Symptomatic chronic subdural hematoma is treated by surgical evacuation followed by drain insertion for post-operative drainage. There is no international consensus on the location of the drain (subdural or subperiosteal), the type of drainage (passive or active suction), or the duration of drainage (hours or days). However, a growing body of literature highlights the risk of iatrogenic brain injury during subdural drain insertion, causing increased interest in the subperiosteal drainage technique, which has been suggested to be equally effective. There is no consensus on the optimal subperiosteal drain insertion technique, resulting in numerous technical variations in the published literature. Additionally, drain anchoring is crucial to prevent the drain from displacing away from the burr hole. To address both issues, this article presents a standardized method for subperiosteal drain insertion and a novel anchorage technique for drains. All necessary drain entry-, exit-, and anchorage points are clearly defined and marked prior to placement of local anesthesia and skin incision. The stepwise insertion and anchorage of the drain are thoroughly described and illustrated, as well as the removal of the drain after post-operative drainage is complete.

BACKGROUND:In Denmark, the current treatment of patients with symptomatic chronic subdural hematoma (CSDH) is single burr hole hematoma evacuation followed by 24-h passive subdural drainage. However, recent studies indicate that 24-h active subperiosteal drainage may be safer and have fewer recurrences. The upcoming SUPERDURA trial will investigate 24-h active subperiosteal drainage versus 24-h passive subdural drainage following single burr-hole evacuation of symptomatic CSDH. This study presents the statistical analysis plan for the SUPERDURA trial. METHODS:SUPERDURA is a national multi-center non-inferiority randomized clinical trial. The primary outcome is a composite of 90-day mortality and ipsilateral recurrent CSDH requiring reoperation within the 90-day observation period. Secondary outcomes are 90-day simplified modified Rankin Scale questionnaire (smRSq) score, complications related to surgery, postoperative serious adverse events during the admission and at 90 days, and length of hospitalization. Exploratory outcomes are smRSq score as an ordinal outcome, each component of the primary outcome, and discharge destination. A total of 354 participants must be included (177 in each intervention group) in the study to achieve a stable power > 90% with an alpha of 5% for non-inferiority testing of the primary composite outcome with a margin at 7% absolute risk increase. The allocation sequence and block sizes are blinded to the investigators. Interim analyses for safety and efficacy/futility will be performed after follow-up is completed for 120 and 240 participants, respectively. A Data Safety Monitoring Committee charter has been created following published recommendations. Final analysis will be done by two statisticians blinded to the intervention, creating two abstracts that are unblinded once approved by the study steering committee. DISCUSSION:The proposed analysis plan is designed in accordance with current guidelines, has clinically important primary and secondary outcomes, and was submitted before the inclusion of the first participant in the SUPERDURA trial to limit bias and increase study transparency and reproducibility. TRIAL REGISTRATION:ClinicalTrials.gov identifier NCT06621407.

Chronic subdural hematoma (CSDH) frequently recurs after burr-hole craniostomy with drainage. The role of intraoperative irrigation—whether to irrigate at all, and the optimal fluid, temperature, and volume—remains uncertain. We aimed to synthesise contemporary comparative evidence. MEDLINE, Embase, and Scopus were searched to 14 October 2024; ClinicalTrials.gov and grey literature (conference abstracts, theses/dissertations) were also searched. Screening and risk-of-bias assessment were performed in duplicate. The primary outcome was reoperation for recurrence; mortality and overall complications were secondary outcomes. Random-effects meta-analyses pooled two prespecified comparisons: irrigation versus no irrigation and artificial cerebrospinal fluid (aCSF) versus saline. Heterogeneity (I²/τ²) and small-study effects (Egger’s test where k ≥ 10) were examined, with fixed-effects models as sensitivity analyses. Irrigation temperature and volume were summarised narratively because of heterogeneous protocols. Fifty-six studies were included. Across 29 comparisons (n = 4,042), irrigation did not clearly reduce reoperation versus no irrigation (RR 0.89, 95

