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Xu H, He J, Chen S, Huang C, Zhao K, Zhang S, Wang A, Liu X. Ventriculoperitoneal shunting obstruction: a multicentre clinical audit for cerebrospinal fluid parameters and its prediction role. Neurol Sci 2024; 45:3495-3501. [PMID: 38714597 DOI: 10.1007/s10072-024-07551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/24/2024] [Indexed: 05/10/2024]
Abstract
BACKGROUND Shunt obstruction is a type of ventriculoperitoneal shunt (VPS) failure. Whether changes in cerebrospinal fluid (CSF) parameters can influence shunt outcomes or not is debatable. METHODS In this study, we retrospectively included adult hydrocephalus patients who received VPS from 6 general hospitals in different provinces of China from November 2013 to September 2021. The inclusion criteria: Patients with hydrocephalus of all etiologies underwent shunt surgery from 6 general hospitals in different provinces of China were included in the study. The exclusion criteria: 1.Patients under the age of 18; 2.Patients who had previous shunt surgery; 3. Shunt failure from other factors; 4.Patients died from other causes; 5. Patients with incomplete data. The CSF of shunt patients had been analyzed at the time of shunt insertion. The CSF samples were collected and analyzed when the shunt was implanted. The relationship between CSF parameters and the incidence rate of shunt obstruction in one year was analyzed. RESULTS A total of 717 eligible patients from 6 hospitals were included, of whom 59(8.23%) experienced obstruction. Multivariate logistic regression analysis identified that protein level(odds ratio [OR] 1.161, 95% CI 1.005 ~ 1.341, p = 0.043), decreased glucose level(< 2.5 mmol/L)(odds ratio 3.784, 95% confidence interval 1.872 ~ 7.652, p = 0.001) and protein level increase(> 0.45 g/L) (odds ratio 3.653, 95% confidence interval 1.931 ~ 6.910, p = 0.001)were independent risk factors of shunt obstruction. CONCLUSION This study suggested that increased protein level (> 0.45 g/L) and decreased glucose level (< 2.5 mmol/L) in CSF indicated an increased risk of shunt obstruction in a patient with hydrocephalus. Thus, shunt surgery should be more carefully considered when the CSF glucose and protein were abnormal.
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Affiliation(s)
- Hao Xu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Jiawei He
- Department of neurosurgery, The first Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361000, Fujian, China
| | - Shouren Chen
- Department of Neurosurgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Xiamen University, Zhangzhou, 363300, Fujian, China
| | - Caiquan Huang
- Department of Neurosurgery, Tongji hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, Hubei, China
| | - Kai Zhao
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Shaolin Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241001, Anhui, China
- Department of Neurosurgery, Center for Pituitary Tumor Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Anshuo Wang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Xinfeng Liu
- Department of Neurosurgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Xiamen University, Zhangzhou, 363300, Fujian, China.
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Benaroch D, Brozynski M, Seyidova N, Oleru O, Agandi L, Abu El Hawa AA, Taub PJ. Nonsyndromic Craniosynostosis Correlation Between Ethnicity, Race, and Pattern of Affected Suture Type: Meta-Analysis. J Craniofac Surg 2024:00001665-990000000-01654. [PMID: 38819145 DOI: 10.1097/scs.0000000000010339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 05/01/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Previous studies have sought to analyze risk factors associated with craniosynostosis and while syndromic craniosynostosis is often linked to genetic mutations, the factors impacting nonsyndromic cases are less investigated. The aim of current meta-analysis is to evaluate the relationship between ethnicity and suture type in nonsyndromic craniosynostosis patients. METHODS The search term "craniosynostosis [Title/Abstract] AND (race [Title/Abstract] OR ethnicity [Title/Abstract])) NOT (syndrome [Title/Abstract])" was used to search the PubMed, Cochrane, and MEDLINE databases. Analyses were conducted separately for each racial and ethnic group for each suture type cohort. Odds ratios were conducted for each suture cohort and confounders were adjusted using linear mixed-effect models. Because of the homogeneity of the populations and categorical nature of the classification, binary logistic regression was run on aggregate data. RESULTS The literature search yielded 165 articles. After reviewing titles, abstracts, and manuscript contents of these articles, 5 studies were ultimately included in a meta-analysis. Studies with missing data for a particular cohort or variable were excluded from the respective analysis. Hispanic children had higher odds of sagittal suture involvement (OR: 1.53, P<0.001), whereas Asian had coronal suture (OR: 2.47, P<0.001). Both Asian and African American children had significantly lower odds of sagittal suture involvement (OR: 0.50, P<0.001 and OR: 0.7, P=0.04, respectively). CONCLUSION The relationship between ethnicity and craniosynostosis has been suggested as a risk factor, but without definitive conclusion. Present meta-analysis findings demonstrated association between ethnicity and suture type, however further research with larger scale and geographically varied data is warranted.
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Affiliation(s)
- David Benaroch
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
- American Medical Program at Tel Aviv University, New York, NY
| | - Martina Brozynski
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nargiz Seyidova
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Olachi Oleru
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lorreen Agandi
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
- Touro College of Osteopathic Medicine, New York, NY
| | - Areeg A Abu El Hawa
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter J Taub
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Rajkumar S, Ikeda DS, Scanlon M, Shields M, Kestle JR, Plonsker J, Brandel M, Gonda DD, Levy M, Lucas DJ, Choi PM, Ravindra VM. Frequency and predictors of concurrent complications in multi-suture release for syndromic craniosynostosis. Childs Nerv Syst 2024; 40:153-162. [PMID: 37462812 PMCID: PMC10761552 DOI: 10.1007/s00381-023-06076-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/09/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Understanding the complication profile of craniosynostosis surgery is important, yet little is known about complication co-occurrence in syndromic children after multi-suture craniosynostosis surgery. We examined concurrent perioperative complications and predictive factors in this population. METHODS In this retrospective cohort study, children with syndromic diagnoses and multi-suture involvement who underwent craniosynostosis surgery in 2012-2020 were identified from the National Surgical Quality Improvement Program-Pediatric database. The primary outcome was concurrent complications; factors associated with concurrent complications were identified. Correlations between complications and patient outcomes were assessed. RESULTS Among 5,848 children identified, 161 children (2.75%) had concurrent complications: 129 (2.21%) experienced two complications and 32 (0.55%) experienced ≥ 3. The most frequent complication was bleeding/transfusion (69.53%). The most common concurrent complications were transfusion/superficial infection (27.95%) and transfusion/deep incisional infection (13.04%) or transfusion/sepsis (13.04%). Two cardiac factors (major cardiac risk factors (odds ratio (OR) 3.50 [1.92-6.38]) and previous cardiac surgery (OR 4.87 [2.36-10.04])), two pulmonary factors (preoperative ventilator dependence (OR 3.27 [1.16-9.21]) and structural pulmonary/airway abnormalities (OR 2.89 [2.05-4.08])), and preoperative nutritional support (OR 4.05 [2.34-7.01]) were independently associated with concurrent complications. Children who received blood transfusion had higher odds of deep surgical site infection (OR 4.62 [1.08-19.73]; p = 0.04). CONCLUSIONS Our results indicate that several cardiac and pulmonary risk factors, along with preoperative nutritional support, were independently associated with concurrent complications but procedural factors were not. This information can help inform presurgical counseling and preoperative risk stratification in this population.
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Affiliation(s)
- Sujay Rajkumar
- Drexel University School of Medicine, Philadelphia, PA, USA
| | - Daniel S Ikeda
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Michaela Scanlon
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Neurosurgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - Margaret Shields
- Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Neurosurgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - John R Kestle
- Division of Pediatric Neurosurgery, Primary Children's Hospital, Salt Lake City, UT, USA
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Jillian Plonsker
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - Michael Brandel
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
| | - David D Gonda
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
- Division of Pediatric Neurosurgery, Rady Children's Hospital, San Diego, CA, USA
| | - Michael Levy
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA
- Division of Pediatric Neurosurgery, Rady Children's Hospital, San Diego, CA, USA
| | - Donald J Lucas
- Division of Pediatric Surgery, Department of General Surgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - Pamela M Choi
- Division of Pediatric Surgery, Department of General Surgery, Naval Medical Center San Diego, San Diego, CA, USA
| | - Vijay M Ravindra
- Department of Neurosurgery, Naval Medical Center San Diego, San Diego, CA, USA.
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA.
- Department of Neurosurgery, University of California San Diego, San Diego, CA, USA.
- Division of Pediatric Neurosurgery, Rady Children's Hospital, San Diego, CA, USA.
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Sese LVC, Guillermo MCL. Risk factors for unplanned readmissions in paediatric neurosurgery: a systematic review protocol. BMJ Paediatr Open 2023; 7:e002269. [PMID: 38114243 DOI: 10.1136/bmjpo-2023-002269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Unplanned hospital readmission (UHR) following surgical procedures reflects patient outcomes. While adult readmission studies are abundant, limited research exists in paediatric populations, especially in the context of neurosurgery. METHODS AND ANALYSIS This protocol outlines a systematic review aimed at identifying reasons for unplanned readmissions (30-day and 90-day readmissions) and risk factors following paediatric neurosurgical procedures. Narrative synthesis, sensitivity analyses, subgroup analyses, and meta-analysis, when appropriate, will be done. ETHICS AND DISSEMINATION There are no primary data involved and no access to confidential patient information. The findings aim to contribute to refining clinical practice, enhance patient counselling, and optimise healthcare resource utilisation in paediatric neurosurgical care. PROSPERO REGISTRATION NUMBER CRD42023455779.
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Affiliation(s)
- Lance Vincent Caburian Sese
- Department for Continuing Education, University of Oxford, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Kasper J, Wach J, Vychopen M, Arlt F, Güresir E, Wende T, Wilhelmy F. Unplanned 30-Day Readmission in Glioblastoma Patients: Implications for the Extent of Resection and Adjuvant Therapy. Cancers (Basel) 2023; 15:3907. [PMID: 37568723 PMCID: PMC10417525 DOI: 10.3390/cancers15153907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Unplanned early readmission (UER) within 30 days after hospital release is a negative prognostic marker for patients diagnosed with glioblastoma (GBM). This work analyzes the impact of UER on the effects of standard therapy modalities for GBM patients, including the extent of resection (EOR) and adjuvant therapy regimen. METHODS Records were searched for patients with newly diagnosed GBM between 2014 and 2020 who were treated at our facility. Exclusion criteria were being aged below 18 years or missing data. An overall survival (OS) analysis (Kaplan-Meier estimate; Cox regression) was performed on various GBM patient sub-cohorts. RESULTS A total of 276 patients were included in the study. UER occurred in 13.4% (n = 37) of all cases, significantly reduced median OS (5.7 vs. 14.5 months, p < 0.001 by logrank), and was associated with an increased hazard of mortality (hazard ratio 3.875, p < 0.001) in multivariate Cox regression when other clinical parameters were applied as confounders. The Kaplan-Meier analysis also showed that patients experiencing UER still benefitted from adjuvant radio-chemotherapy when compared to radiotherapy or no adjuvant therapy (p < 0.001 by logrank). A higher EOR did not improve OS in GBM patients with UER (p = 0.659). CONCLUSION UER is negatively associated with survival in GBM patients. In contrast to EOR, adjuvant radio-chemotherapy was beneficial, even after UER.
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Affiliation(s)
- Johannes Kasper
- Department of Neurosurgery, University Hospital Leipzig, 04103 Leipzig, Germany; (J.W.); (M.V.); (F.A.); (E.G.); (T.W.); (F.W.)
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Marquart JP, Mukherjee D, Canales BN, Flynn-O'Brien KT, Szabo A, Wagner AJ. Factors Associated with Hospital Readmission One Year Post-Discharge in Infants with Gastroschisis. Fetal Diagn Ther 2023; 50:344-352. [PMID: 37285815 DOI: 10.1159/000531449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/15/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Gastroschisis is the most common congenital abdominal wall defect with a rising prevalence. Infants with gastroschisis are at risk for multiple complications, leading to a potential increased risk for hospital readmission after discharge. We aimed to find the frequency and factors associated with an increased risk of readmission. METHODS A retrospective analysis of infants born with gastroschisis between 2013 and 2019 who received initial surgical intervention and follow-up care in the Children's Wisconsin health system was performed. The primary outcome was the frequency of hospital readmission within 1 year of discharge. We also compared maternal and infant clinical and demographic variables between those readmitted for reasons related to gastroschisis, and those readmitted for other reasons or not readmitted. RESULTS Forty of 90 (44%) infants born with gastroschisis were readmitted within 1-year of the initial discharge date, with 33 (37%) of the 90 infants being readmitted due to reasons directly related to gastroschisis. The presence of a feeding tube (p < 0.0001), a central line at discharge (p = 0.007), complex gastroschisis (p = 0.045), conjugated hyperbilirubinemia (p = 0.035), and the number of operations during the initial hospitalization (p = 0.044) were associated with readmission. Maternal race/ethnicity was the only maternal variable associated with readmission, with Black race being less likely to be readmitted (p = 0.003). Those who were readmitted were also more likely to be seen in outpatient clinics and utilize emergency healthcare resources. There was no statistically significant difference in readmission based on socioeconomic factors (all p > 0.084). CONCLUSION Infants with gastroschisis have a high hospital readmission rate, which is associated with a variety of risk factors including complex gastroschisis, multiple operations, and the presence of a feeding tube or central line at discharge. Improved awareness of these risk factors may help stratify patients in need of increased parental counseling and additional follow-up.
