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Chen JR, Tatum R, Sanders VL, Ahmad D, Morris RJ, Tchantchaleishvili V. Surgeon and Hospital Factors Associated With Outcomes in the New York State Database. J Surg Res 2024; 300:402-408. [PMID: 38848640 DOI: 10.1016/j.jss.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 06/09/2024]
Abstract
INTRODUCTION We sought to explore the relationship between various surgeon-related and hospital-level characteristics and clinical outcomes among patients requiring cardiac surgery. METHODS We searched the New York State Cardiac Data Reporting System for all coronary artery bypass grafting (CABG) and valve cases between 2015 and 2017. The data were analyzed without dichotomization. RESULTS Among CABG/valve surgeons, case volume was positively correlated with years in practice (P = 0.002) and negatively correlated with risk-adjusted mortality ratio (P = 0.014). For CABG and CABG/valve surgeons, our results showed a negative association between teaching status and case volume (P = 0.002, P = 0.018). Among CABG surgeons, hospital teaching status and presence of cardiothoracic surgery residency were inversely associated with risk-adjusted mortality ratio (P = 0.006, P = 0.029). CONCLUSIONS There is a complex relationship between case volume, teaching status, and surgical outcomes suggesting that balance between academics and volume is needed.
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Affiliation(s)
- Joshua R Chen
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert Tatum
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Victoria L Sanders
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Danial Ahmad
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rohinton J Morris
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
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Ramsay IA, Elarjani T, Govindarajan V, Silva MA, Abdelsalam A, Burks JD, Starke RM, Luther E. Concurrent bacterial endocarditis is associated with worse inpatient outcomes for large vessel occlusions. J Neurointerv Surg 2024; 16:657-662. [PMID: 37586820 DOI: 10.1136/jnis-2023-020381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/24/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Neurological complications of bacterial endocarditis (BE) are common, including acute ischemic stroke (AIS). Although mechanical thrombectomy (MT) is effective for large vessel occlusion (LVO) stroke, data are limited on MT for LVOs in patients with endocarditis. We assess outcomes in patients treated with thrombectomy for LVOs with concurrent BE. METHODS The National Inpatient Sample (NIS) was used. The NIS was queried from October 2015-2019 for patients receiving MT for LVO of the middle cerebral artery. Odds ratios (OR) were calculated using a multivariate logistic regression model. RESULTS A total of 635 AIS with BE patients and 57 420 AIS only patients were identified undergoing MT. AIS with BE patients had a death rate of 26.8% versus 10.2% in the stroke alone cohort, and were also less likely to have a routine discharge (10.2% vs 20.9%, both P<0.0001). AIS with BE patients had higher odds of death (OR 3.94) and lower odds of routine discharge (OR 0.23). AIS with BE patients also had higher rates of post-treatment cerebral hemorrhage, 39.4% vs 23.7%, with an OR of 2.20 (P<0.0001 for both analyses). These patients also had higher odds of other complications, including hydrocephalus, respiratory failure, acute kidney injury, and sepsis. CONCLUSION While MT can be used to treat endocarditis patients with LVOs, these patients have worse outcomes. Additional investigations should be undertaken to better understand their clinical course, and further develop treatments for endocarditis patients with stroke.
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Affiliation(s)
- Ian A Ramsay
- MD-MPH Program, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Turki Elarjani
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vaidya Govindarajan
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael A Silva
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ahmed Abdelsalam
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joshua D Burks
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert M Starke
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Evan Luther
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Luther E, Ramsay I, Govindarajan V, Berke CN, Makhoul V, Merenzon M, Berry K, Morell A, Eichberg D, Lu VM, Shah A, Komotar RJ, Ivan ME. The Effect of the Coronavirus Disease 2019 Pandemic on Pituitary Surgery. World Neurosurg 2024; 186:e440-e448. [PMID: 38583567 DOI: 10.1016/j.wneu.2024.03.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE As the coronavirus disease 2019 (COVID-19) pandemic spread to the United States in 2020, there was an impetus toward postponing or ceasing nonurgent transsphenoidal pituitary surgeries to prevent the spread of the virus. Some centers encouraged transcranial approaches for patients with declining neurologic function. However, no large-scale data exist evaluating the effects that this situation had on national pituitary practice patterns. METHODS Pituitary surgeries in the National Inpatient Sample were identified from 2017 to 2020. Surgeries in 2020 were compared with the 3 years previously to determine any differences in demographics, surgical trends/approaches, and perioperative outcomes. RESULTS In 2020, there was a decline in overall pituitary surgeries (34.2 vs. 36.3%; odds ratio (OR), 0.88; P < 0.001) yet transsphenoidal approaches represented a higher proportion of interventions (69.0 vs. 64.9%; P < 0.001). Neurosurgical complications were higher (51.9 vs. 47.4%; OR, 1.13; P < 0.001) and patients were less likely to be discharged home (86.4 vs. 88.5%; OR, 0.84; P < 0.001). This finding was especially true in April 2020 during the first peak in COVID-19 cases, when transcranial approaches and odds of mortality/complications were highest. CONCLUSIONS In 2020, transsphenoidal surgery remained the preferred approach for pituitary tumor resection despite initial recommendations against the approach to prevent COVID-19 spread. Pituitary surgeries had a higher risk of periprocedural complications despite accounting for preoperative comorbidities, COVID-19 infection status, and surgical approach, suggesting that an overwhelmed hospital system can negatively influence surgical outcomes in noninfected patients.
