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Quddusi A, Pedro KM, Alvi MA, Hejrati N, Fehlings MG. Early surgical intervention for acute spinal cord injury: time is spine. Acta Neurochir (Wien) 2023; 165:2665-2674. [PMID: 37468659 DOI: 10.1007/s00701-023-05698-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/28/2023] [Indexed: 07/21/2023]
Abstract
Acute traumatic spinal cord injury (tSCI) is a devastating occurrence that significantly contributes to global morbidity and mortality. Surgical decompression with stabilization is the most effective way to minimize the damaging sequelae that follow acute tSCI. In recent years, strong evidence has emerged that supports the rationale that early surgical intervention, within 24 h following the initial injury, is associated with a better prognosis and functional outcomes. In this review, we have summarized the evidence and elaborated on the nuances of this concept. Additionally, we have reviewed further concepts that stem from "time is spine," including earlier cutoffs less than 24 h and the challenging entity of central cord syndrome, as well as the emerging concept of adequate surgical decompression. Lastly, we identify barriers to early surgical care for acute tSCI, a key aspect of spine care that needs to be globally addressed via research and policy on an urgent basis.
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Affiliation(s)
- Ayesha Quddusi
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Karlo M Pedro
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mohammed Ali Alvi
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Nader Hejrati
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Michael G Fehlings
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
- Toronto Western Hospital, 399 Bathurst Street, Suite 4WW-449, Toronto, ON, M5T 2S8, Canada.
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Pedro KM, Fehlings MG. Time is spine: What's over the horizon. J Clin Orthop Trauma 2022; 35:102043. [PMID: 36340959 PMCID: PMC9634004 DOI: 10.1016/j.jcot.2022.102043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/13/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
The overarching theme in the early treatment of acute spinal cord injury (SCI) is to reduce the extent of secondary damage to facilitate early neurological and functional recovery. Although multiple studies have brought us innovative and potential new therapies to treat SCI, ameliorating neural damage remains a formidable challenge. Knowledge translation of clinical and basic research studies has shown that surgical intervention is a valuable treatment modality; however, the role, timing and optimal technique in surgery remains a topic of great controversy. While evidence to support the concept of ultra-early surgery for acute SCI continues to emerge, current protocols and international guidelines that encourage reducing time from trauma to surgery support the concept of "Time is Spine". The present article provides a critical narrative review of the current best practice, with a particular focus on the timing of surgical intervention, which shapes our understanding of how time is of the essence in the management of acute SCI.
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Affiliation(s)
- Karlo M. Pedro
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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Zilbermints V, Hershkovitz Y, Peleg K, Dubose JJ, Givon A, Aranovich D, Dudkiewicz M, Kessel B. Spinal cord injury in the setting of traumatic thoracolumbar fracture is not reliably associated with increased risk of associated intra-abdominal injury following blunt trauma: An analysis of a National Trauma Registry database. Chin J Traumatol 2021; 24:132-135. [PMID: 33824073 PMCID: PMC8173583 DOI: 10.1016/j.cjtee.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 02/15/2021] [Accepted: 03/02/2021] [Indexed: 02/04/2023] Open
Abstract
PURPOSE There is a common opinion that spinal fractures usually reflect the substantial impact of injuries and therefore may be used as a marker of significant associated injuries, specifically for intra-abdominal injury (IAI). The impact of concomitant spinal cord injury (SCI) with the risk of associated IAI has not been well clarified. The aim of this study was to evaluate the incidence and severity of IAIs in patients suffering from spinal fractures with or without SCI. METHODS A retrospective cohort study using the Israeli National Trauma Registry was conducted. Patients with thoracic, lumbar and thoracolumbar fractures resulting from blunt mechanisms of injury from January 1, 1997 to December 31, 2018 were examined, comparing the incidence, severity and mortality of IAIs in patients with or without SCI. The collected variables included age, gender, mechanism of injury, incidence and