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Affiliation(s)
- John P Marquart
- Department of Pediatric Surgery, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Devashis Mukherjee
- Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Bethany N Canales
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Aniko Szabo
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amy J Wagner
- Department of Pediatric Surgery, Children's Wisconsin, Milwaukee, Wisconsin, USA
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Livergant RJ, Fraulin G, Stefanyk K, Binda C, Maleki S, Joharifard S, Hillier T, Joos E. Postoperative morbidity and mortality in pediatric indigenous populations: a scoping review and meta-analysis. Pediatr Surg Int 2023; 39:129. [PMID: 36795335 PMCID: PMC9935719 DOI: 10.1007/s00383-023-05377-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/17/2023]
Abstract
Mounting evidence suggests that childhood health is an important predictor of wellness as an adult. Indigenous peoples worldwide suffer worse health outcomes compared to settler populations. No study comprehensively evaluates surgical outcomes for Indigenous pediatric patients. This review evaluates inequities between Indigenous and non-Indigenous children globally for postoperative complications, morbidities, and mortality. Nine databases were searched for relevant subject headings including "pediatric", "Indigenous", "postoperative", "complications", and related terms. Main outcomes included postoperative complications, mortality, reoperations, and hospital readmission. A random-effects model was used for statistical analysis. The Newcastle Ottawa Scale was used for quality assessment. Fourteen studies were included in this review, and 12 met inclusion criteria for meta-analysis, representing 4793 Indigenous and 83,592 non-Indigenous patients. Indigenous pediatric patients had a greater than twofold overall (OR 2.0.6, 95% CI 1.23-3.46) and 30-day postoperative mortality (OR 2.23, 95% CI 1.23-4.05) than non-Indigenous populations. Surgical site infections (OR 1.05, 95% CI 0.73-1.50), reoperations (OR 0.75, 95% CI 0.51-1.11), and length of hospital stay (SMD = 0.55, 95% CI - 0.55-1.65) were similar between the two groups. There was a non-significant increase in hospital readmissions (OR 6.09, 95% CI 0.32-116.41, p = 0.23) and overall morbidity (OR 1.13, 95% CI 0.91-1.40) for Indigenous children. Indigenous children worldwide experience increased postoperative mortality. It is necessary to collaborate with Indigenous communities to promote solutions for more equitable and culturally appropriate pediatric surgical care.
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Affiliation(s)
- Rachel J Livergant
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Georgia Fraulin
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kelsey Stefanyk
- Faculty of Medicine, University of British Columbia, Prince George, BC, Canada
| | - Catherine Binda
- Faculty of Medicine, University of British Columbia, Terrace, BC, Canada
| | - Sasha Maleki
- Lower Mainland Pharmacy Services, Vancouver General Hospital, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Shahrzad Joharifard
- Department of Pediatric and Thoracic Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Tracey Hillier
- Mi'kmaq Qalipu First Nation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Emilie Joos
- Division of General Surgery, Trauma and Acute Care Surgery, Vancouver General Hospital, University of British Columbia, 767 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada.
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Sletvold TP, Boland S, Schipmann S, Mahesparan R. Quality indicators for evaluating the 30-day postoperative outcome in pediatric brain tumor surgery: a 10-year single-center study and systematic review of the literature. J Neurosurg Pediatr 2023; 31:109-123. [PMID: 36401544 DOI: 10.3171/2022.10.peds22308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Surgery is the cornerstone in the management of pediatric brain tumors. To provide safe and effective health services, quantifying and evaluating quality of care are important. To do this, there is a need for universal measures in the form of indicators reflecting quality of the delivered care. The objective of this study was to analyze currently applied quality indicators in pediatric brain tumor surgery and identify factors associated with poor outcome at a tertiary neurosurgical referral center in western Norway. METHODS All patients younger than 18 years of age who underwent surgery for an intracranial tumor at the Department of Neurosurgery at Haukeland University Hospital in Bergen, Norway, between 2009 and 2020 were included. The primary outcomes of interest were classic quality indicators: 30-day readmission, 30-day reoperation, 30-day mortality, 30-day nosocomial infection, and 30-day surgical site infection (SSI) rates; and length of stay. The secondary aim was the identification of risk factors related to unfavorable outcome. The authors also conducted a systematic literature review. Articles concerning pediatric brain tumor surgery reporting at least two quality indicators were of interest. RESULTS The authors included 82 patients aged 0-17 years. The 30-day outcomes for unplanned reoperation, unplanned remission, mortality, nosocomial infection, and SSI were 9.8%, 14.6%, 0%, 6.1%, and 3.7%, respectively. Unplanned reoperation was associated with eloquent localization (p = 0.009), primary emergency surgery (p = 0.003), and CSF diversion procedures (p = 0.002). Greater tumor volume was associated with unplanned readmission (p = 0.008), nosocomial infection (p = 0.004), and CSF leakage (p = 0.005). In the systematic review, after full-text screening, 16 articles were included and provided outcome data for 1856 procedures. Overall, the 30-day mortality rate was low, varying from 0% to 9.3%. The 30-day reoperation rate varied from 1.5% to 12%. The SSI rate ranged between 0% and 3.9%, and 0% to 17.4% of patients developed CSF leakage. Four studies reported infratentorial tumor location as a risk factor for postoperative CSF leakage. CONCLUSIONS The 30-day outcomes in the authors' department were comparable to published outcomes. The most relevant factors related to unfavorable outcomes are tumor volume and location, both of which are not modifiable by the surgeon. This highlights the importance of risk adjustment. This evaluation of quality indicators reveals concerns related to the unclear and nonstandardized definitions of outcomes. Standardized outcome definitions and documentation in a large and multicentric database are needed in the future for further evaluation of quality indicators.
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Affiliation(s)
| | - Solveig Boland
- 1Department of Clinical Medicine, University of Bergen; and
| | | | - Rupavatana Mahesparan
- 1Department of Clinical Medicine, University of Bergen; and
- 2Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
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Matsumoto H, Franzone JM, Sinha R, Roye BD, Glotzbeker MP, Skaggs DL, Flynn JM, Lenke LG, Sponseller PD, Vitale MG. A novel risk calculator predicting surgical site infection after spinal surgery in patients with cerebral palsy. Dev Med Child Neurol 2022; 64:1034-1043. [PMID: 35229288 DOI: 10.1111/dmcn.15193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/28/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022]
Abstract
AIM To develop and validate a risk calculator based on preoperative factors to predict the probability of surgical site infection (SSI) in patients with cerebral palsy (CP) undergoing spinal surgery. METHOD This was a multicenter retrospective cohort study of pediatric patients with CP who underwent spinal fusion. In the development stage, preoperative known factors were collected, and a risk calculator was developed by comparing multiple models and choosing the model with the highest discrimination and calibration abilities. This model was then tested with a separate population in the validation stage. RESULTS Among the 255 patients in the development stage, risk of SSI was 11%. A final prediction model included non-ambulatory status (odds ratio [OR] 4.0), diaper dependence (OR 2.5), age younger than 12 years (OR 2.5), major coronal curve magnitude greater than 90° (OR 1.3), behavioral disorder/delay (OR 1.3), and revision surgery (OR 1.3) as risk factors. This model had a predictive ability of 73.4% for SSI, along with excellent calibration ability (p = 0.878). Among the 390 patients in the validation stage, risk of SSI was 8.2%. The discrimination of the model in the validation phase was 0.743 and calibration was p = 0.435, indicating 74.3% predictive ability and no difference between predicted and observed values. INTERPRETATION This study provides a risk calculator to identify the risk of SSI after spine surgery for patients with CP. This will allow us to enhance decision-making and patient care while providing valid hospital comparisons, public reporting mechanisms, and reimbursement determinations.
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Affiliation(s)
- Hiroko Matsumoto
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jeanne M Franzone
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Rishi Sinha
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Benjamin D Roye
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Michael P Glotzbeker
- Department of Orthopaedic Surgery, University Hospital Cleveland Medical Center, Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - David L Skaggs
- Spine Center, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - John M Flynn
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Philadelphia, USA
| | - Lawrence G Lenke
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Paul D Sponseller
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.,Bloomberg Children's Center, Baltimore, Maryland, USA
| | - Michael G Vitale
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, New York, USA
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10
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Drapeau AI, Onwuka A, Koppera S, Leonard JR. Hospital Case-Volume and Patient Outcomes Following Pediatric Brain Tumor Surgery in the Pediatric Health Information System. Pediatr Neurol 2022; 133:48-54. [PMID: 35759803 DOI: 10.1016/j.pediatrneurol.2022.06.002] [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: 01/05/2022] [Revised: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Markers of quality of care in various surgical specialties have been shown to correlate with hospital volumes. This study investigates the effect of hospital volume and patient-related factors on the outcomes of children undergoing brain tumor resection. METHODS We examined the data within the Pediatric Health Information System (PHIS) for children aged zero to 17 years undergoing brain tumor resection between 2016 and 2020. Length of hospital stay (LOS), costs, and reoperation rates were analyzed for associations with hospital case-volume, patient factors, and other hospital-related factors. RESULTS A total of 2568 patients were included in this PHIS analysis. After adjusting for covariates, care provided by high-case-volume hospitals led to shorter LOS (P = 0.01). The effect of hospital case-volume on median cost was present on univariate analysis (US $63,845 at low-volume hospital versus US $54,909 at high-volume hospital, P = 0.002); this finding was attenuated by LOS. A trend was observed between reoperation rates and hospital case-volume, with lowest quartile volume hospitals having higher odds of reoperation than hospitals with volumes in the highest quartile (P = 0.06). Racial and ethnic minorities, medical comorbidities, and other sociodemographic factors were associated with poorer outcomes following surgery. CONCLUSIONS Centering care around high-case-volume hospitals can potentially lead to shorter hospital stays and decreased costs for children with brain tumors. This PHIS article highlights the association of the studied outcomes with certain sociodemographic factors and illustrates that inequalities in pediatric health care still exist. Further efforts are required to understand and eliminate these potentially harmful differences.
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Affiliation(s)
- Annie I Drapeau
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio; Division of Pediatric Neurological Surgery, Nationwide Children's Hospital, Columbus, Ohio.
| | - Amanda Onwuka
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, Ohio
| | - Swapna Koppera
- Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, Ohio
| | - Jeffrey R Leonard
- Department of Neurological Surgery, The Ohio State University College of Medicine, Columbus, Ohio; Division of Pediatric Neurological Surgery, Nationwide Children's Hospital, Columbus, Ohio
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11
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Clinical predictors of survival for patients with atypical teratoid/rhabdoid tumors. Childs Nerv Syst 2022; 38:1297-1306. [PMID: 35362829 DOI: 10.1007/s00381-022-05511-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/21/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Atypical teratoid/rhabdoid tumors (AT/RTs) are malignant central nervous system (CNS) neoplasms of the young. Our study analyzed a large AT/RT cohort from the National Cancer Database (NCDB) to elucidate predictors of short-term mortality and overall survival (OS). METHODS Information was collected on patients with histologically confirmed AT/RT using the NCDB (2004-2016). Kaplan-Meier analysis indicated OS. Prognostic factors for 30-day mortality, 90-day mortality, and OS were determined via multivariate Cox proportional hazards (CPH) and logistic regression models. RESULTS Our cohort of 189 patients had a median age of 1 year (IQR [1, 4]) and tumor size of 4.7 ± 2.0 cm at diagnosis. Seventy-two percent were under 3 years old; 55.6% were male and 71.0% were Caucasian. Fifty (27.2%) patients received only surgery (S) (OS = 5.91 months), 51 (27.7%) received surgery and chemotherapy (S + CT) (OS = 11.2 months), and 9 (4.89%) received surgery and radiotherapy (S + RT) (OS = 10.3 months). Forty-five (24.5%) received S + CT + RT combination therapy (OS = 45.4 months), 13 (17.1%) received S + CT + BMT/SCT (bone marrow or stem cell transplant) (OS = 55.5 months), and 16 (8.70%) received S + CT + RT + BMT/SCT (OS = 68.4 months). Bivariate analysis of dichotomized age (HR = 0.550, 95% CI [0.357, 0.847], p = 0.0067) demonstrated significantly increased patient survival if diagnosed at or above 1 year old. On multivariate analysis, administration of S + CT + RT, S + CT + BMT/SCT, or S + CT + RT + BMT/SCT combination therapy predicted significantly (p < 0.05) increased OS compared to surgery alone. CONCLUSION AT/RTs are CNS tumors where those diagnosed under 1 year old have a significantly worse prognosis. Our study demonstrates that while traditional CT, RT, and BMT/SCT combination regimens prolong life, overall survival in this population is still low.
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12
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Niehaus IM, Kansy N, Stock S, Dötsch J, Müller D. Applicability of predictive models for 30-day unplanned hospital readmission risk in paediatrics: a systematic review. BMJ Open 2022; 12:e055956. [PMID: 35354615 PMCID: PMC8968996 DOI: 10.1136/bmjopen-2021-055956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To summarise multivariable predictive models for 30-day unplanned hospital readmissions (UHRs) in paediatrics, describe their performance and completeness in reporting, and determine their potential for application in practice. DESIGN Systematic review. DATA SOURCE CINAHL, Embase and PubMed up to 7 October 2021. ELIGIBILITY CRITERIA English or German language studies aiming to develop or validate a multivariable predictive model for 30-day paediatric UHRs related to all-cause, surgical conditions or general medical conditions were included. DATA EXTRACTION AND SYNTHESIS Study characteristics, risk factors significant for predicting readmissions and information about performance measures (eg, c-statistic) were extracted. Reporting quality was addressed by the 'Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis' (TRIPOD) adherence form. The study quality was assessed by applying six domains of potential biases. Due to expected heterogeneity among the studies, the data were qualitatively synthesised. RESULTS Based on 28 studies, 37 predictive models were identified, which could potentially be used for determining individual 30-day UHR risk in paediatrics. The number of study participants ranged from 190 children to 1.4 million encounters. The two most common significant risk factors were comorbidity and (postoperative) length of stay. 23 models showed a c-statistic above 0.7 and are primarily applicable at discharge. The median TRIPOD adherence of the models was 59% (P25-P75, 55%-69%), ranging from a minimum of 33% to a maximum of 81%. Overall, the quality of many studies was moderate to low in all six domains. CONCLUSION Predictive models may be useful in identifying paediatric patients at increased risk of readmission. To support the application of predictive models, more attention should be placed on completeness in reporting, particularly for those items that may be relevant for implementation in practice.
