivery rate of 11.1% compared with 16.7% in the matched control group (OR 0.59; 95% CI 0.47 to 7.43).Conclusion: Cesarean delivery and operative vaginal delivery rates following successful ECV are not increased in our data set compared with matched controls, even in patients with a prior cesarean delivery. This information may be useful when counseling patients who are contemplating an ECV attempt due to non-cephalic presentation at term.

The computer-driven protocol achieved excellent glycemic control.

BackgroundPost-operative wound care can be an important strategy to prevent surgical site infection (SSI) following craniotomy. Insufficient wound care, blood clots, and oily hair near the incision can increase SSI risk.MethodsWe conducted a pre-post prospective cohort evaluation of a quality improvement intervention to address inpatient post-operative craniotomy wounds at an academic hospital. A post-op wound care protocol was jointly developed by neurosurgical wound care nurses, clinicians, and infection preventionists. The protocol began on postoperative day 1, and included use of soft ties to keep adjacent hair away from the incision, use of 2% CHG cloths to clean skin and hair within 2 inches of the incision as well as the proximal 6 inches of any surgical drain, and use of 2% CHG cloths to remove blood clots. Selection of 2% CHG cloths for blood clot removal was made following comparison to several concentrations of peroxide. A twice-weekly photo-survey of all inpatients undergoing craniotomy was undertaken during the baseline period (October–December 2018) and intervention period (March–April 2019), with feedback to wound care nurses occurring during the intervention period only. The proportion of redness, extensive blood clots (>50% incision), and oily hair near the incision were compared between the baseline period and the intervention period using Fisher’s exact tests.ResultsA total of 156 photo assessments were performed in 71 patients (101 assessments in 45 patients in the baseline period, and 55 photo assessments in 26 patients in the intervention period). Demographics, body mass index, emergent status, and prior craniotomy were similar across the baseline and intervention periods. The intervention was associated with significant reductions in redness (27.7% vs. 11%, P = 0.015), blood clots (33.7% vs. 10.9%, P = 0.002), and oily hair near the incision (76.7% vs. 28.6%, P < 0.001) (Figure 1).ConclusionThe care of post-operative craniotomy wounds and adjacent hair was significantly improved through a standardized protocol to remove blood clots and ensure clean skin and hair adjacent to the incision during the post-operative inpatient stay. Photo documentation and feedback to wound care nurses helped ensure protocol adherence. Disclosures All authors: No reported disclosures.