severity of the concomitant IAIs and pelvic fractures, abbreviated injury scale, injury severity score, and mortality. Statistical analysis was performed using GraphPad InStat ® Version 3.10, with Chi-square test for independence and two sided Fisher's exact probability test. RESULTS Review of the Israeli National Trauma Database revealed a total of 16,878 patients with spinal fractures. Combined thoracic and lumbar fractures were observed in 1272 patients (7.5%), isolated thoracic fractures in 4967 patients (29.4%) and isolated lumbar fractures in 10,639 patients (63.0%). The incidence of concomitant SCI was found in 4.95% (63/1272), 7.65% (380/4967) and 2.50% (266/10639) of these patients, respectively. The overall mortality was 2.5%, proving higher among isolated thoracic fracture patient than among isolated lumbar fracture counterparts (11.3% vs. 4.6%, p < 0.001). Isolated thoracic fractures with SCI were significantly more likely to die than non-SCI counterparts (8.2% vs. 3.1%, p < 0.001). There were no differences in the incidence of IAIs between patients with or without SCI following thoracolumbar fractures overall or in isolated thoracic fractures; although isolated lumbar fractures patients with SCI were more likely to have renal (3.4% vs. 1.6%, p = 0.02) or bowel injuries (2.3% vs. 1.0%, p = 0.04) than the non-SCI counterparts. CONCLUSION SCI in the setting of thoracolumbar fracture does not appear to be a marker for associated IAI. However, in a subset of isolated lumbar fractures, SCI patient is associated with increased risks for renal and bowel injury.
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Affiliation(s)
- Veacheslav Zilbermints
- Surgical Division, Hillel Yaffe Medical Center Affiliated to Rappoport Medical School, Technion, Hadera, Israel,Corresponding author.
| | - Yehuda Hershkovitz
- Department of Surgery, Shamir Medical Center Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kobi Peleg
- National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | | | - Adi Givon
- National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - David Aranovich
- Surgical Division, Hillel Yaffe Medical Center Affiliated to Rappoport Medical School, Technion, Hadera, Israel
| | - Mickey Dudkiewicz
- Hospital Administration, Hillel Yaffe Medical Center, Hadera, Israel
| | | | - Boris Kessel
- Surgical Division, Hillel Yaffe Medical Center Affiliated to Rappoport Medical School, Technion, Hadera, Israel
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Bibliometric Study of Pain after Spinal Cord Injury. Neural Plast 2021; 2021:6634644. [PMID: 33688338 PMCID: PMC7914384 DOI: 10.1155/2021/6634644] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/31/2021] [Accepted: 02/09/2021] [Indexed: 12/04/2022] Open
Abstract
Background The prevalence of comorbid pain after spinal cord injury (SCI) is relatively high in clinical observations and has continued to increase over time. Neuropathic pain (70.14%) is the most popular subject in academic journals after SCI. However, studies that used the bibliometric method to analyze comorbid pain after SCI are still lacking. This study is aimed at combining and integrating acquired information to analyze the global trends of research on the comorbidity of pain after SCI in the last three decades (1990–2019). Methods Systematic works of literature published from 1990 to 2019 were obtained from the Web of Science Core Collection. CiteSpace software was used to analyze the relationship of publication year with the country, institution, journals, authors, references, and keywords. The regression analysis is used to evaluate the percentage of the category increase or decrease over time significantly. IBM SPSS Statistics was used in the statistical analysis. Results A total of 730 publications were included in the analysis. A remarkable increase in the number of publications was observed in the study period (P < 0.05). A total of 202 academic journals focused on the categories of clinical neurology, neurosciences, and rehabilitation, and the annual growth rate of articles in these three categories was statistically significant (P < 0.05). The USA (356, 48.77%) and the University of Miami (64, 8.77%) were the country and institution with the highest number of publications, respectively. Spinal Cord, which was the main journal for research on pain after SCI, had the most publications (88, 12.05%). Burst keywords showed that the individual, inflammation, and central sensitization with pain after SCI are the research development trends and focus in this research field. Conclusions Overall, this study provides the latest research direction for pain after SCI. This historical overview of research into pain after SCI will be a useful basis for further research into development trends, focus issues, cooperators, and cooperative institutions.