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Affiliation(s)
- Ines Marina Niehaus
- Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
| | - Nina Kansy
- Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Jörg Dötsch
- Department of Paediatrics and Adolescent Medicine, University Hospital Cologne, Cologne, Germany
| | - Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
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13
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Rizvi I, Harrison LM, Parsa S, Hallac RR, Seaward JR, Kane AA. Open Versus Minimally Invasive Approach for Craniosynostosis: Analysis of the National Surgical Quality Improvement Program-Pediatric. Cleft Palate Craniofac J 2022:10556656221085478. [PMID: 35249396 DOI: 10.1177/10556656221085478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This multicenter study aimed to compare demographic, operative, and short-term outcomes data between open and minimally invasive surgical approaches for craniosynostosis repair utilizing the American College of Surgeon's National Surgical Quality Improvement Program Pediatric (NSQIP-P) database and highlight surgical disparities among races and ethnicities. DESIGN Retrospective review of large multicenter database. SETTING Freestanding general acute care children's hospitals, children's hospitals within a larger hospital, specialty children's hospitals, or general acute care hospitals with a pediatric wing. PATIENTS AND PARTICIPANTS A total of 4931 pediatric patients underwent craniosynostosis correction within the NSQIP-P database from 2013 to 2019. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) Demographic information included age at surgery, sex, race, and ethnicity. Operative and outcomes measures included operative time, anesthesia time, days until discharge, postoperative complications, blood transfusions, 30-day readmission, and 30-day unplanned return to operating room. RESULTS Patients who underwent minimally invasive surgery had significantly shorter operative and anesthesia times (p < .001; p < .001), fewer days until discharge (p < .001), fewer postoperative complications (p < .05), and less blood transfusions (p < .001). The proportion of White patients was significantly higher in the minimally invasive surgery group (p < .01), whereas Black and Hispanic patients had a significantly higher proportion in the open surgery group (p < .001; p < .001). Additionally, the percentage of patients undergoing minimally invasive surgery increased from 3.8% in 2014 to over 13% in 2019. CONCLUSIONS This study adds to a growing consensus that minimally invasive surgery has significantly decreased operative time, anesthesia time, transfusion rates, length of hospital stay, and postoperative complications compared to open surgery. Racial and ethnic surgical disparities showed larger proportions of Black and Hispanic populations undergoing open procedures.
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Affiliation(s)
- Imran Rizvi
- Department of Plastic Surgery, 25989University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lucas M Harrison
- Department of Plastic Surgery, 25989University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shyon Parsa
- Department of Plastic Surgery, 25989University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rami R Hallac
- Department of Plastic Surgery, 25989University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James R Seaward
- Department of Plastic Surgery, 25989University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alex A Kane
- Department of Plastic Surgery, 25989University of Texas Southwestern Medical Center, Dallas, TX, USA
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14
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Matsumoto H, Larson EL, Warren SI, Hammoor BT, Bonsignore-Opp L, Troy MJ, Barrett KK, Striano BM, Li G, Terry MB, Roye BD, Lenke LG, Skaggs DL, Glotzbecker MP, Flynn JM, Roye DP, Vitale MG. A Clinical Risk Model for Surgical Site Infection Following Pediatric Spine Deformity Surgery. J Bone Joint Surg Am 2022; 104:364-375. [PMID: 34851324 DOI: 10.2106/jbjs.21.00751] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite tremendous efforts, the incidence of surgical site infection (SSI) following the surgical treatment of pediatric spinal deformity remains a concern. Although previous studies have reported some risk factors for SSI, these studies have been limited by not being able to investigate multiple risk factors at the same time. The aim of the present study was to evaluate a wide range of preoperative and intraoperative factors in predicting SSI and to develop and validate a prediction model that quantifies the risk of SSI for individual pediatric spinal deformity patients. METHODS Pediatric patients with spinal deformity who underwent primary, revision, or definitive spinal fusion at 1 of 7 institutions were included. Candidate predictors were known preoperatively and were not modifiable in most cases; these included 31 patient, 12 surgical, and 4 hospital factors. The Centers for Disease Control and Prevention definition of SSI within 90 days of surgery was utilized. Following multiple imputation and multicollinearity testing, predictor selection was conducted with use of logistic regression to develop multiple models. The data set was randomly split into training and testing sets, and fivefold cross-validation was performed to compare discrimination, calibration, and overfitting of each model and to determine the final model. A risk probability calculator and a mobile device application were developed from the model in order to calculate the probability of SSI in individual patients. RESULTS A total of 3,092 spinal deformity surgeries were included, in which there were 132 cases of SSI (4.3%). The final model achieved adequate discrimination (area under the receiver operating characteristic curve: 0.76), as well as calibration and no overfitting. Predictors included in the model were nonambulatory status, neuromuscular etiology, pelvic instrumentation, procedure time ≥7 hours, American Society of Anesthesiologists grade >2, revision procedure, hospital spine surgical cases <100/year, abnormal hemoglobin level, and overweight or obese body mass index. CONCLUSIONS The risk probability calculator encompassing patient, surgical, and hospital factors developed in the present study predicts the probability of 90-day SSI in pediatric spinal deformity surgery. This validated calculator can be utilized to improve informed consent and shared decision-making and may allow the deployment of additional resources and strategies selectively in high-risk patients. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hiroko Matsumoto
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Elaine L Larson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.,School of Nursing, Columbia University Irving Medical Center, New York, NY
| | - Shay I Warren
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Bradley T Hammoor
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Lisa Bonsignore-Opp
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Michael J Troy
- Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Kody K Barrett
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, California
| | - Brendan M Striano
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gen Li
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Benjamin D Roye
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - David L Skaggs
- Spine Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Michael P Glotzbecker
- Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital, University Hospital Cleveland Medical Center, Cleveland, Ohio
| | - John M Flynn
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David P Roye
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Michael G Vitale
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
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15
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Iihara K, Saito N, Suzuki M, Date I, Fujii Y, Houkin K, Inoue T, Iwama T, Kawamata T, Kim P, Kinouchi H, Kishima H, Kohmura E, Kurisu K, Maruyama K, Matsumaru Y, Mikuni N, Miyamoto S, Morita A, Nakase H, Narita Y, Nishikawa R, Nozaki K, Ogasawara K, Ohata K, Sakai N, Sakamoto H, Shiokawa Y, Takahashi JC, Ueki K, Wakabayashi T, Yoshimoto K, Arai H, Tominaga T. The Japan Neurosurgical Database: Statistics Update 2018 and 2019. Neurol Med Chir (Tokyo) 2021; 61:675-710. [PMID: 34732592 PMCID: PMC8666296 DOI: 10.2176/nmc.st.2021-0254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Each year, the Japan Neurosurgical Society (JNS) reports up-to-date statistics from the Japan Neurosurgical Database regarding case volume, patient demographics, and in-hospital outcomes of the overall cohort and neurosurgical subgroup according to the major classifications of main diagnosis. We hereby report patient demographics, in-hospital mortality, length of hospital stay, purpose of admission, number of medical management, direct surgery, endovascular treatment, and radiosurgery of the patients based on the major classifications and/or main diagnosis registered in 2018 and 2019 in the overall cohort (523283 and 571143 patients, respectively) and neurosurgical subgroup (177184 and 191595 patients, respectively). The patient demographics, disease severity, proportion of purpose of admission (e.g., operation, 33.9-33.5%) and emergent admission (68.4-67.8%), and in-hospital mortality (e.g., cerebrovascular diseases, 6.3-6.5%; brain tumor, 3.1-3%; and neurotrauma, 4.3%) in the overall cohort were comparable between 2018 and 2019. In total, 207783 and 225217 neurosurgical procedures were performed in the neurosurgical subgroup in 2018 and 2019, respectively, of which endovascular treatment comprised 19.1% and 20.3%, respectively. Neurosurgical management of chronic subdural hematoma (19.4-18.9%) and cerebral aneurysm (15.4-14.8%) was most common. Notably, the proportion of management of ischemic stroke/transient ischemic attack, including recombinant tissue plasminogen activator infusion and endovascular acute reperfusion therapy, increased from 7.5% in 2018 to 8.8% in 2019. The JNS statistical update represents a critical resource for the lay public, policy makers, media professionals, neurosurgeons, healthcare administrators, researchers, health advocates, and others seeking the best available data on neurosurgical practice.
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Affiliation(s)
- Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | | | - Michiyasu Suzuki
- Department of Advanced ThermoNeuroBiology, Yamaguchi University Graduate School of Medicine
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University School of Medicine
| | - Toru Iwama
- Department of Neurosurgery, Gifu University School of Medicine
| | | | - Phyo Kim
- Department of Neurologic Surgery, Utsunomiya Neurospine Center
| | - Hiroyuki Kinouchi
- Department of Neurosurgery, University of Yamanashi Interdisciplinary Graduate School of Medicine
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Eiji Kohmura
- Kinki Central Hospital of the Mutual Aid Association of Public School Teachers
| | - Kaoru Kurisu
- Department of Neurosurgery, Chugoku Rosai Hospital
| | - Keisuke Maruyama
- Department of Neurosurgery, Kyorin University, School of Medicine
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | | | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School
| | | | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science
| | | | | | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Hiroaki Sakamoto
- Department of Pediatric Neurosurgery, Osaka City General Hospital
| | | | - Jun C Takahashi
- Department of Neurosurgery, Kindai University Faculty of Medicine
| | - Keisuke Ueki
- Department of Neurologic Surgery, Dokkyo Medical University
| | | | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
| | | | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine
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16
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Lechtholz-Zey E, Bonney PA, Cardinal T, Mendoza J, Strickland BA, Pangal DJ, Giannotta S, Durham S, Zada G. Systematic Review of Racial, Socioeconomic, and Insurance Status Disparities in the Treatment of Pediatric Neurosurgical Diseases in the United States. World Neurosurg 2021; 158:65-83. [PMID: 34718199 DOI: 10.1016/j.wneu.2021.10.150] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Increasing light is being shed on how race, insurance, and socioeconomic status (SES) may be related to outcomes from disease in the United States. To better understand the impact of these health care disparities in pediatric neurosurgery, we performed a systematic review of the literature. METHODS We conducted a systematic review using PRISMA guidelines and MeSH terms involving neurosurgical conditions and racial, ethnic, and SES disparities. Three independent reviewers screened articles and analyzed texts selected for full analysis. RESULTS Thirty-eight studies were included in the final analysis, of which all but 2 were retrospective database reviews. Thirty-four studies analyzed race, 22 analyzed insurance status, and 13 analyzed SES/income. Overall, nonwhite patients, patients with public insurance, and patients from lower SES were shown to have reduced access to treatment and greater rates of adverse outcomes. Nonwhite patients were more likely to present at an older age with more severe disease, less likely to undergo surgery at a high-volume surgical center, and more likely to experience postoperative morbidity and mortality. Underinsured and publicly insured patients were more likely to experience delay in surgical referral, less likely to undergo surgical treatment, and more likely to experience inpatient mortality. CONCLUSIONS Health care disparities are present within multiple populations of patients receiving pediatric neurosurgical care. This review highlights the need for continued investigation into identifying and addressing health care disparities in pediatric neurosurgery patients.
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Affiliation(s)
- Elizabeth Lechtholz-Zey
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Phillip A Bonney
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Tyler Cardinal
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
| | - Jesse Mendoza
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Ben A Strickland
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Dhiraj J Pangal
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Steven Giannotta
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Susan Durham
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA; Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Gabriel Zada
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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17
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Ammanuel SG, Edwards CS, Chan AK, Mummaneni PV, Kidane J, Vargas E, D’Souza S, Nichols AD, Sankaran S, Abla AA, Aghi MK, Chang EF, Hervey-Jumper SL, Kunwar S, Larson PS, Lawton MT, Starr PA, Theodosopoulos PV, Berger MS, McDermott MW. Are preoperative chlorhexidine gluconate showers associated with a reduction in surgical site infection following craniotomy? A retrospective cohort analysis of 3126 surgical procedures. J Neurosurg 2021; 135:1889-1897. [PMID: 33930864 PMCID: PMC9448162 DOI: 10.3171/2020.10.jns201255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical site infection (SSI) is a complication linked to increased costs and length of hospital stay. Prevention of SSI is important to reduce its burden on individual patients and the healthcare system. The authors aimed to assess the efficacy of preoperative chlorhexidine gluconate (CHG) showers on SSI rates following cranial surgery. METHODS In November 2013, a preoperative CHG shower protocol was implemented at the authors' institution. A total of 3126 surgical procedures were analyzed, encompassing a time frame from April 2012 to April 2016. Cohorts before and after implementation of the CHG shower protocol were evaluated for differences in SSI rates. RESULTS The overall SSI rate was 0.6%. No significant differences (p = 0.11) were observed between the rate of SSI of the 892 patients in the preimplementation cohort (0.2%) and that of the 2234 patients in the postimplementation cohort (0.8%). Following multivariable analysis, implementation of preoperative CHG showers was not associated with decreased SSI (adjusted OR 2.96, 95% CI 0.67-13.1; p = 0.15). CONCLUSIONS This is the largest study, according to sample size, to examine the association between CHG showers and SSI following craniotomy. CHG showers did not significantly alter the risk of SSI after a cranial procedure.