Passive subdural drainage is used to reduce the risk of chronic subdural hematoma (cSDH) recurrence and mortality. However, the effects of patient positioning on intracranial pressure (ICP) during passive drainage remain unclear. To examine how subdural drainage and patient positions influence postoperative ICP in cSDH patients with a subdural passive drainage system. This was a prospective, single-center observational cohort study. Eleven patients (mean age 78 years) underwent burr hole evacuation for cSDH with placement of a subdural drain connected to a bile bag system. An ICP probe was placed in the subdural space posteriorly via the same burr hole. During the first 48 h, ICP was measured in supine, 30° head elevation, and sitting positions before and after removal of the subdural drain. Given the small sample size, the study was a priori considered hypothesis‑generating; the width of confidence intervals and potential type II error are therefore emphasised throughout. Also, the associations between ICP and radiographic parameters (midline shift, hematoma size, pneumocephalus) were assessed. When all positions were combined, mean ICP with the drain in situ was − 2.5 (− 4.8 to − 0.2) mmHg versus − 0.5 (− 2.9 to 1.9) mmHg after removal (p = 0.233). Position-specific differences after vs before removal were likewise small and non-significant: supine -1.9 (-7.8 to 4.1, p = 0.537), 30° -2.6 mmHg (-8.5 to 3.3, p = 0.378), sitting -3.6 (-9.8 to 2.6, p = 0.244) mmHg; mixed-effects modelling confirmed these findings. Greater midline shift and hematoma volume were associated with higher ICP, whereas larger pneumocephalus volumes correlated with lower ICP. After burr-hole evacuation of cSDH, ICP remained within normal physiological limits across all head positions, both with the subdural drain in situ and after its routine removal at 24 h. Providing that the drainage height is adjusted to the pivot point for CSF pressure at shoulder level, mobilization—even to the upright position—did not provoke dangerously low ICP. These data, together with emerging randomised evidence, support early mobilisation after cSDH surgery; nonetheless, confirmation in adequately powered multicentre trials is required before firm practice recommendations can be issued.

OBJECTIVE: Chronic subdural hematoma (CSDH) poses a significant recurrence risk, yet predicting recurrence and its impact remains a challenge. This study investigates whether patient competence-defined as the ability to understand and make informed medical decisions-affects recurrence risk, and examines how recurrence impacts patients' quality of life (QoL) at a 90-day postsurgical follow-up. METHODS: In this subanalysis of the Drain Time 2 trial, we analyzed data from 330 patients undergoing primary surgery for CSDH. Patients were categorized as competent (n = 281) or incompetent (n = 49) based on clinician evaluations. We explored associations among patient competence, recurrence, mortality, and QoL using the Short Form Health Survey (SF-36) questionnaire. Statistical analyses included logistic regression for recurrence and mortality, and independent t-tests and multiple linear regression for SF-36 scores. RESULTS: Of 330 patients, no significant correlation was found between patient incompetence and CSDH recurrence. Recurrence rates were 20% in competent patients and 14% in incompetent patients (P = 0.382). However, incompetence was significantly associated with increased mortality (unadjusted odds ratio [OR]: 24.3, P < 0.001; fully adjusted OR: 41, P < 0.001) and the composite outcome of recurrence or death (unadjusted OR: 2.2, P = 0.019; fully adjusted OR: 2.3, P = 0.021). Preoperative SF-36 scores improved significantly postoperatively (107.2 to 113.9, P < 0.001); yet no significant difference in QoL was observed between competent patients with and without recurrence CONCLUSIONS: Patient incompetence was not significantly associated with CSDH recurrence within 90 days. However, it was strongly associated with increased mortality. Additionally, recurrence did not significantly impact the QoL in competent patients at follow-up. Further research is needed to investigate long-term QoL outcomes, particularly among incompetent patients, to better understand potential lasting effects.