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Al-Qurayshi Z, Sullivan CB, Pagedar N, Randolph G, Kandil E. Prevalence of major structures injury in thyroid and neck surgeries: a national perspective. Gland Surg 2020; 9:1924-1932. [PMID: 33447543 DOI: 10.21037/gs-20-369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background The objectives of the study is to examine the prevalence and burden of major structures injury (pharynx, esophagus, trachea, larynx, lymphatic, vessels & nerves) in patients who underwent thyroid, parathyroid, and neck dissection surgeries in the United States. Methods The study is a retrospective cross-sectional analysis utilizing the Nationwide Readmissions Database, 2010-2015. The study population included adults (≥18 years) patients who underwent thyroid, parathyroid, and neck dissection surgeries. Results A total of 54,443 patients were included. Major structures injury was reported in 221 (0.48%) patients. The injured structures were vascular (0.22%), lymphatic (0.18%), pharynx/esophagus (0.06%), neural (0.03%), and trachea/larynx (0.002%). The risk of injury increased annually during the study period (OR: 1.29, 95% CI: 1.16, 1.44, P<0.001). The risk of injury was highest in patients who underwent thyroidectomy with neck dissection (1.01%) or neck dissection alone (1.81%) (P<0.001 each). The risk was also highest for patients with a head and neck cancer diagnosis (OR: 1.80, 95% CI: 1.24, 2.61, P=0.002). Patients with those injuries had a higher prevalence of blood transfusion (2.82% vs. 0.17%), postoperative fistula (3.10% vs. 0.03%), readmission (28.90% vs. 3.59%), and postoperative mortality (0.87% vs. 0.06%) (P<0.05 each). Management of patients with those injuries was associated with a longer hospital stay by 4.86±0.48 days (P<0.001), and a higher cost by $16,151.00±173.36 (P<0.001). Conclusions Injuries of major structures in thyroid and neck surgeries are more prevalent in cancer patients. There has been a recent increase in the risk of such injuries in the United States. Those injuries are associated with significant clinical and economic burden.
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Affiliation(s)
- Zaid Al-Qurayshi
- Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Christopher Blake Sullivan
- Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Nitin Pagedar
- Department of Otolaryngology - Head & Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Gregory Randolph
- Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, USA.,Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Perfetti DC, Job AV, Satin AM, Katz AD, Silber JS, Essig DA. Is academic department teaching status associated with adverse outcomes after lumbar laminectomy and discectomy for degenerative spine diseases? Spine J 2020; 20:1397-1402. [PMID: 32445804 DOI: 10.1016/j.spinee.2020.05.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar laminectomy and discectomy surgeries are among the most common procedures performed in the United States, and often take place at academic teaching hospitals, involving the care of resident physicians. While academic institutions are critical for the maturation of the next generation of attending surgeons, concerns have been raised regarding the quality of resident-involved care. There is conflicting evidence regarding the effects of resident participation in teaching hospitals on spine surgery patient outcomes. As the volume of lumbar laminectomy and discectomy increases, it is imperative to determine how academic status impacts clinical and economic outcomes. PURPOSE The purpose of this study is to determine if lumbar laminectomy and discectomy surgeries for degenerative spine diseases performed at academic teaching centers is associated with more adverse clinical outcomes and increased cost compared to those performed at nonacademic centers. STUDY DESIGN/SETTING This study is a multi-center retrospective cohort study using a New York Statewide database. PATIENT SAMPLE We identified 36,866 patients who met the criteria through the New York Statewide Planning and Research Cooperative System who underwent an elective lumbar laminectomy and/or discectomy in New York State between January 1, 2009 and September 30, 2014. OUTCOME MEASURES The primary functional outcomes of interest included: length of stay, cost of the index admission; 30-day and 90-day readmission; 30-day, 90-day, and 1-year return to the operating room. METHODS International Classification of Diseases, Ninth revision codes were utilized to define patients undergoing a laminectomy and/or discectomy who also had a diagnosis code for a lumbar spine degenerative condition. We excluded patients with a procedural code for lumbar fusion, as well as those with a diagnosis of scoliosis, neoplasm, inflammatory disorder, infection or trauma. Hospital