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Affiliation(s)
- Simon G. Ammanuel
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Caleb S. Edwards
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Andrew K. Chan
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Praveen V. Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Joseph Kidane
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Enrique Vargas
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Sarah D’Souza
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Amy D. Nichols
- Department of Hospital Epidemiology and Infection Control, University of California, San Francisco, California
| | - Sujatha Sankaran
- Department of Hospital Medicine, University of California, San Francisco, California
| | - Adib A. Abla
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Manish K. Aghi
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Edward F. Chang
- Department of Neurological Surgery, University of California, San Francisco, California
| | | | - Sandeep Kunwar
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Paul S. Larson
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael T. Lawton
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Philip A. Starr
- Department of Neurological Surgery, University of California, San Francisco, California
| | | | - Mitchel S. Berger
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael W. McDermott
- Department of Neurological Surgery, University of California, San Francisco, California
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18
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Kerezoudis P, Kelley PC, Watts CR, Heiderscheit CJ, Roskos MC. Using a Data-Driven Improvement Methodology to Decrease Surgical Site Infections in a Community Neurosurgery Practice: Optimizing Preoperative Screening and Perioperative Antibiotics. World Neurosurg 2021; 149:e989-e1000. [PMID: 33515799 DOI: 10.1016/j.wneu.2021.01.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We used a data-driven methodology to decrease the departmental surgical site infection rate to a goal of 1%. METHODS A prospective interventional study with historical controls comparing preimplementation/intervention (unknown methicillin-sensitive Staphylococcus aureus [MSSA]/methicillin-resistant Staphylococcus aureus [MRSA] status and standard weight and drug allergy-based preoperative antibiotics) with postimplementation/intervention (optimized preoperative chlorhexidine showers, MSSA/MRSA screening, MSSA/MRSA decolonization, and optimized preoperative antibiotic order set implementation). The American College of Surgeons National Surgical Quality Improvement Program was used for case surveillance. The primary outcome was the presence of a surgical site infection with a secondary outcome of cost(s) of implementation. RESULTS A total of 317 National Surgical Quality Improvement Program abstracted neurosurgical cases were analyzed, 163 cases before implementation and 154 cases after implementation. There were no significant differences between the preimplementation and postimplementation cohorts regarding patient demographics and baseline comorbidities, with the exceptions of inpatient and functional status (P < 0.001). The most common procedures were lumbar decompression (31%), lumbar discectomy (27%), and anterior cervical discectomy and fusion (10.4%). After implementation, 30 patients were MSSA positive (20%) and 4 MRSA positive (2.6%). Thirty patients received preoperative intranasal mupirocin decolonization (88%), and 4 patients received adjusted preoperative antibiotics (12%). After protocol implementation, the surgical site infection rate decreased from 6.7% (odds ratio, 2.82) to 0.96% (odds ratio, 0.91). The cost of implementation was $27,179, or $58 per patient. CONCLUSIONS The findings highlight the importance of systematically investigating areas of gap in existing clinical practice and quality improvement projects to increase patient safety and enhance the value of care delivered to neurosurgical patients.
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Affiliation(s)
| | - Parker C Kelley
- Department of Neurosurgery, Mayo Clinic Health System, La Crosse, Wisconsin, USA
| | - Charles R Watts
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurosurgery, Mayo Clinic Health System, La Crosse, Wisconsin, USA.
| | - Chris J Heiderscheit
- Department of Clinical Quality Management, Mayo Clinic Health System, La Crosse, Wisconsin, USA
| | - Michael C Roskos
- Department of Surgery, Mayo Clinic Health System, La Crosse, Wisconsin, USA
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19
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Holle J, Finger T, Lugonja J, Schmidt F, Schaumann A, Gratopp A, Thomale UW, von Bernuth H, Schulz M. The Influence of Perioperative Antibiotic Prophylaxis on Wound Infection and on the Colonization of Wound Drains in Patients After Correction of Craniosynostosis. Front Pediatr 2021; 9:720074. [PMID: 34504818 PMCID: PMC8421650 DOI: 10.3389/fped.2021.720074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/19/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: Evidence for the duration of perioperative antibiotic prophylaxis (PAP) after the correction of craniosynostosis in children is scarce. We evaluated the necessary duration of PAP to ensure a minimal rate of postoperative wound infections. Methods: In this monocentric, retrospective, and prospective pilot study, two PAP protocols were compared. From August 2017 to May 2018, treatment group 1 (TG 1) was treated using the standard PAP protocol with at least three doses of antibiotics. Between May 2018 and March 2019, a shortened PAP with a single-shot administration was given to treatment group 2 (TG 2a and b). Endpoints of this study were wound infection rate, colonization rate of wound drains, and the course of treatment reflected by clinical and laboratory data. Results: A cohort of 187 children underwent craniosynostosis correction: 167 were treated according to protocols--95 patients with at least three doses (TG 1) and 72 patients with a single-shot of cefuroxime (TG 2a). Baseline characteristics were similar for both groups. We could not detect significant differences, neither for wound infection rates (TG 1: 1.1%, TG 2a: 0.0%, p = 0.38) nor for colonization rates of wound drains (TG 1: 4.8%, TG 2a: 10.5%, p = 0.27). Conclusions: Single-shot PAP had no adverse effects on the wound infection rate or the colonization rate of the wound drains compared with prolonged perioperative antibiotic prophylaxis. As a result, single-shot preoperative PAP is now applied to the majority craniosynostosis patients undergoing surgical correction in our unit.
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Affiliation(s)
- Johannes Holle
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Finger
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Lugonja
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Schmidt
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Schaumann
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Gratopp
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Horst von Bernuth
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Immunology, Labor Berlin GmbH, Berlin, Germany
| | - Matthias Schulz
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
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20
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Rotter J, Dowlati E, Cobourn K, Kalhorn C. A cross-sectional analysis of variables associated with morbidity and mortality in postoperative neurosurgical patients diagnosed with sepsis. Acta Neurochir (Wien) 2020; 162:2837-2848. [PMID: 32959343 DOI: 10.1007/s00701-020-04586-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/15/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Sepsis is a systemic, inflammatory response to infection associated with significant morbidity and mortality. There is a considerable lack of literature exploring sepsis in neurosurgery. We aimed to identify variables that were correlated with mortality and increased morbidity as defined by readmission and increased length of stay in postoperative neurosurgical patients that met a sepsis diagnosis. METHODS A retrospective chart review was conducted of 105 patients who underwent a neurosurgical operation at our institution from 2012 to 2017 who were discharged with at least one sepsis diagnosis code and who did not have a preoperative infection. We identified variables that were correlated with mortality, readmission, and increased length of stay. RESULTS Patients who survived were preferentially distributed towards lower ASA Physical Status Classification scores. A larger percentage of patients who did not survive had cranial surgery, whereas patients who survived were more likely to have undergone spinal surgery. Higher respiratory rates, higher maximum lactic acid levels, positive sputum cultures, and lower incoming Glasgow Coma Scores (GCS) were significantly correlated with mortality. A larger fraction of readmitted patients had positive surgical site cultures but had negative sputum cultures. Length of hospitalization was correlated with incoming GCS, non-elective operations, and Foley catheter, arterial line, central line, and endotracheal tube duration. CONCLUSIONS Neurosurgical postoperative patients diagnosed with sepsis may be risk stratified for mortality, readmission, and increased length of stay based on certain variables that may help direct their care. Further prospective studies are needed to explore causal relationships.
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Affiliation(s)
- Juliana Rotter
- Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Ehsan Dowlati
- Department of Neurological Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd. PHC 7, Washington, DC, 20007, USA
| | - Kelsey Cobourn
- Department of Neurological Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd. PHC 7, Washington, DC, 20007, USA
| | - Christopher Kalhorn
- Department of Neurological Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd. PHC 7, Washington, DC, 20007, USA
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21
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Cools M, Northam W, Goodnight W, Mulvaney G, Elton S, Quinsey C. Thirty-day medical and surgical readmission following prenatal versus postnatal myelomeningocele repair. Neurosurg Focus 2020; 47:E14. [PMID: 31574468 DOI: 10.3171/2019.7.focus19355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/22/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hospital readmission is an important quality metric that has not been evaluated in prenatal versus postnatal myelomeningocele (MMC) repair. This study compares hospital readmission outcomes between these two groups as well as their etiologies. METHODS The medical records of patients who had undergone MMC repair in the period from 2011 to 2017 at a single academic medical center were retrospectively reviewed. Collected clinical data included surgery and defect details, neonatal intensive care unit (NICU) stay, and any readmissions or surgical procedures up to 1 year after surgery. Patient and defect characteristics, readmission outcomes at 30 and 60 days and 1 year after discharge from the NICU, and cerebrospinal fluid (CSF) diversion surgery rates were analyzed with the two-tailed t-test and/or k-sample test on the equality of medians. RESULTS A total of 24 prenatal and 34 postnatal MMC repairs were completed during the study period. Prenatally repaired patients were born more prematurely (p < 0.001) and with lower birth weights (p < 0.001), although the NICU stay was similar between the two groups (p = 0.59). Fewer prenatally repaired patients were readmitted at 30 days (p = 0.005), 90 days (p = 0.004), and 1 year (p = 0.007) than the postnatal repair group. Hydrocephalus was the most common readmission etiology, and 29% of prenatal repair patients required CSF diversion at 1 year versus 81% of the postnatal repair group (p < 0.01). Prenatal patients who required CSF diversion had a higher body weight (p = 0.02) and an older age (p = 0.01) at the time of CSF diversion surgery than the postnatal group. CONCLUSIONS Patients with prenatal MMC repair had fewer hospital readmissions at 30 days, 60 days, and 1 year than the postnatal repair group, despite similar NICU lengths of stay. The prenatal repair group had lower requirements for CSF diversion at 1 year and was older with greater body weights at the time of CSF diversion surgery, compared to those of the postnatal repair group. Future study of hospital quality metrics such as readmissions should be performed to better understand outcomes of these two procedures.
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Affiliation(s)
- Michael Cools
- 1Department of Neurosurgery, University of North Carolina School of Medicine
| | - Weston Northam
- 1Department of Neurosurgery, University of North Carolina School of Medicine
| | - William Goodnight
- 2Maternal Fetal Care Program, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill; and
| | - Graham Mulvaney
- 3Carolina Neurosurgery and Spine Associates, Carolinas Medical Center, Charlotte, North Carolina
| | - Scott Elton
- 1Department of Neurosurgery, University of North Carolina School of Medicine
| | - Carolyn Quinsey
- 1Department of Neurosurgery, University of North Carolina School of Medicine
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22
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Iglesias Rodríguez IM, Mizukami S, Manh DH, Thuan TM, Justiniano HA, Miura S, Ito G, Huy NT, Smith C, Hirayama K. Knowledge, behaviour and attitudes towards Chagas disease among the Bolivian migrant population living in Japan: a cross-sectional study. BMJ Open 2020; 10:e032546. [PMID: 32928842 PMCID: PMC7490920 DOI: 10.1136/bmjopen-2019-032546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the knowledge, behaviour and attitudes towards Chagas disease (CD) among Latin American migrants in Japan and to evaluate the effectiveness of an educational activity (EA) in increasing knowledge of CD. DESIGN A cross-sectional, mixed-methods study employing a preknowledge and postknowledge test and focus group discussion, conducted from March 2018 to June 2018. PARTICIPANTS Seventy-two participants were included, all born in Bolivia and residents in four Japanese cities. Fifty-nine of them participated in the EA. INTERVENTIONS The EA comprised showing three videos about CD and a group discussion covering different dimensions of CD and was evaluated with questionnaires to analyse the knowledge of the participants before and after. RESULTS Seventy-two participants were enrolled, predominantly from highly endemic CD areas of Bolivia. Though most participants were familiar with vector-borne transmission, epidemiology and symptomatology of CD, the baseline knowledge of CD was low. Less than 10% of them had been tested prior for CD. The dominant factors associated with better knowledge were living in Japan for more than 10 years (OR=8.42, 95% CI 1.56 to 48.62) and previously testing for CD (OR=11.32; 95% CI 1.52 to 105.9). The EA significantly improved the CD knowledge of the participants (p value <0.0001; 95% CI 2.32 to 3.84). The participants associated the term 'Chagas' mostly with fear and concern. The level of stigmatisation was low, in contrast to the results of other studies. The barriers encountered in care-seeking behaviour were language, the migration process and difficulties to access the healthcare system. CONCLUSION EA with an integrative approach is useful to increase the knowledge of CD within the Bolivian migrant population living in Japan. The activity brings the possibility to explore not only the level of knowledge but also to reveal experiences and to understand the needs of the people at risk. Considering them as actors towards healthcare solutions could lead to better outcomes for the success of future policies and interventions aimed to decrease the global burden.
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Affiliation(s)
| | - Shusaku Mizukami
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Dao Huy Manh
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Tieu Minh Thuan
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Sachio Miura
- NPO organization. MAIKEN. Motohachiojimachi, Hachioji-shi, Tokyo, Japan
| | - George Ito
- Consulate General of Brazil in Japan, Shinagawa-ku, Tokyo, Japan
| | - Nguyen Tien Huy
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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23
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Lee RP, Ajmera S, Thomas F, Dave P, Lillard JC, Wallace D, Broussard A, Motiwala M, Norrdahl SP, Venable GT, Khan NR, Harrell C, Jones TL, Vaughn BN, Gooldy T, Hersh DS, Klimo P. Shunt Failure-The First 30 Days. Neurosurgery 2020; 87:123-129. [PMID: 31557298 DOI: 10.1093/neuros/nyz379] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/06/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Incontrovertible predictors of shunt malfunction remain elusive. OBJECTIVE To determine predictors of shunt failure within 30 d of index surgery. METHODS This was a single-center retrospective cohort study from January 2010 through November 2016. Using a ventricular shunt surgery research database, clinical and procedural variables were procured. An "index surgery" was defined as implantation of a new shunt or revision or augmentation of an existing shunt system. The primary outcome was shunt failure of any kind within the first 30 days of index surgery. Bivariate models were created, followed by a final multivariable logistic regression model using a backward-forward selection procedure. RESULTS Our dataset contained 655 unique patients with a total of 1206 operations. The median age for the cohort at the time of first shunt surgery was 4.6 yr (range, 0-28; first and third quartile, .37 and 11.8, respectively). The 30-day failure rates were 12.4% when analyzing the first-index operation only (81/655), and 15.7% when analyzing all-index operations (189/1206). Small or slit ventricles at the time of index surgery and prior ventricular shunt operations were found to be significant covariates in both the "first-index" (P < .01 and P = .05, respectively) and "all-index" (P = .02 and P < .01, respectively) multivariable models. Intraventricular hemorrhage at the time of index surgery was an additional predictor in the all-index model (P = .01). CONCLUSION This study demonstrates that only 3 variables are predictive of 30-day shunt failure when following established variable selection procedures, 2 of which are potentially under direct control of the surgeon.