Objective This study aimed to investigate the immunologic profile of chronic subdural hematoma (CSDH) subtypes based on their radiologic appearances, with a focus on comparing the membranous CSDH to other subtypes. Methods We prospectively analyzed 170 CSDH cases from 138 patients, categorizing them into “Membranous” and ‘Other’ subtypes based on computed tomography scans. Samples were collected from the subdural fluid and systemic blood and analyzed for a panel of inflammatory markers. Demographic data, clinical characteristics, and time since trauma were also assessed. Results Time since trauma to diagnostic computed tomography was significantly longer for the “membranous” subtype (P = 0.001). ‘Membranous” CSDH exhibited a distinct immunoprofile, including lower hemoglobin levels (P = 0.0002) and higher concentrations of matrix metallopeptidase 9 (P = 0.005) and interleukin-8 (IL-8) (P < 0.0001). Additionally, “Membranous” CSDH showed elevated levels of interferon gamma-induced protein 10, monokine induced by gamma interferon, and uPAR compared to ‘Other’ subtypes, with significant correlations between interferon gamma-induced protein 10 and monocyte chemoattractant protein-1 (P = 0.013), monokine induced by gamma interferon (P = 0.002), and urokinase-type plasminogen activator receptor (P = 0.006). IL-8 levels also correlated significantly with monocyte chemoattractant protein-1 (P = 0.02), suggesting distinct inflammatory pathways in the “Membranous” subtype. Conclusions This study demonstrates that CSDH subtypes, particularly the “Membranous” subtype, possess a distinct immunologic profile. These findings provide novel insights into CSDH pathophysiology. The unique inflammatory landscape of “Membranous” CSDH, marked by elevated matrix metallopeptidase 9 and IL-8 levels, may contribute to its chronic nature.

Objective: Lordosis Distribution Index (LDI) is a new radiographic parameter associated with postoperative residual symptoms in patients undergoing Transforaminal Lumbar Interbody Fusion (TLIF). Recently, it has been applied on patients undergoing instrumented spine surgery, however not correlated to Patient Related Outcome Measures (PROMs). This study investigates whether the obtained the postoperative LDI after TLIF surgery correlates with the clinical outcome measured with PROMs. Methods: This study was based on prospectively obtained data in patients undergoing TLIF throughout 2017 at a Danish university hospital. Medical records and the DaneSpine Database were accessed to obtain preoperative, operative and follow-up data. Primary outcome was Oswestry Disability Index (ODI) 12 months postoperatively. Secondary outcomes included revision rate and additional PROMs. Results: 126 patients were included. 70 patients were classified with normolordosis (56 %), 42 hypolordosis (33 %) and 14 hyperlordosis (11 %). All groups experienced significant radiological changes undergoing surgery. Average reduction in ODI at 12 months postoperatively was -15.3 (+/- 20.0). Minimally clinical important difference was achieved in 68 patients (54.0 %). No significant difference in PROMs between LDI-groups was observed in unadjusted or adjusted analyses. Revision surgery was performed in 8 patients with normolordosis (11.4 %), 7 hypolordosis (16.7 %) and 4 hyperlordosis (28.6 %). Conclusions: We found no significant correlation between postoperative LDI subgroups of normolordotic, hypo- or hyperlordotic patients and the clinical outcome of posterolateral fusion and TLIF surgery. A trend towards lower rate of revision surgery in the normolordotic group compared to the hypo- and hyperlordotic group was observed.

Differentiating recurrent cerebral metastasis (CM) from brain radiation necrosis (BRN) is pivotal for guiding appropriate treatment and prognostication. Despite advances in imaging techniques, however, accurately distinguishing these conditions non-invasively is still challenging. This single-center retrospective study reviewed 32 cases (28 patients) with confirmed cerebral metastases who underwent surgical excision of lesions initially diagnosed by MRI and/or MR perfusion scans from 1 January 2015 to 30 September 2020. Diagnostic accuracy was assessed by comparing imaging findings with postoperative histopathology. Conventional MRI accurately identified recurrent CM in 75% of cases. MR perfusion scans showed significantly higher mean maximum relative cerebral blood volume (max. rCBV) in metastasis cases, indicating its potential as a discriminative biomarker. No single imaging modality could definitively distinguish CM from BRN. Survival analysis revealed gender as the only significant factor affecting overall survival, with no significant survival difference observed between patients with CM and BRN after controlling for confounding factors. This study underscores the limitations of both conventional MRI and MR perfusion scans in differentiating recurrent CM from BRN. Histopathological examination remains essential for accurate diagnosis. Further research is needed to improve the reliability of non-invasive imaging and to guide the management of patients with these post-radiation events.

This review investigates focused ultrasound for treating neuro-oncological diseases as an emerging treatment modality. The technique is based on focused ultrasound waves guided by MRI. By using high or low-frequency waves, thermoablation of smaller tissue volumes centrally in the brain or a safe, temporary opening of the blood-brain barrier can be carried out for better penetration of chemotherapy. Numerous studies on neuro-oncological treatments are ongoing, signaling increasing popularity for the technique in the near future.