academic status was determined by the Accreditation Council for Graduate Medical Education. Unique encrypted patient identifiers allowed for longitudinal follow-up for readmission and re-operation analyses. We extracted charges billed for each admission and calculated costs through cost-to-charge ratios. Logistic regression models compared teaching and nonteaching hospitals after adjusting for patient demographics and comorbidities. RESULTS Compared to patients at nonteaching hospitals, patients at teaching hospitals were more likely to be younger, male, non-Caucasian, be privately insured and have fewer comorbidities (p<.001). Patients undergoing surgery at teaching hospitals had 10% shorter lengths of stay (2.7 vs. 3.0 days, p<.001), but 21.5% higher costs of admission ($13,693 vs. $11,601 p<.001). Academic institutions had a decreased risk of return to the operating room for revision procedures or irrigation and debridement at 30 days (OR:0.70, 95% confidence interval [CI]: 0.60-0.82, p<.001), 90 days (OR:0.75, 95%CI: 0.66-0.86, p<.001), and 1 year (OR:0.84, 95%CI: 0.77-0.91, p<.001) post index procedure. There was no difference in 30- and 90-day all-cause readmission, or discharge disposition between the two groups. CONCLUSIONS Elective lumbar laminectomy and discectomy for degenerative lumbar conditions at teaching hospitals is associated with higher costs, but decreased length of stay and no difference in readmission rates at 30- and 90-days postoperatively compared to nonteaching hospitals. Teaching hospitals had a decreased risk of return to the operating room at 30 days, 90 days and 1 year postoperatively. Our findings might serve as an impetus for other states or regions to compare outcomes at teaching and nonteaching sites.
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Affiliation(s)
- Dean C Perfetti
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040, USA
| | - Alan V Job
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040, USA.
| | - Alexander M Satin
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040, USA
| | - Austen D Katz
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040, USA
| | - Jeff S Silber
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040, USA
| | - David A Essig
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040, USA
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Lau D, Dalle Ore CL, Tarapore PE, Huang M, Manley G, Singh V, Mummaneni PV, Beattie M, Bresnahan J, Ferguson AR, Talbott JF, Whetstone W, Dhall SS. Value of aggressive surgical and intensive care unit in elderly patients with traumatic spinal cord injury. Neurosurg Focus 2020; 46:E3. [PMID: 30835676 DOI: 10.3171/2018.12.focus18555] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/06/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe elderly are a growing subpopulation within traumatic spinal cord injury (SCI) patients. Studies have reported high morbidity and mortality rates in elderly patients who undergo surgery for SCI. In this study, the authors compare the perioperative outcomes of surgically managed elderly SCI patients with those of a younger cohort and those reported in the literature.METHODSData on a consecutive series of adult traumatic SCI patients surgically managed at a single institution in the period from 2007 to 2017 were retrospectively reviewed. The cohort was divided into two groups based on age: younger than 70 years and 70 years or older. Assessed outcomes included complications, in-hospital mortality, intensive care unit (ICU) stay, hospital length of stay (LOS), disposition, and neurological status.RESULTSA total of 106 patients were included in the study: 83 young and 23 elderly. The two groups were similar in terms of imaging features (cord hemorrhage and fracture), operative technique, and American Spinal Injury Association Impairment Scale (AIS) grade. The elderly had a significantly higher proportion of cervical SCIs (95.7% vs 71.1%, p = 0.047). There were no significant differences between the young and the elderly in terms of the ICU stay (13.1 vs 13.3 days, respectively, p = 0.948) and hospital LOS (23.3 vs 21.7 days, p = 0.793). Elderly patients experienced significantly higher complication (73.9% vs 43.4%, p = 0.010) and mortality (13.0% vs 1.2%, p = 0.008) rates; in other words, the elderly patients had 1.7 times and 10.8 times the rate of complications and mortality, respectively, than the younger patients. No elderly patients were discharged home (0.0% vs 18.1%, p = 0.029). Discharge AIS grade and AIS grade change were similar between the groups.CONCLUSIONSElderly patients had higher complication and mortality rates than those in younger patients and were less likely to be discharged home. However, it does seem that mortality rates have improved compared to those in prior historical reports.