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Affiliation(s)
- Ryan P Lee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sonia Ajmera
- College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Fridtjof Thomas
- Division of Biostatistics, Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Jock C Lillard
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - David Wallace
- College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Austin Broussard
- College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mustafa Motiwala
- College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sebastian P Norrdahl
- College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Garrett T Venable
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Nickalus R Khan
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Camden Harrell
- Department of Pediatrics, The University of Tennessee Health Science Center, Children's Foundation Research Institute, Memphis, Tennessee.,Department of Preventive Medicine, The University of Tennessee Health Science Center, Children's Foundation Research Institute, Memphis, Tennessee
| | - Tamekia L Jones
- Department of Pediatrics, The University of Tennessee Health Science Center, Children's Foundation Research Institute, Memphis, Tennessee.,Department of Preventive Medicine, The University of Tennessee Health Science Center, Children's Foundation Research Institute, Memphis, Tennessee
| | | | - Tim Gooldy
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - David S Hersh
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee.,Le Bonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey, Memphis, Tennessee
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24
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Janjua MB, Reddy S, Welch WC, Samdani AF, Ozturk AK, Hwang SW, Price AV, Weprin BE, Swift DM. Thirty-day readmission risk after intracranial tumor resection surgeries in children. J Neurosurg Pediatr 2020; 25:97-105. [PMID: 31675691 DOI: 10.3171/2019.7.peds19272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/29/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The risk of readmission after brain tumor resection among pediatric patients has not been defined. The authors' objective was to evaluate the readmission rates and predictors of readmission after pediatric brain tumor resection. METHODS Nationwide Readmissions Database (NRD) data sets from 2010 to 2014 were searched for unplanned readmissions within 30 days of the discharge date after pediatric brain tumor resection. Patient demographic variables included sex, age, expected payment source (Medicaid or private insurance), and median annual household income. Readmission events for chemotherapy, radiation therapy, or further tumor resection were not included. RESULTS Of 282 patients (12.7%) readmitted within 30 days of the index event, the median time to readmission was 10 days (IQR 5-19 days). The most common reason for readmission was hydrocephalus, which accounted for 19% of readmission events. Other CNS-related complications (24%), surgical site infections or septicemia (14%), seizures (7%), and hematological disorders (7%) accounted for other major readmission events. The median charge for readmission events was $35,431, and the median length of readmission stay was 4 days. In multivariate regression, factors associated with a significant increase in readmission risk included Medicaid as the primary payor, discharge from the index event with home health services, and fluid and electrolyte disorders during the index event. CONCLUSIONS More than 10% of pediatric brain tumor patients have unplanned readmission events within 30 days of discharge after tumor resection. Medicaid patients and those with preoperative or early postoperative fluid and electrolyte disturbances may benefit from early or frequent outpatient visits after tumor resection.
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Affiliation(s)
- M Burhan Janjua
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas
- 2Department of Neurosurgery, University of Pennsylvania Hospital System, Philadelphia; and
| | - Sumanth Reddy
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas
| | - William C Welch
- 2Department of Neurosurgery, University of Pennsylvania Hospital System, Philadelphia; and
| | - Amer F Samdani
- 3Department of Neurosurgery, Shriners Hospital for Children, Philadelphia, Pennsylvania
| | - Ali K Ozturk
- 2Department of Neurosurgery, University of Pennsylvania Hospital System, Philadelphia; and
| | - Steven W Hwang
- 3Department of Neurosurgery, Shriners Hospital for Children, Philadelphia, Pennsylvania
| | - Angela V Price
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas
| | - Bradley E Weprin
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas
| | - Dale M Swift
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas
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25
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Norrdahl SP, Jones TL, Dave P, Hersh DS, Vaughn B, Klimo P. A hospital-based analysis of pseudomeningoceles after elective craniotomy in children: what predicts need for intervention? J Neurosurg Pediatr 2020; 25:462-469. [PMID: 32005010 DOI: 10.3171/2019.11.peds19227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 11/06/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In pediatric patients, the development of a postoperative pseudomeningocele after an elective craniotomy is not unusual. Most will resolve with time, but some may require intervention. In this study, the authors analyzed patients who required intervention for a postoperative pseudomeningocele following an elective craniotomy or craniectomy and identified factors associated with the need for intervention. METHODS An institutional operative database of elective craniotomies and craniectomies was queried to identify all surgeries associated with development of a postoperative pseudomeningocele from January 1, 2010, to December 31, 2017. Demographic and surgical data were collected, as were details regarding postoperative events and interventions during either the initial admission or upon readmission. A bivariate analysis was performed to compare patients who underwent observation with those who required intervention. RESULTS Following 1648 elective craniotomies or craniectomies, 84 (5.1%) clinically significant pseudomeningoceles were identified in 82 unique patients. Of these, 58 (69%) of the pseudomeningoceles were diagnosed during the index admission (8 of which persisted and resulted in readmission), and 26 (31%) were diagnosed upon readmission. Forty-nine patients (59.8% of those with a pseudomeningocele) required one or more interventions, such as lumbar puncture(s), lumbar drain placement, wound exploration, or shunt placement or revision. Only race (p < 0.01) and duraplasty (p = 0.03, OR 3.0) were associated with the need for pseudomeningocele treatment. CONCLUSIONS Clinically relevant pseudomeningoceles developed in 5% of patients undergoing an elective craniotomy, with 60% of these pseudomeningoceles needing some form of intervention. The need for intervention was associated with race and whether a duraplasty was performed.
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Affiliation(s)
| | - Tamekia L Jones
- Departments of2Pediatrics and
- 3Preventive Medicine, University of Tennessee Health Science Center, Memphis
- 4Children's Foundation Research Institute, Memphis
| | | | - David S Hersh
- 6Department of Neurosurgery, University of Tennessee Health Science Center, Memphis
- 7Le Bonheur Children's Hospital, Memphis; and
| | | | - Paul Klimo
- 6Department of Neurosurgery, University of Tennessee Health Science Center, Memphis
- 7Le Bonheur Children's Hospital, Memphis; and
- 8Semmes Murphey, Memphis, Tennessee
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26
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Hersh DS, Smith LGF, Jones TL, Fraser BD, Kumar R, Vaughn B, Klimo P. Predictors of an Extended Length of Stay following an Elective Craniotomy in Children and Young Adults. Pediatr Neurosurg 2020; 55:259-267. [PMID: 33099552 DOI: 10.1159/000511090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Length of stay (LOS) is now a generally accepted clinical metric within the USA. An extended LOS following an elective craniotomy can significantly impact overall costs. Few studies have evaluated predictors of an extended LOS in pediatric neurosurgical patients. OBJECTIVE The aim of the study was to determine predictors of an extended hospital LOS following an elective craniotomy in children and young adults. METHODS All pediatric patients and young adults undergoing an elective craniotomy between January 1, 2010, and April 1, 2019, were retrospectively identified using a prospectively maintained database. Demographic, clinical, radiological, and surgical data were collected. The primary outcome was extended LOS, defined as a postsurgical stay greater than 7 days. Bivariate and multivariable analyses were performed. RESULTS A total of 1,498 patients underwent 1,720 elective craniotomies during the study period over the course of 1,698 hospitalizations with a median LOS of 4 days (interquartile range 3-6 days). Of these encounters, 218 (12.8%) had a prolonged LOS. Multivariable analysis demonstrated that non-Caucasian race (OR = 1.9 [African American]; OR = 1.6 [other]), the presence of an existing shunt (OR = 1.8), the type of craniotomy (OR = 0.3 [vascular relative to Chiari]), and the presence of a postoperative complication (OR = 14.7) were associated with an extended LOS. CONCLUSIONS Inherent and modifiable factors predict a hospital stay of more than a week in children and young adults undergoing an elective craniotomy.
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Affiliation(s)
- David S Hersh
- Division of Neurosurgery, Connecticut Children's, Hartford, Connecticut, USA, .,Department of Surgery, UConn School of Medicine, Farmington, Connecticut, USA,
| | - Luke G F Smith
- Department of Neurosurgery, The Ohio State University, Columbus, Ohio, USA
| | - Tamekia L Jones
- Departments of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Brittany D Fraser
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Rahul Kumar
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Brandy Vaughn
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Paul Klimo
- Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Semmes Murphey, Memphis, Tennessee, USA
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27
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Dave P, Venable GT, Jones TL, Khan NR, Albert GW, Chern JJ, Wheelus JL, Governale LS, Huntoon KM, Maher CO, Bruzek AK, Mangano FT, Mehta V, Beaudoin W, Naftel RP, Basem J, Whitney A, Shimony N, Rodriguez LF, Vaughn BN, Klimo P. The Preventable Shunt Revision Rate: A Multicenter Evaluation. Neurosurgery 2020; 84:788-798. [PMID: 29982642 DOI: 10.1093/neuros/nyy263] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/17/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Preventable Shunt Revision Rate (PSRR) was recently introduced as a novel quality metric. OBJECTIVE To evaluate the PSRR across multiple centers and determine associated variables. METHODS Nine participating centers in North America provided at least 2 years of consecutive shunt operations. Index surgery was defined as new shunt implantation, or revision of an existing shunt. For any index surgery that resulted in a reoperation within 90-days, index surgery information (demographic, clinical, and procedural) was collected and a decision made whether the failure was potentially preventable. The 90-day shunt failure rate and PSRR were calculated per institution and combined. Bivariate analyses were performed to evaluate individual effects of each independent variable on preventable shunt failure followed by a final multivariable model using a backward model selection approach. RESULTS A total of 5092 shunt operations were performed; 861 failed within 90 days of index operation, resulting in a 16.9% combined 90-day shunt failure rate and 17.6% median failure rate (range, 8.7%-26.9%). Of the failures, 307 were potentially preventable (overall and median 90-day PSRR, 35.7% and 33.9%, respectively; range, 16.1%-55.4%). The most common etiologies of avoidable failure were infection (n = 134, 44%) and proximal catheter malposition (n = 83, 27%). Independent predictors of preventable failure (P < .05) were lack of endoscopy (odds ratio [OR] = 2.26), recent shunt infection (OR = 3.65), shunt type (OR = 2.06) and center. CONCLUSION PSRR is variable across institutions, but can be 50% or higher. While the PSRR may never reach zero, this study demonstrates that overall about a third of early failures are potentially preventable.
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Affiliation(s)
| | - Garrett T Venable
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Tamekia L Jones
- Departments of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center, Children's Foundation Research Institute, Memphis, Tennessee
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Gregory W Albert
- Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, Arkansas.,Department of Neurosurgery, University of Arkansas, Little Rock, Arkansas
| | - Joshua J Chern
- Pediatric Neurosurgical Associates, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Jennifer L Wheelus
- Pediatric Neurosurgical Associates, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Lance S Governale
- Division of Pediatric Neurosurgery, University of Florida, Gainesville, Florida
| | | | - Cormac O Maher
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Amy K Bruzek
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Vivek Mehta
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | | | - Robert P Naftel
- Division of Pediatric Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jade Basem
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anna Whitney
- Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nir Shimony
- Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Luis F Rodriguez
- Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | | | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Le Bonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey, Memphis, Tennessee
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Lin D, Bridgeman MB, Brunetti L. Evaluation of alterations in serum immunoglobulin concentrations in components of metabolic syndrome, obesity, diabetes, and dyslipidemia. BMC Cardiovasc Disord 2019; 19:319. [PMID: 31888499 PMCID: PMC6936077 DOI: 10.1186/s12872-019-01296-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 12/05/2019] [Indexed: 12/03/2022] Open
Abstract
Purpose Serum immunoglobulins (Igs) play a critical role in modulating the immune response by neutralizing pathogens, although little is known about the effect of Igs in development of atherosclerotic cardiovascular disease (ASCVD). Elevated serum Immunoglobulin A (IgA) concentrations have been identified in previous studies in populations with obesity and hypertriglyceridemia, whereas variable concentrations of Immunoglobulin M (IgM) have been observed in the setting of dyslipidemia. Methods In this cross-sectional study, investigators examined the association of serum Ig concentrations with components of metabolic syndrome, including obesity, diabetes, and dyslipidemia. All consecutive adult patients aged 18 years or older discharged from two academic teaching hospitals with serum Immunoglobulin G (IgG) concentration measured during their admission were evaluated, with a total of 1809 individuals included and stratified into two groups: those with and those without dyslipidemia. Results Mean IgG concentration in individuals with and without dyslipidemia was 997 ± 485 mg/dL and 1144 ± 677 mg/dL, respectively (P < 0.0001). After controlling for confounders in the generalized linear model (GLM), the least square mean IgG concentration in individuals with and without dyslipidemia was 1095 and 1239 mg/dL, respectively (P < 0.0001). The mean IgA and IgM concentrations were not significantly different in individuals with and without dyslipidemia both before and after adjusting covariates. After controlling for confounding variables, all three serum Ig concentrations were not significantly different in individuals with and without diabetes. Conclusion Dyslipidemia was associated with a lower mean serum IgG concentration. No association with any serum Ig was indentified in individuals with diabetes. Exploration of the association between alterations in serum Igs and metabolic syndrome and the role of alterations of Ig concentrations in disease progression represents an important step in identification of appropriate targeted treatment options for reducing cardiovascular risk.