BACKGROUND AND OBJECTIVES: In most neurosurgical centers, irrigation is an essential part of the surgical procedure for chronic subdural hematoma (CSDH). However, it is unknown whether the volume of irrigation fluid affects the risk of CSDH recurrence. This study aimed to investigate a potential association between the volume of irrigation fluid used during burr hole evacuation of CSDH and the risk of CSDH recurrence. METHODS: This study is a subanalysis of 2 randomized trials (Drain Time & Drain Time 2) designed to investigate the effect of drainage duration on the recurrence of CSDH. Intraoperative irrigation volume was measured, and patients were followed for 90 days for recurrent CSDH. RESULTS: A total of 525 patients with CSDH were included. There was no significant difference in the volume of irrigation fluid used between patients with recurrence (mean = 938 mL, SD = ±552) and without recurrence (mean = 852 mL, SD = ±454) ( P -value = .15). Patients with recurrent CSDH had larger primary CSDH volumes (mean = 134 cm 3 , SD = ±69) than patients without recurrence (mean = 119 cm 3 , SD = ±58) ( P = .04). Multiple logistic regression analysis revealed no association between irrigation volume and recurrence, also when stratified for hematoma size. CONCLUSION: There was no significant association between irrigation volume and recurrent CSDH within 90 days in patients undergoing burr hole surgery for CSDH.

Introduction Acetylsalicylic acid (ASA) has commonly been touted for its potential to extend the aesthetic lifespan (EL) of Christmas trees when added to the water in the tree stand. This study examined the efficacy of ASA in prolonging the aesthetic longevity of spruce branches, in comparison to placebo and sildenafil. Intervention We conducted a triple-blinded, randomised clinical trial, wherein 60 spruce branches were allocated to one of three treatment arms in a 1:1:1 ratio. The primary intervention was ASA, compared against both placebo and sildenafil treatments. The study's primary endpoint was the EL of the spruce branches. Results All participating branches completed the study. No statistically significant differences were observed in the survival times across the three groups: ASA 17 days (standard deviation (SD): 6), placebo 20 days (SD: 8), and sildenafil 21 days (SD: 7); p = 0.30. Both the log-rank test and adjusted Cox proportional-hazards analyses failed to show any significant variations in aesthetic survival time among the treatment arms (p > 0.05). Conclusion Given our findings, there is no empirical support for the widely held recommendation of adding ASA to the water at the base of a Christmas tree to extend its aesthetic lifespan. Funding none. Trial registration none.

Abstract Christmas trees are engaged in a race against time, from being cut down to Christmas Eve, where their beauty must be maximized. An old housewife's remedy recommends adding an aspirin tablet to the water for the Christmas tree to extend its period of looking beautiful (Aesthetic Lifespan: AL). However, there is no evidence supporting this advice, so we pose the question: Can acetylsalicylic acid (ASA) prolong the lifespan of Norway spruces in terms of AL? We will include 60 spruce branches divided into three groups of 20 and examine the effects of ASA compared to a placebo group, as well as a group where we intervene with Sildenafil. Our hypothesis is that the antipyretic effect of aspirin will lower the internal temperature of the spruce branches, bringing them closer to the conditions in which the tree was cut down - the cold December weather.

Abstract Background Acute Kidney Injury (AKI) is a frequent and serious postoperative complication in trauma or critically ill patients in the intensive care unit. We aimed to estimate the risk of AKI following major emergency abdominal surgery and the association between AKI and 90-day postoperative mortality. Methods In this retrospective cohort study, we included patients undergoing major emergency abdominal surgery at the Department of Surgery, Zealand University Hospital, Denmark, from 2010 to 2016. The primary outcome was the occurrence of AKI within postoperative day seven (POD7). AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO)-criteria. The risk of AKI was analysed with a multivariable logistic regression. The association between AKI and 90-day mortality was analysed with a multivariable survival analysis. Results In the cohort, 122 out of 703 (17.4%) surgical patients had AKI within POD7. Of these, 82 (67.2%) had AKI stage 1, 26 (21.3%) had AKI stage 2, and 14 (11.5%) had AKI stage 3. Fifty-eight percent of the patients who developed postoperative AKI did so within the first 24 h of surgery. Ninety-day mortality was significantly higher in patients with AKI compared with patients without AKI (41/122 (33.6%) versus 40/581 (6.9%), adjusted hazard ratio 4.45 (95% confidence interval 2.69–7.39, P < 0.0001)), and rose with increasing KDIGO stage. Pre-existing hypertension and intraoperative peritoneal contamination were independently associated with the risk of AKI. Conclusions The risk of AKI is high after major emergency abdominal surgery and is independently associated with the risk of death within 90 days of surgery.