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Affiliation(s)
| | | | - Phiroz E Tarapore
- Departments of1Neurological Surgery.,2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California
| | - Michael Huang
- Departments of1Neurological Surgery.,2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California
| | | | - Vineeta Singh
- 2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California.,4Neurology
| | | | - Michael Beattie
- 2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California
| | - Jacqueline Bresnahan
- 2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California
| | - Adam R Ferguson
- 2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California
| | - Jason F Talbott
- 2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California.,5Radiology, and
| | - William Whetstone
- 3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California.,6Emergency Medicine
| | - Sanjay S Dhall
- Departments of1Neurological Surgery.,2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California
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Sherrod B, Karsy M, Guan J, Brock AA, Eli IM, Bisson EF, Dailey AT. Spine trauma and spinal cord injury in Utah: a geographic cohort study utilizing the National Inpatient Sample. J Neurosurg Spine 2019; 31:93-102. [PMID: 30925480 DOI: 10.3171/2018.12.spine18964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 12/27/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the effect of hospital type and patient transfer during the treatment of patients with vertebral fracture and/or spinal cord injury (SCI). METHODS The National Inpatient Sample (NIS) database was queried to identify patients treated in Utah from 2001 to 2011 for vertebral column fracture and/or SCI (ICD-9-CM codes 805, 806, and 952). Variables related to patient transfer into and out of the index hospital were evaluated in relation to patient disposition, hospital length of stay, mortality, and cost. RESULTS A total of 53,644 patients were seen (mean [± SEM] age 55.3 ± 0.1 years, 46.0% females, 90.2% white), of which 10,620 patients were transferred from another institution rather than directly admitted. Directly admitted (vs transferred) patients showed a greater likelihood of routine disposition (54.4% vs 26.0%) and a lower likelihood of skilled nursing facility disposition (28.2% vs 49.2%) (p < 0.0001). Directly admitted patients also had a significantly shorter length of stay (5.6 ± 6.7 vs 7.8 ± 9.5 days, p < 0.0001) and lower total charges ($26,882 ± $37,348 vs $42,965 ± $52,118, p < 0.0001). A multivariable analysis showed that major operative procedures (hazard ratio [HR] 1.7, 95% confidence interval [CI] 1.4-2.0, p < 0.0001) and SCI (HR 2.1, 95% CI 1.6-2.8, p < 0.0001) were associated with reduced survival whereas patient transfer was associated with better survival rates (HR 0.4, 95% CI 0.3-0.5, p < 0.0001). A multivariable analysis of cost showed that disposition (β = 0.1), length of stay (β = 0.6), and major operative procedure (β = 0.3) (p < 0.0001) affected cost the most. CONCLUSIONS Overall, transferred patients had lower mortality but greater likelihood for poor outcomes, longer length of stay, and higher cost compared with directly admitted patients. These results suggest some significant benefits to transferring patients with acute injury to facilities capable of providing appropriate treatment, but also support the need to further improve coordinated care of transferred patients, including surgical treatment and rehabilitation.