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Affiliation(s)
- Dee Lin
- Health Outcomes Policy & Economics, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Mary Barna Bridgeman
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, NJ, 08854, USA.,RWJBarnabas Health, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Luigi Brunetti
- Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, 160 Frelinghuysen Road, Piscataway, NJ, 08854, USA. .,RWJBarnabas Health, Robert Wood Johnson Somerset, Somerville, NJ, USA.
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Preoperative risk stratification of patient mortality following elective craniotomy; a comparative analysis of prediction algorithms. J Clin Neurosci 2019; 67:24-31. [DOI: 10.1016/j.jocn.2019.06.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 05/10/2019] [Accepted: 06/21/2019] [Indexed: 11/17/2022]
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30
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Chaubey D, Kumar V, Thakur VK, Yadav R, Hasan Z, Prasad R, Rahul SK. Wound Closure in Large Neural Tube Defects: Role of Rhomboid Flaps. J Cutan Aesthet Surg 2019; 12:124-127. [PMID: 31413481 PMCID: PMC6676817 DOI: 10.4103/jcas.jcas_158_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Large wounds following surgery for neural tube defects are difficult to close; physical wound characteristics such as position and dimension would serve as a guide for their surgical closure. Aim: To study how wound dimension determines the choice between primary and rhomboid flap closure of skin defects following surgery for neural tube defects. Materials And Methods: A retrospective study was carried out on cases of neural tube defects operated in the department of paediatric surgery at a tertiary center for 3 years from January 2015 to December 2017. Data regarding clinical features, location, wound dimensions following surgery, any bony deformity, method of closure used, distance of wound from anus, and postoperative complications were collected and analyzed. Results: A total of 114 cases were operated during this period; 86/114 had primary closure, whereas 28/114 needed rhomboid flap for tension-free cover. Primarily closed wounds had a biphasic distribution of (long axis)/(short axis) ratio (with values either >1.65 or <0.63), whereas those covered by rhomboid flaps had a mean ratio of 1.25 (range, 0.71–1.45). All six cases with bony deformity needed rhomboid flaps. Although all lipomeningomyelocele defects could be primarily closed, all rachischisis needed flap cover. Infected lesions had a mean wound distance of 5.3cm from posterior anal margin. Conclusion: Defect’s position, its size and shape, and any bony deformity determine the choice of closure of postoperative wound. The versatile, safe, and universal rhomboid flap is an aesthetic solution to the large skin defects in patients of neural tube defects.
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Affiliation(s)
- Digamber Chaubey
- Department of Paediatric Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Vijayendra Kumar
- Department of Paediatric Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Vinit K Thakur
- Department of Paediatric Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Ramdhani Yadav
- Department of Paediatric Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Zaheer Hasan
- Department of Paediatric Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Ramjee Prasad
- Department of Paediatric Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Sandip K Rahul
- Department of Paediatric Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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31
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Cote DJ, Dasenbrock HH, Gormley WB, Smith TR, Dunn IF. Adverse Events After Microvascular Decompression: A National Surgical Quality Improvement Program Analysis. World Neurosurg 2019; 128:e884-e894. [PMID: 31082546 DOI: 10.1016/j.wneu.2019.05.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although microvascular decompression (MVD) is a durable treatment for medically refractory trigeminal neuralgia, hemifacial spasm, or glossopharyngeal neuralgia attributable to neurovascular conflict, few national studies have analyzed predictors of postoperative complications. OBJECTIVE To determine the incidence and risk factors for adverse events after MVD. METHODS Patients who underwent MVD were extracted from the prospectively collected National Surgical Quality Improvement Program registry (2006-2017). Multivariable logistic regression identified predictors of 30-day adverse events and unplanned readmission; multivariable linear regression analyzed predictors of a longer hospital stay. RESULTS Among the 1005 patients evaluated, the mortality was 0.3%, major neurologic complication rate 0.4%, and 2.8% had a nonroutine hospital discharge. Patient age was not a predictor of any adverse events. Statistically significant independent predictors both of any adverse event (9.2%) and of a longer hospitalization were American Society of Anesthesiologists (ASA) classification III-IV designation and longer operative duration (P ≤ 0.03) The 30-day readmission rate was 6.8%, and the most common reasons were surgical site infections (22.4%) and cerebrospinal fluid leakage (14.3%). Higher ASA classification, diabetes mellitus, and operative time were predictors of readmission (P < 0.04). CONCLUSIONS In this National Surgical Quality Improvement Program analysis, postoperative morbidity and mortality after MVD was low. Patient age was not a predictor of postoperative complications, whereas higher ASA classification, diabetes mellitus, and longer operative duration were predictive of any adverse event and readmission. ASA classification provided superior risk stratification compared with the total number of patient comorbidities or laboratory values. These data can assist with preoperative patient counseling and risk stratification.
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Affiliation(s)
- David J Cote
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - William B Gormley
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Timothy R Smith
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ian F Dunn
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Sherrod BA, McClugage SG, Mortellaro VE, Aban IB, Rocque BG. Venous thromboembolism following inpatient pediatric surgery: Analysis of 153,220 patients. J Pediatr Surg 2019; 54:631-639. [PMID: 30361075 PMCID: PMC6451662 DOI: 10.1016/j.jpedsurg.2018.09.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate venous thromboembolism (VTE) rates and risk factors following inpatient pediatric surgery. METHODS 153,220 inpatient pediatric surgical patients were selected from the 2012-2015 NSQIP-P database. Demographic and perioperative variables were documented. Primary outcome was VTE requiring treatment within 30 postoperative days. Secondary outcomes included length of stay (LOS) and 30-day mortality. Prediction models were generated using logistic regression. Mortality and time to VTE were assessed using Kaplan-Meier survival analysis. RESULTS 305 patients (0.20%) developed 296 venous thromboses and 12 pulmonary emboli (3 cooccurrences). Median time to VTE was 9 days. Most VTEs (81%) occurred predischarge. Subspecialties with highest VTE rates were cardiothoracic (0.72%) and general surgery (0.28%). No differences were seen for elective vs. urgent/emergent procedures (p = 0.106). All-cause mortality VTE patients was 1.2% vs. 0.2% in patients without VTE (p < 0.001). After stratifying by American Society of Anesthesiologists (ASA) class, no mortality differences remained when ASA < 3. Preoperative, postoperative, and total LOSs were longer for patients with VTE (p < 0.001 for each). ASA ≥ 3, preoperative sepsis, ventilator dependence, enteral/parenteral feeding, steroid use, preoperative blood transfusion, gastrointestinal disease, hematologic disorders, operative time, and age were independent predictors (C-statistic = 0.83). CONCLUSIONS Pediatric postsurgical patients have unique risk factors for developing VTE. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Brandon A Sherrod
- Department of Neurosurgery, Division of Pediatric Neurosurgery, The University of Alabama at Birmingham and Children's Hospital of Alabama, Birmingham, AL.
| | - Samuel G McClugage
- Department of Neurosurgery, Division of Pediatric Neurosurgery, The University of Alabama at Birmingham and Children's Hospital of Alabama, Birmingham, AL
| | - Vincent E Mortellaro
- Department of Surgery, Division of Pediatric Surgery, The University of Alabama at Birmingham and Children's Hospital of Alabama, Birmingham, AL
| | - Inmaculada B Aban
- Department of Biostatistics, The University of Alabama at Birmingham, School of Public Health, Birmingham, AL
| | - Brandon G Rocque
- Department of Neurosurgery, Division of Pediatric Neurosurgery, The University of Alabama at Birmingham and Children's Hospital of Alabama, Birmingham, AL
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Buchanan IA, Lin M, Donoho DA, Ding L, Giannotta SL, Attenello F, Mack WJ, Liu JC. Venous Thromboembolism After Degenerative Spine Surgery: A Nationwide Readmissions Database Analysis. World Neurosurg 2019; 125:e165-e174. [PMID: 30684695 DOI: 10.1016/j.wneu.2019.01.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/31/2018] [Accepted: 01/02/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is an appreciable burden on health care. The protracted recumbency experienced by many spinal patients juxtaposed with concerns for postoperative hemorrhage from early anticoagulation results in conflicting stances regarding chemoprophylaxis. Identifying risk factors associated with VTE is therefore instrumental in guiding management. OBJECTIVE To identify VTE risk factors in patients undergoing degenerative spine surgery. METHODS The Nationwide Readmissions Database was searched for adults undergoing spine surgery for degenerative diseases between 2010 and 2014. The 30-day and 90-day VTE incidence was estimated from readmissions with new VTE diagnoses. A multivariate survey-adjusted logistic regression model was used to identify variables associated with VTE diagnoses on readmission. RESULTS Of 838,507 degenerative spine cases queried, 3499 patients (0.42%) were readmitted with a VTE diagnosis within 30 days and 4321 patients (0.62%) were readmitted within 90 days. In multivariate analysis, steroids were independently associated with a higher likelihood of readmission with VTE at both 30 days (odds ratio, 1.58; P < 0.001) and 90 days (odds ratio, 1.97; P < 0.001). Significant associations were also identified with thoracolumbar surgery, length of stay, and discharge to institutional care. CONCLUSIONS The incidence of readmission with VTE diagnoses in spine surgery is low. However, their devastating consequences underscore the need to identify those patients deemed high risk. These patients include those having thoracolumbar surgery, of advanced age, with prolonged length of stay, using corticosteroids, and with a disposition to institutional care (e.g., skilled nursing facility or long-term acute care). Given the association between steroids and VTE, clinicians should be judicious about perioperative administration despite their obvious antiinflammatory benefits.
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Affiliation(s)
- Ian A Buchanan
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
| | - Michelle Lin
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Daniel A Donoho
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Li Ding
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Steven L Giannotta
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Frank Attenello
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - William J Mack
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - John C Liu
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Cannon JGD, Ho AL, Mohole J, Pendharkar AV, Sussman ES, Cheshier SH, Grant GA. Topical vancomycin for surgical prophylaxis in non-instrumented pediatric spinal surgeries. Childs Nerv Syst 2019; 35:107-111. [PMID: 29955942 DOI: 10.1007/s00381-018-3881-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 06/22/2018] [Indexed: 01/07/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine if topical vancomycin irrigation reduces the incidence of post-operative surgical site infections following pediatric spinal procedures. Surgical site infections (SSIs) following spinal procedures performed in pediatric patients represent a serious complication. Prophylactic use of topical vancomycin prior to closure has been shown to be effective in reducing incidence of SSIs in adult spinal procedures. Non-instrumented cases make up the majority of spinal procedures in pediatric patients, and the efficacy of prophylactic topical vancomycin in these procedures has not previously been reported. METHODS This retrospective study reviewed all non-instrumented spinal procedures performed over a period from 05/2014-12/2016 for topical vancomycin use, surgical site infections, and clinical variables associated with SSI. Topical vancomycin was utilized as infection prophylaxis, and applied as a liquid solution within the wound prior to closure. RESULTS Ninety-five consecutive, non-instrumented, pediatric spinal surgeries were completed between 01/2015 and 12/2016, of which the last 68 utilized topical vancomycin. There was a 11.1% SSI rate in the non-topical vancomycin cohort versus 0% in the topical vancomycin cohort (P = 0.005). The number needed to treat was 9. There were no significant differences in risk factors for SSI between cohorts. There were no complications associated topical vancomycin use. CONCLUSIONS Routine topical vancomycin administration during closure of non-instrumented spinal procedures can be a safe and effective tool for reducing SSIs in the pediatric neurosurgical population.
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Affiliation(s)
- John G D Cannon
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Allen L Ho
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Jyodi Mohole
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Arjun V Pendharkar
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Eric S Sussman
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Samuel H Cheshier
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
- Division of Neurosurgery, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
- Division of Neurosurgery, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.
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Deng Z, Yu H, Wang N, Alafate W, Wang J, Wang T, Du C, Wang M. Impact of preoperative Karnofsky Performance Scale (KPS) and American Society of Anesthesiologists (ASA) scores on perioperative complications in patients with recurrent glioma undergoing repeated operation. JOURNAL OF NEURORESTORATOLOGY 2019. [DOI: 10.26599/jnr.2019.9040015] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective: The objective of this study was to document the impact of the preoperative Karnofsky Performance Scale (KPS) and American Society of Anesthesiologists (ASA) scores on perioperative complications in patients with recurrent glioma who underwent tumor resection via craniotomy. Methods: A total of 96 patients were retrospectively reviewed. Based on KPS and ASA scores, patients were categorized into high KPS (> 70) or low KPS (≤ 70) and high ASA (3~4) or low ASA (1~2) groups. Differences in intraoperative risk factors and perioperative complications among the groups were analyzed. Multivariate analysis was performed to identify risk factors for perioperative complications. Results: The most frequent perioperative complications were cerebrospinal fluid leakage (31.8%) and intracranial infection (27.0%); 30-day mortality was 5.2%. The incidence rates of severe complications, central nervous system complications, and total complications were comparable in the low and high KPS groups and in the low and high ASA groups (all p > 0.05). Multivariate analysis showed that low KPS and high ASA scores were not the independent risk factors for perioperative complications. Conclusion: Low KPS and high ASA scores are not associated with increased postoperative complications in patients with recurrent glioma who undergo tumor resection via craniotomy.