Major emergency abdominal surgery is associated with excess mortality. Transfusion is known to be associated with increased morbidity and emergency surgery is an independent risk factor for perioperative transfusion. The primary objectives of this study were to identify risk factors for transfusion, and secondarily to investigate the influence of transfusion on clinical outcomes after major emergency abdominal surgery. This study combined retrospective observational data including intraoperative, postoperative, and transfusion data in patients undergoing major emergency abdominal surgery from January 2010 to October 2016 at a Danish university hospital. The primary outcome was a transfusion of any kind from initiation of surgery to postoperative day 7. Secondary outcomes included 7-, 30-, 90-day and long-term mortality (median follow-up = 34.6 months, IQR = 13.0–58.3), lengths of stay, and surgical complication rate (Clavien–Dindo score ≥ 3a). A total of 1288 patients were included and 391 (30%) received a transfusion of any kind. Multivariate logistic regression identified age, hepatic comorbidity, cardiac comorbidity, post-surgical anemia, ADP-receptor inhibitors, acetylsalicylic acid, anticoagulants, and operation type as risk factors for postoperative transfusion. 60.1% of the transfused patients experienced a serious surgical complication within 30 days of surgery compared with 28.1% of the non-transfused patients (p < 0.001). Among patients receiving a postoperative transfusion, unadjusted long-term mortality was increased with a hazard ratio of 3.8 (95% CI 2.9–5.0), p < 0.01. Transfused patients had significantly higher mortality at 7-, 30-, 90- and long-term, as well as a longer hospital stay but in the multivariate analyses, transfusion was not associated with mortality. Peri- and postoperative transfusion in relation to major emergency abdominal surgery was associated with an increased risk of postoperative complications. The potential benefits and harms of blood transfusion and clinical significance of pre- and postoperative anemia after major emergency abdominal surgery should be further studied in clinical prospective studies.

Background: Early oral or enteral nutrition (EEN) has been proven safe, tolerable, and beneficial in elective surgery. In emergency abdominal surgery no consensus exists regarding postoperative nutrition standard regimens. This review aimed to assess the safety and clinical outcomes of EEN compared to standard care after emergency abdominal surgery. Methods: The review protocol was performed according to the Cochrane Handbook and reported according to PRISMA. Clinical outcomes included mortality, specific complication rates, length of stay, and serious adverse events. Risk of bias was assessed by Cochrane risk of bias tool and Downs and Black. GRADE assessment of each outcome was performed, and Trial Sequential Analysis was completed to obtain the Required Information Size (RIS) of each outcome. Results: From a total of 4741 records screened, a total of five randomized controlled trials and two nonrandomized controlled trials were included covering 1309 patients. The included studies reported no safety issues regarding the use of EEN. A significant reduction in the mortality rate of EEN compared with standard care was seen (OR 0.59 (CI 95% 0.34-1.0 0), I2 1/4 0%). Meta-analyses on sepsis and postoperative pulmonary complications showed non-significant tendencies in favor of EEN compared with standard care. GRADE assessment of all outcomes was evaluated ?low? or ?very low?. Trial Sequential Analysis revealed that all outcomes had insufficient RIS to confirm the effects of EEN. Conclusion: EEN after major emergency surgery is correlated with reduced mortality, however, more high-quality data regarding the optimal timing and composition of nutrition are needed before final conclusions regarding the effects of EEN can be made. 0 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Fast axonal transport of neuropeptide-containing dense core vesicles (DCVs), endolysosomal organelles, and presynaptic components is critical for maintaining neuronal functionality. How the transport of DCVs is orchestrated remains an important unresolved question. The small GTPase Rab2 mediates DCV biogenesis and endosome-lysosome fusion. Here, we use Drosophila to demonstrate that Rab2 also plays a critical role in bidirectional axonal transport of DCVs, endosomes, and lysosomal organelles, most likely by controlling molecular motors. We further show that the lysosomal motility factor Arl8 is required as well for axonal transport of DCVs, but unlike Rab2, it is also critical for DCV exit from cell bodies into axons. We also provide evidence that the upstream regulators of Rab2 and Arl8, Ema and BORC, activate these GTPases during DCV transport. Our results uncover the mechanisms underlying axonal transport of DCVs and reveal surprising parallels between the regulation of DCV and lysosomal motility.