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Qin C, Zhang WH, Yang DG, Yang ML, Du LJ, Li JJ. Myelotomy promotes locomotor recovery in rats subjected to spinal cord injury: A meta-analysis of six randomized controlled trials. Neural Regen Res 2018; 13:1096-1106. [PMID: 29926838 PMCID: PMC6022467 DOI: 10.4103/1673-5374.233454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE: To investigate the effects of myelotomy on locomotor recovery in rats subjected to spinal cord injury. DATA SOURCES: Electronic databases including PubMed, Science Citation Index, Cochrane Library, China National Knowledge Infrastructure, Chinese Journals Full-text Database, China Biology Medicine disc, and Wanfang Database were searched to retrieve related studies published before September 2017. The MeSH terms (the Medical Subject Headings) such as “myelotomy”, “spinal cord injuries”, “rats”, “randomized controlled trial” and all related entry terms were searched. DATA SELECTION: Randomized controlled trials using myelotomy for the treatment of acute spinal cord injury in rats were included. Basso, Beattie, and Bresnahan scores were adopted as the evaluation method. RevMan Software (version 5.3) was used for data processing. The χ2 and I2 tests were used to assess heterogeneity. Using a random-effects model, a subgroup analysis was conducted to analyze the source of the heterogeneity. OUTCOME MEASURES: Basso, Beattie, and Bresnahan scores were observed 1–6 weeks after spinal cord injury. RESULTS: Six animal trials were included, using a total of 143 lab rats. The included trials were divided into two subgroups by injury degrees (moderate or severe). The pooled results showed that, 1–6 weeks after spinal cord injury, the overall Basso, Beattie, and Bresnahan score was significantly higher in the myelotomy group than in the contusion group (weighted mean difference (WMD) = 0.60; 95% confidence interval (CI): 0.23–0.97; P = 0.001; WMD = 2.10; 95% CI: 1.56–2.64; P < 0.001; WMD = 2.65; 95% CI: 1.73–3.57; P < 0.001; WMD = 1.66; 95% CI: 0.80–2.52; P < 0.001; WMD = 2.09; 95% CI: 0.92–3.26, P < 0.001; WMD = 2.25; 95% CI: 1.06–3.44, P < 0.001). The overall heterogeneity was high (I2 = 85%; I2 = 95%; I2 = 94%; I2 = 88%; I2 = 91%; I2 = 89%). The results in the moderate injury subgroup showed that Basso, Beattie, and Bresnahan scores were significantly higher in the myelotomy group than in the contusion group (WMD = 0.91, 95% CI: 0.52–1.3, P < 0.001; WMD = 2.10; 95% CI: 1.56–2.64, P < 0.001; WMD = 2.65; 95% CI: 1.73–3.57, P < 0.001; WMD = 2.50, 95% CI: 1.72–3.28, P < 0.001; WMD = 3.29, 95% CI: 2.21–4.38, P < 0.001; WMD = 3.27; 95% CI: 2.31–4.23, P < 0.001). The relevant heterogeneity was low. However, there were no significant differences in Basso, Beattie, and Bresnahan scores between the myelotomy and contusion groups in the severe injury subgroup at 2 and 3 weeks after the injury (P = 0.75; P = 0.92). CONCLUSION: To date, this is the first attempt to summarize the potential effect of myelotomy on locomotor recovery in rats with spinal cord injury. Our findings conclude that myelotomy promotes locomotor recovery in rats with spinal cord injury, especially in those with moderate injury.
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Affiliation(s)
- Chuan Qin
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Wen-Hao Zhang
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - De-Gang Yang
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center; Beijing Key Laboratory of Neural Injury and Rehabilitation; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
| | - Ming-Liang Yang
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center; Beijing Key Laboratory of Neural Injury and Rehabilitation; China Rehabilitation Science Institute; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
| | - Liang-Jie Du
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center; Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Jian-Jun Li
- School of Rehabilitation Medicine, Capital Medical University; Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center; Beijing Key Laboratory of Neural Injury and Rehabilitation; China Rehabilitation Science Institute; Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
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De la Garza Ramos R, Nakhla J, Nasser R, Jada A, Bhashyam N, Kinon MD, Yassari R. Volume-Outcome Relationship After 1 and 2 Level Anterior Cervical Discectomy and Fusion. World Neurosurg 2017; 105:543-548. [DOI: 10.1016/j.wneu.2017.05.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
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11
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Stancic MF. A Letter to the Editor regarding "The Impact of Hospital Teaching Status on Timing of Intervention, Inpatient Morbidity, and Mortality After Surgery for Vertebral Column Fractures with Spinal Cord Injury". World Neurosurg 2017; 102:688. [PMID: 28582833 DOI: 10.1016/j.wneu.2017.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/07/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Marin F Stancic
- Department of Neurosurgery, University of Zagreb School of Medicine, Zagreb, Croatia.
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De la Garza Ramos R, Yassari R. In Reply to A Letter to the Editor regarding "The Impact of Hospital Teaching Status on Timing of Intervention, Inpatient Morbidity, and Mortality After Surgery for Vertebral Column Fractures with Spinal Cord Injury.". World Neurosurg 2017; 102:689. [PMID: 28582834 DOI: 10.1016/j.wneu.2017.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 04/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Rafael De la Garza Ramos
- Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Reza Yassari
- Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
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