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Oravec CS, Motiwala M, Reed K, Jones TL, Klimo P. Big Data Research in Pediatric Neurosurgery: Content, Statistical Output, and Bibliometric Analysis. Pediatr Neurosurg 2019; 54:85-97. [PMID: 30799390 DOI: 10.1159/000495790] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/23/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS We sought to describe pediatric "big data" publications since 2000, their statistical output, and clinical implications. METHODS We searched 4 major North American neurosurgical journals for articles utilizing non-neurosurgery-specific databases for clinical pediatric neurosurgery research. Articles were analyzed for descriptive and statistical information. We analyzed effect sizes (ESs), confidence intervals (CIs), and p values for clinical relevance. A bibliometric analysis was performed using several key citation metrics. RESULTS We identified 74 articles, which constituted 1.7% of all pediatric articles (n = 4,436) published, with an exponential increase after 2013 (53/74, 72%). The Healthcare Cost and Utilization Project (HCUP) databases were most frequently utilized (n = 33); hydrocephalus (n = 19) was the most common study topic. The statistical output (n = 49 studies with 464 ESs, 456 CIs, and 389 p values) demonstrated that the majority of the ESs (253/464, 55%) were categorized as small; half or more of the CI spread (CIS) values and p values were high (274/456, 60%) and very strong (195/389, 50%), respectively. Associations with a combination of medium-to-large ESs (i.e., magnitude of difference), medium-to-high CISs (i.e., precision), and strong-to-very strong p values comprised only 20% (75/381) of the reported ESs. The total number of citations for the 74 articles was 1,115 (range per article, 0-129), with the median number of citations per article being 8.5. Four studies had > 50 citations, and 2 of them had > 100 citations. The calculated h-index was 16, h-core citations were 718, the e-index was 21.5, and the Google i10-index was 34. CONCLUSIONS There has been a dramatic increase in the use of "big data" in the pediatric neurosurgical literature. Reported associations that may, as a group, be of greatest interest to practitioners represented only 20% of the total output from these publications. Citations were weighted towards a few highly cited publications.
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Affiliation(s)
- Chesney S Oravec
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mustafa Motiwala
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kevin Reed
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Tamekia L Jones
- Departments of Pediatrics and Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA, .,Semmes Murphey, Memphis, Tennessee, USA, .,Le Bonheur Children's Hospital, Memphis, Tennessee, USA,
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Decreasing Unexpected Returns to Orthopedic Hand Clinic: Improving Efficiency of Health Care Delivery. Pediatr Qual Saf 2018; 3:e107. [PMID: 30584634 PMCID: PMC6221584 DOI: 10.1097/pq9.0000000000000107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/14/2018] [Indexed: 11/26/2022] Open
Abstract
Purpose: An unexpected return to clinic (URTC) visit can place a substantial financial burden on patients and families while stressing the health care system. Our SMART aim was to decrease the rate of URTC visits from 1.8 per 100 patient follow-up visits by 50% using quality improvement methodology. Methods: The rate of URTC visits was tracked at our tertiary care pediatric hospital from February 1, 2014, to May 31, 2015, using a weekly P-chart. Interventions were studied from January 1 to May 31, 2015. Pareto charts determined the common causes of URTC visits. Interventions were studied using Plan-Do-Study-Act cycles. Medical charges for URTC patient visits were collected and patients/families were given a cost survey to determine nonmedical costs associated with the clinic visits. Results: Cast issues (50.5%) were most common, followed by new symptom/complaints (29.5%), and persistent or worse symptoms (15.2%). Following interventions, URTC rates decreased from 1.8 to 0.7 (⇓62%) per 100 follow-up visits during the study period. Interventions were targeted toward cast use and improved patient education via standardized materials. The average URTC resulted in $350.38 of charges. Additionally, the average URTC cost families $70 for a half day of lost wages and travel expenses. Discussion: Applying quality improvement methodology to URTC visits by standardizing patient education and minimizing cast usage resulted in a substantial decrease in the number of patients returning to clinic, both for scheduled follow-ups and unexpectedly. This improvement resulted in a savings of more than $420 per visit saved, including medical and nonmedical costs.
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Khan NR, Moore K, Basma J, Hersh DS, Choudhri AF, Vaughn B, Klimo P. Ischemic stroke following elective craniotomy in children. J Neurosurg Pediatr 2018; 23:355-362. [PMID: 30579265 DOI: 10.3171/2018.10.peds18491] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/04/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE An ischemic stroke following an elective craniotomy in a child is perceived to be a rare event. However, to date there are few papers on this topic. The purpose of this study was to investigate the occurrence of stroke following elective intracranial surgery at a children’s hospital. METHODS The authors performed a retrospective review of all patients who developed a perioperative stroke following an elective craniotomy from 2010 through 2017. Data were collected using an institutional database that contained demographic, medical, radiological, and outcome variables. RESULTS A total of 1591 elective craniotomies were performed at the authors’ institution during the study period. Of these, 28 (1.8%) were followed by a perioperative stroke. Radiographic diagnosis of the infarction occurred at a median of 1.7 days (range 0–9 days) from the time of surgery, and neurological deficits were apparent within 24 hours of surgery in 18 patients (62.5%). Infarcts tended to occur adjacent to tumor resection sites (86% of cases), and in a unilateral (89%), unifocal (93%), and supratentorial (93%) location. Overall, 11 (39.3%) strokes were due to a perforating artery, 10 (35.7%) were due to a large vessel, 4 (14.3%) were venous, and 3 (10.7%) were related to hypoperfusion or embolic causes. Intraoperative MRI (iMRI) was used in 11 of the 28 cases, and 6 (55%) infarcts were not detected, all of which were deep. CONCLUSIONS The incidence of stroke following an elective craniotomy is low, with nearly all cases (86%) occurring after tumor resection. Perforator infarcts were most common but may be missed on iMRI. ABBREVIATIONS ACA = anterior cerebral artery; AChA = anterior choroidal artery; ACS NSQIP-P = American College of Surgeons National Surgical Quality Improvement Program–Pediatric; CVA = cerebrovascular accident; DWI = diffusion weighted imaging; iMRI = intraoperative MRI; MCA = middle cerebral artery; mRS = modified Rankin Scale; PCA = posterior cerebral artery.
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Affiliation(s)
| | | | | | | | - Asim F Choudhri
- Departments of1Neurosurgery and.,2Radiology, University of Tennessee Health Science Center
| | | | - Paul Klimo
- Departments of1Neurosurgery and.,3Le Bonheur Children's Hospital; and.,4Semmes Murphey, Memphis, Tennessee
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Maldonado N, Michel J, Barnes K. Thirty-day hospital readmissions after augmentation cystoplasty: A Nationwide readmissions database analysis. J Pediatr Urol 2018; 14:533.e1-533.e9. [PMID: 30061087 DOI: 10.1016/j.jpurol.2018.05.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/23/2018] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Reducing hospital readmissions is a growing priority for hospitals and clinicians in their efforts to improve quality of care and curtail costs. Augmentation cystoplasty is among the most complex and high-morbidity operations in pediatric urology, with up to 25% of patients experiencing a postoperative complication. However, there is a paucity of literature addressing the incidence and characteristics of hospital readmissions after these procedures. This information may be useful in tailoring perioperative interventions to reduce rehospitalization in this population. OBJECTIVE This study sought to determine the rate, causes, risk factors, and costs associated with 30-day readmissions for children undergoing augmentation cystoplasty. STUDY DESIGN We analyzed the Nationwide Readmissions Database (NRD) for children (≤18 years of age) who underwent augmentation cystoplasty for any indication between 2010 and 2014. Rates, causes, and costs of 30-day readmissions were determined. Multivariate logistic regression was used to identify risk factors for readmission. RESULTS Among 1873 identified cases, the 30-day readmission rate was 19.6%, with an average cost per readmission of $11,667. The most common reasons for readmission were gastrointestinal complications (19.6%), urinary tract infections (14.1%), and wound complications (11.2%). The median time to readmission was 13 days (interquartile range 6-19 days). Non-infectious genitourinary complications (e.g. hydronephrosis) ($25,286) and gastrointestinal complications ($12,924) led to the costliest readmissions, while dehydration/vomiting ($3739) and fever ($4803) were the least costly. On multivariate regression, the only significant risk factor for readmission was an indication of neurogenic bladder (OR 3.82, 95% CI 1.03-14.20, p = 0.04). DISCUSSION We present the first study to capture readmissions with 30 days of discharge to the same or outside hospitals after augmentation cystoplasty. Limitations include inability to separate planned and unplanned readmissions and 30-day follow-up period, which prevented analysis of readmissions caused by late complications. CONCLUSION Approximately one in five children undergoing augmentation cystoplasty are readmitted within 30 days. An indication of neurogenic bladder is an independent risk factor, while gastrointestinal complications and urinary tract infections are the most common reasons for readmission.
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Affiliation(s)
- Nancy Maldonado
- University of California, Los Angeles, Los Angeles, CA, USA.
| | - Joaquin Michel
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Kelly Barnes
- Department of Pediatrics, Mercy Hospital St. Louis, St. Louis, MO, USA
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Gupta S, Ahmed AK, Bi WL, Dawood HY, Iorgulescu JB, Corrales CE, Dunn IF, Smith TR. Predicting Readmission and Reoperation for Benign Cranial Nerve Neoplasms: A Nationwide Analysis. World Neurosurg 2018; 121:e223-e229. [PMID: 30261394 DOI: 10.1016/j.wneu.2018.09.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Readmission and reoperation are risks in the resection of benign cranial nerve tumors (BCNTs). This report analyzes the impact of patient-level and surgical factors on these adverse outcomes. METHODS This retrospective cohort review comprised patients with a diagnosis of BCNT enrolled in the American College of Surgeons National Surgical Quality Improvement Program registry from 2011 to 2015. Multivariate logistic regression was used to determine the impact of select medical and operative factors on the primary outcomes of readmission and reoperation within 30 days, adjusted for relevant covariates. RESULTS We identified 996 patients who underwent resection of a BCNT. The most frequent major complications were readmission (11%), reoperation (8%), surgical site infections (2.6%), and venous thromboembolism (1.5%). The most frequent indications for readmission were management of infection (2.5%), cerebrospinal fluid leak (2.3%), and hydrocephalus (0.5%). Repair of cranial and meningeal defects (3.0%), correction of lagophthalmos (1.2%), and repair of middle ear defects (1.0%) were the most common indications for reoperation. Logistic regression revealed that extremes of age were associated with readmission, whereas preoperative steroid usage, long operative time, and postoperative length of stay >3 days were associated with reoperation (P < 0.05). Obesity trended toward an association with readmission and reoperation. CONCLUSIONS Extremes of age were associated with readmission; preoperative steroid use, long operative time, and postoperative length of stay >3 days were associated with reoperation. Surgeons should consider these factors when assessing risk of postoperative complications for BCNTs.
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Affiliation(s)
- Saksham Gupta
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Abdul-Kareem Ahmed
- Department of Neurosurgery, University of Maryland Medical College, Baltimore, Maryland, USA
| | - Wenya Linda Bi
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hassan Y Dawood
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - J Bryan Iorgulescu
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - C Eduardo Corrales
- Department of Otolaryngology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ian F Dunn
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy R Smith
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Zhang G, Zheng G, Zhang Y, Ma R, Kang X. Evaluation of a micro/nanofluidic chip platform for the high-throughput detection of bacteria and their antibiotic resistance genes in post-neurosurgical meningitis. Int J Infect Dis 2018; 70:115-120. [PMID: 29559366 DOI: 10.1016/j.ijid.2018.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/11/2018] [Accepted: 03/12/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Post-neurosurgical meningitis (PNM) is one of the most severe hospital-acquired infections worldwide, and a large number of pathogens, especially those possessing multi-resistance genes, are related to these infections. Existing methods for detecting bacteria and measuring their response to antibiotics lack sensitivity and stability, and laboratory-based detection methods are inconvenient, requiring at least 24h to complete. Rapid identification of bacteria and the determination of their susceptibility to antibiotics are urgently needed, in order to combat the emergence of multi-resistant bacterial strains. METHODS This study evaluated a novel, fast, and easy-to-use micro/nanofluidic chip platform (MNCP), which overcomes the difficulties of diagnosing bacterial infections in neurosurgery. This platform can identify 10 genus or species targets and 13 genetic resistance determinants within 1h, and it is very simple to operate. A total of 108 bacterium-containing cerebrospinal fluid (CSF) cultures were tested using the MNCP for the identification of bacteria and determinants of genetic resistance. The results were compared to those obtained with conventional identification and antimicrobial susceptibility testing methods. RESULTS For the 108 CSF cultures, the concordance rate between the MNCP and the conventional identification method was 94.44%; six species attained 100% consistency. For the production of carbapenemase- and extended-spectrum beta-lactamase (ESBL)-related antibiotic resistance genes, both the sensitivity and specificity of the MNCP tests were high (>90.0%) and could fully meet the requirements of clinical diagnosis. CONCLUSIONS The MNCP is fast, accurate, and easy to use, and has great clinical potential in the treatment of post-neurosurgical meningitis.
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Affiliation(s)
- Guojun Zhang
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital and Capital Medical University, Beijing, China
| | - Guanghui Zheng
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital and Capital Medical University, Beijing, China
| | - Yan Zhang
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China; National Engineering Research Center for Beijing Biochip Technology, Beijing 102206, China.
| | - Ruimin Ma
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital and Capital Medical University, Beijing, China
| | - Xixiong Kang
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital and Capital Medical University, Beijing, China.