The purpose of this study was to evaluate the timewise postoperative respiratory function measured by spirometry and peak flow during the first postoperative week after major emergency abdominal surgery. Patients were tested daily with forced expiratory volume (FEV) and peak flow (PEF) from postoperative day (POD) 1 through to POD7. FEV1, FEV6, FEV1/FEV6 ratio and PEF were analysed by unadjusted linear regression with 95% confidence interval (CI) on mean values for each postoperative day. A total of 35 consecutive patients were included in the study. The FEV at 1 second was 51% of predicted at POD1, which increased to 67% at POD7 (p = 0.005), whereas FEV6 was 55% of predicted at POD1, which increased to 70% at POD7 (p = .008). Respiratory function was not significantly correlated to synchronous pain scores. In conclusion, respiratory function following major emergency abdominal surgery was reduced throughout the first postoperative week irrespective of pain scores.

Objectives: To evaluate whether blondes have more fun, as proposed by Sir Roderick David Stewart in 1978. Design: Prospective, non-randomised crossover field study, 1-2 June 2018. Setting: Single centre medical writing course, during a break in the course program. Participants: Convenience sample of 21 healthy Danish researchers: ten blondes, nine non-blondes, and two with missing data (bald). Intervention: Participants completed a visual analogue scale (VAS) for fun and Profile of Mood States-Adolescents (POMS-A) questionnaires before and after two rides each on a waterslide (once sitting upright, once lying down). There was a wash-out between rides. Main outcome measures: Fun, as assessed by VAS completed moments after completing each waterslide ride. Results: Blondes did not have more fun than non-blondes, neither while sitting upright (median VAS. 60 [IQR, 23-66] v25 [10R, 4.5-57]; P= 0.39) nor lying down (median VAS, 70 [IQR, 60-85] v 66 [IQR, 35-80]; P= 0.62). Riding the waterslide lying down was significantly faster (median duration. 9 s; range, 8-13 s) than sitting upright (median duration, 13.6 s; range. 8-37 s; P< 0.001). and also more fun (median VAS, 72 [IQR, 59-85] v41 [IQR, 14-66]; P= 0.002). Conclusions: Our findings are not consistent with the statement by Sir Roderick David Stewart that "blondes have more fun"; we found no evidence that blondes experience more fun or are more susceptible to mood changes than non-blondes.

In a retrospective cohort study, we looked at the incidence and risk factors of developing in-hospital venous thromboembolism (VTE) after major emergency abdominal surgery and the risk factors for developing a venous thrombosis. Data were extracted through medical records from all patients undergoing major emergency abdominal surgery at a Danish University Hospital from 2010 until 2016. The primary outcome was the incidence of venous thrombosis developed in the time from surgery until discharge from hospital. The secondary outcomes were 30-day mortality and postoperative complications. Multivariate logistic analyses were used for confounder control. In total, 1179 patients who underwent major emergency abdominal surgery during 2010–2016 were included. Thirteen patients developed a postoperative venous thromboembolism (1.1%) while hospitalized. Eight patients developed a pulmonary embolism all verified by CT scan and five patients developed a deep venous thrombosis verified by ultrasound scan. Patients diagnosed with a VTE were significantly longer in hospital with a length of stay of 34 versus 14 days, P < 0.001, and they suffered significantly more surgical complications (69.2% vs. 30.4%, P = 0.007). Thirty-day mortality was equal in patients with and without a venous thrombosis. In a multivariate analysis adjusting for gender, ASA group, BMI, type of surgery, dalteparin dose and treatment with anticoagulants, we found that a dalteparin dose ≥5000 IU was associated with the risk of postoperative surgical complications (odds ratio 1.55, 95% CI 1.11–2.16, P = 0.009). In this study, we found a low incidence of venous thrombosis among patients undergoing major emergency abdominal surgery, comparable to the incidence after elective surgery.