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Piper K, DeAndrea-Lazarus I, Algattas H, Kimmell KT, Towner J, Li YM, Walter K, Vates GE. Risk Factors Associated with Readmission and Reoperation in Patients Undergoing Spine Surgery. World Neurosurg 2018; 110:e627-e635. [DOI: 10.1016/j.wneu.2017.11.057] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 11/09/2017] [Accepted: 11/11/2017] [Indexed: 12/21/2022]
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Oravec CS, Motiwala M, Reed K, Kondziolka D, Barker FG, Michael LM, Klimo P. Big Data Research in Neurosurgery: A Critical Look at this Popular New Study Design. Neurosurgery 2017; 82:728-746. [DOI: 10.1093/neuros/nyx328] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/17/2017] [Indexed: 01/10/2023] Open
Affiliation(s)
- Chesney S Oravec
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mustafa Motiwala
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kevin Reed
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Langone Medical Center, New York, New York
| | - Fred G Barker
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - L Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes Murphey Clinic, Memphis, Tennessee
- Department of Neurosurgery, Le Bonheur Children's Hospital, Memphis, Tennessee
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Staykov D, Kuramatsu JB, Bardutzky J, Volbers B, Gerner ST, Kloska SP, Doerfler A, Schwab S, Huttner HB. Efficacy and safety of combined intraventricular fibrinolysis with lumbar drainage for prevention of permanent shunt dependency after intracerebral hemorrhage with severe ventricular involvement: A randomized trial and individual patient data meta-analysis. Ann Neurol 2017; 81:93-103. [PMID: 27888608 DOI: 10.1002/ana.24834] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/24/2016] [Accepted: 11/25/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Intraventricular hemorrhage (IVH) is a negative prognostic factor in intracerebral hemorrhage (ICH) and is associated with permanent shunt dependency in a substantial proportion of patients post-ICH. IVH treatment by intraventricular fibrinolysis (IVF) was recently linked to reduced mortality rates in the CLEAR III study and IVF represents a safe and effective strategy to hasten clot resolution that may reduce shunt rates. Additionally, promising results from observational studies reported reductions in shunt dependency for a combined treatment approach of IVF plus lumbar drains (LDs). The present randomized, controlled trial investigated efficacy and safety of a combined strategy-IVF plus LD versus IVF alone-on shunt dependency in patients with ICH and severe IVH. METHODS This randomized, open-label, parallel-group study included patients aged 18 to 85 years, prehospital modified Rankin Scale ≤3, ICH volume < 60ml, Glasgow Coma Scale of <9, and severe IVH with tamponade of the third and fourth ventricles requiring placement of external ventricular drainage (EVD). Over a 3-year recruitment period, patients were allocated to either standard treatment (control group receiving IVF consisting of 1mg of recombinant human tissue plasminogen activator every 8 hours until clot clearance of third and fourth ventricles) or a combined treatment approach of IVF and-upon clot clearance of third and fourth ventricles-subsequent placement of an LD for drainage of cerebrospinal fluid (CSF; intervention group). The primary endpoint consisted of permanent shunt placement indicated after a total of three unsuccessful EVD clamping attempts or need for CSF drainage longer than 14 days in both groups. Secondary endpoints included IVF- and LD-related safety, such as bleeding or infections, and functional outcome at 90 and 180 days. Conducted endpoint analyses used individual patient data meta-analyses. The study was registered at clinicaltrials.gov (NCT01041950). RESULTS The trial was stopped upon predefined interim analysis after 30 patients because of significant efficacy of tested intervention. The primary endpoint was analyzed without dropouts and was reached in 43% (7 of 16) of the control group versus 0% (0 of 14) of the intervention group (p = 0.007). Meta-analyses were based on overall 97 patients, 45 patients receiving IVF plus LD versus 42 with IVF only. Meta-analyses on shunt dependency showed an absolute risk reduction of 24% for the intervention (LD, 2.2% [1 of 45] vs no-LD, 26.2% [11 of 42]; odds ratio [OR] = 0.062; confidence interval [CI], 0.011-0.361; p = 0.002). Secondary endpoints did not show significant differences for CSF infections (OR = 0.869;CI, 0.445-1.695; p = 0.680) and functional outcome at 90 days (OR = 0.478; CI, 0.190-1.201; p = 0.116), yet bleeding complications were significantly reduced in favor of the intervention (OR = 0.401; CI, 0.302-0.532; p < 0.001). INTERPRETATION The present trial and individual patient data meta-analyses provide evidence that, in patients with severe IVH, as compared to IVF alone, a combined approach of IVF plus LD treatment is feasible and safe and significantly reduces rates of permanent shunt dependency for aresorptive hydrocephalus post-ICH. ANN NEUROL 2017;81:93-103.
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Affiliation(s)
- Dimitre Staykov
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany.,Department of Neurology, St John Hospital Eisenstadt, Eisenstadt, Austria
| | - Joji B Kuramatsu
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jürgen Bardutzky
- Department of Neurology, University of Freiburg, Freiburg, Germany
| | - Bastian Volbers
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Stefan T Gerner
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Stephan P Kloska
- Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Stefan Schwab
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Hagen B Huttner
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
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Sherrod BA, Rocque BG. Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery. J Neurosurg Pediatr 2017; 19:421-427. [PMID: 28186474 PMCID: PMC5450911 DOI: 10.3171/2016.11.peds16455] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Morbidity associated with surgical site infection (SSI) following nonshunt pediatric neurosurgical procedures is poorly understood. The purpose of this study was to analyze acute morbidity and mortality associated with SSI after nonshunt pediatric neurosurgery using a nationwide cohort. METHODS The authors reviewed data from the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) 2012-2014 database, including all neurosurgical procedures performed on pediatric patients. Procedures were categorized by Current Procedural Terminology (CPT) codes. CSF shunts were excluded. Deep and superficial SSIs occurring within 30 days of an index procedure were identified. Deep SSIs included deep wound infections, intracranial abscesses, meningitis, osteomyelitis, and ventriculitis. The following outcomes occurring within 30 days of an index procedure were analyzed, along with postoperative time to complication development: sepsis, wound disruption, length of postoperative stay, readmission, reoperation, and death. RESULTS A total of 251 procedures associated with a 30-day SSI were identified (2.7% of 9296 procedures). Superficial SSIs were more common than deep SSIs (57.4% versus 42.6%). Deep SSIs occurred more frequently after epilepsy or intracranial tumor procedures. Superficial SSIs occurred more frequently after skin lesion, spine, Chiari decompression, craniofacial, and myelomeningocele closure procedures. The mean (± SD) postoperative length of stay for patients with any SSI was 9.6 ± 14.8 days (median 4 days). Post-SSI outcomes significantly associated with previous SSI included wound disruption (12.4%), sepsis (15.5%), readmission (36.7%), and reoperation (43.4%) (p < 0.001 for each). Post-SSI sepsis rates (6.3% vs 28.0% for superficial versus deep SSI, respectively; p < 0.001), wound disruption rates (4.9% vs 22.4%, p < 0.001), and reoperation rates (23.6% vs 70.1%, p < 0.001) were significantly greater for patients with deep SSIs. Postoperative length of stay in patients discharged before SSI development was not significantly different for deep versus superficial SSI (4.2 ± 2.7 vs 3.6 ± 2.4 days, p = 0.094). No patient with SSI died within 30 days after surgery. CONCLUSIONS Thirty-day SSI is associated with significant 30-day morbidity in pediatric patients undergoing nonshunt neurosurgery. Rates of SSI-associated complications are significantly lower in patients with superficial infection than in those with deep infection. There were no cases of SSI-related mortality within 30 days of the index procedure.
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Sherrod BA, Arynchyna AA, Johnston JM, Rozzelle CJ, Blount JP, Oakes WJ, Rocque BG. Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience. J Neurosurg Pediatr 2017; 19:407-420. [PMID: 28186476 PMCID: PMC5450913 DOI: 10.3171/2016.11.peds16454] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical site infection (SSI) following CSF shunt operations has been well studied, yet risk factors for nonshunt pediatric neurosurgery are less well understood. The purpose of this study was to determine SSI rates and risk factors following nonshunt pediatric neurosurgery using a nationwide patient cohort and an institutional data set specifically for better understanding SSI. METHODS The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-P) database for the years 2012-2014, including all neurosurgical procedures performed on pediatric patients except CSF shunts and hematoma evacuations. SSI included deep (intracranial abscesses, meningitis, osteomyelitis, and ventriculitis) and superficial wound infections. The authors performed univariate analyses of SSI association with procedure, demographic, comorbidity, operative, and hospital variables, with subsequent multivariate logistic regression analysis to determine independent risk factors for SSI within 30 days of the index procedure. A similar analysis was performed using a detailed institutional infection database from Children's of Alabama (COA). RESULTS A total of 9296 nonshunt procedures were identified in NSQIP-P with an overall 30-day SSI rate of 2.7%. The 30-day SSI rate in the COA institutional database was similar (3.3% of 1103 procedures, p = 0.325). Postoperative time to SSI in NSQIP-P and COA was 14.6 ± 6.8 days and 14.8 ± 7.3 days, respectively (mean ± SD). Myelomeningocele (4.3% in NSQIP-P, 6.3% in COA), spine (3.5%, 4.9%), and epilepsy (3.4%, 3.1%) procedure categories had the highest SSI rates by procedure category in both NSQIP-P and COA. Independent SSI risk factors in NSQIP-P included postoperative pneumonia (OR 4.761, 95% CI 1.269-17.857, p = 0.021), immune disease/immunosuppressant use (OR 3.671, 95% CI 1.371-9.827, p = 0.010), cerebral palsy (OR 2.835, 95% CI 1.463-5.494, p = 0.002), emergency operation (OR 1.843, 95% CI 1.011-3.360, p = 0.046), spine procedures (OR 1.673, 95% CI 1.036-2.702, p = 0.035), acquired CNS abnormality (OR 1.620, 95% CI 1.085-2.420, p = 0.018), and female sex (OR 1.475, 95% CI 1.062-2.049, p = 0.021). The only COA factor independently associated with SSI in the COA database included clean-contaminated wound classification (OR 3.887, 95% CI 1.354-11.153, p = 0.012), with public insurance (OR 1.966, 95% CI 0.957-4.041, p = 0.066) and spine procedures (OR 1.982, 95% CI 0.955-4.114, p = 0.066) approaching significance. Both NSQIP-P and COA multivariate model C-statistics were > 0.7. CONCLUSIONS The NSQIP-P SSI rates, but not risk factors, were similar to data from a single center.
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Kuo BJ, Vissoci JRN, Egger JR, Smith ER, Grant GA, Haglund MM, Rice HE. Perioperative outcomes for pediatric neurosurgical procedures: analysis of the National Surgical Quality Improvement Program-Pediatrics. J Neurosurg Pediatr 2017; 19:361-371. [PMID: 28059679 DOI: 10.3171/2016.10.peds16414] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Existing studies have shown a high overall rate of adverse events (AEs) following pediatric neurosurgical procedures. However, little is known regarding the morbidity of specific procedures or the association with risk factors to help guide quality improvement (QI) initiatives. The goal of this study was to describe the 30-day mortality and AE rates for pediatric neurosurgical procedures by using the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatrics (NSQIP-Peds) database platform. METHODS Data on 9996 pediatric neurosurgical patients were acquired from the 2012-2014 NSQIP-Peds participant user file. Neurosurgical cases were analyzed by the NSQIP-Peds targeted procedure categories, including craniotomy/craniectomy, defect repair, laminectomy, shunts, and implants. The primary outcome measure was 30-day mortality, with secondary outcomes including individual AEs, composite morbidity (all AEs excluding mortality and unplanned reoperation), surgical-site infection, and unplanned reoperation. Univariate analysis was performed between individual AEs and patient characteristics using Fischer's exact test. Associations between individual AEs and continuous variables (duration from admission to operation, work relative value unit, and operation time) were examined using the Student t-test. Patient characteristics and continuous variables associated with any AE by univariate analysis were used to develop category-specific multivariable models through backward stepwise logistic regression. RESULTS The authors analyzed 3383 craniotomy/craniectomy, 242 defect repair, 1811 laminectomy, and 4560 shunt and implant cases and found a composite overall morbidity of 30.2%, 38.8%, 10.2%, and 10.7%, respectively. Unplanned reoperation rates were highest for defect repair (29.8%). The mortality rate ranged from 0.1% to 1.2%. Preoperative ventilator dependence was a significant predictor of any AE for all procedure groups, whereas admission from outside hospital transfer was a significant predictor of any AE for all procedure groups except craniotomy/craniectomy. CONCLUSIONS This analysis of NSQIP-Peds, a large risk-adjusted national data set, confirms low perioperative mortality but high morbidity for pediatric neurosurgical procedures. These data provide a baseline understanding of current expected clinical outcomes for pediatric neurosurgical procedures, identify the need for collecting neurosurgery-specific risk factors and complications, and should support targeted QI programs and clinical management interventions to improve care of children.
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Affiliation(s)
- Benjamin J Kuo
- Division of Global Neurosurgery and Neuroscience and.,Global Health Institute, Duke University, Durham, North Carolina.,Duke-NUS Medical School, Singapore
| | - Joao Ricardo N Vissoci
- Division of Global Neurosurgery and Neuroscience and.,Global Health Institute, Duke University, Durham, North Carolina
| | - Joseph R Egger
- Global Health Institute, Duke University, Durham, North Carolina
| | - Emily R Smith
- Division of Global Neurosurgery and Neuroscience and.,Global Health Institute, Duke University, Durham, North Carolina
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University, Stanford, California
| | - Michael M Haglund
- Division of Global Neurosurgery and Neuroscience and.,Global Health Institute, Duke University, Durham, North Carolina.,Departments of 4 Neurosurgery and
| | - Henry E Rice
- Global Health Institute, Duke University, Durham, North Carolina.,Surgery, Duke University Medical Center, Durham, North Carolina; and
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Karhade AV, Cote DJ, Larsen AM, Smith TR. Neurosurgical Infection Rates and Risk Factors: A National Surgical Quality Improvement Program Analysis of 132,000 Patients, 2006–2014. World Neurosurg 2017; 97:205-212. [DOI: 10.1016/j.wneu.2016.09.056] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/11/2016] [Accepted: 09/13/2016] [Indexed: 10/21/2022]
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