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Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Ian Ramsay
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Vaidya Govindarajan
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Chandler N Berke
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA.
| | - Vivien Makhoul
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Martin Merenzon
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Katherine Berry
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Alexis Morell
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Daniel Eichberg
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Ashish Shah
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
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Luther E, Ramsay I, Berke C, Makhoul V, Lu V, Elarjani T, Burks J, Berry K, Eichberg DG, Di L, Mansour S, Echeverry N, Morell A, Ivan M, Komotar R. Widening the Operative Corridor-Evaluating the Transcortical Approach to Giant Falcine Meningiomas. World Neurosurg 2024; 185:e442-e450. [PMID: 38364894 DOI: 10.1016/j.wneu.2024.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Giant falcine meningiomas are surgically complex as they are deep in location, concealed by normal brain parenchyma, in close proximity to various neurovascular structures, and frequently involve the falx bilaterally. Although classically accessed using a bifrontal craniotomy and interhemispheric approach, little data exist on alternative operative corridors for these challenging tumors. We evaluated perioperative and long-term outcomes in patients undergoing transcortical resection of giant bilateral falcine meningiomas. METHODS From 2013 to 2022, fourteen patients with giant bilateral falcine meningiomas treated via a transcortical approach at our institution were identified. Perioperative and long-term outcomes were evaluated to determine predictors of adverse events. Corticectomy depth was also analyzed to determine if it correlated with increased postoperative seizure rates. RESULTS 57.1% of cases were WHO grade 2 meningiomas. Average tumor volume was 77.8 ± 46.5 cm3 and near/gross total resection was achieved in 78.6% of patients. No patient developed a venous infarct or had seizures in the 6 months after surgery. Average corticectomy depth was 0.83 ± 0.71 cm and increasing corticectomy depth did not correlate with higher risk of postoperative seizures (P = 0.44). Increasing extent of tumor resection correlated with lower tumor grade (P = 0.011) and only 1 patient required repeat resection during a median follow-period of 24.9 months. CONCLUSIONS The transcortical approach is a safe alternative corridor for accessing giant, falcine meningiomas, and postoperative seizures were not found to correlate with increasing corticectomy depth. Further prospective studies are necessary to determine the best approach to these surgically complex lesions.
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Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - Ian Ramsay
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chandler Berke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vivien Makhoul
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Victor Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Turki Elarjani
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joshua Burks
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Katherine Berry
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel G Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Long Di
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Samuel Mansour
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nikolas Echeverry
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alexis Morell
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida, USA
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Yu X, Ouyang L, Li J, Peng Y, Zhong D, Yang H, Zhou Y. Knowledge, attitude, practice, needs, and implementation status of intensive care unit staff toward continuous renal replacement therapy: a survey of 66 hospitals in central and South China. BMC Nurs 2024; 23:281. [PMID: 38671501 PMCID: PMC11055233 DOI: 10.1186/s12912-024-01953-6] [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: 10/18/2023] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Continuous renal replacement therapy (CRRT) is a commonly utilized form of renal replacement therapy (RRT) in the intensive care unit (ICU). A specialized CRRT team (SCT, composed of physicians and nurses) engage playing pivotal roles in administering CRRT, but there is paucity of evidence-based research on joint training and management strategies. This study armed to evaluate the knowledge, attitude, and practice (KAP) of ICU staff toward CRRT, and to identify education pathways, needs, and the current status of CRRT implementation. METHODS This study was performed from February 6 to March 20, 2023. A self-made structured questionnaire was used for data collection. Descriptive statistics, T-tests, Analysis of variance (ANOVA), multiple linear regression, and Pearson correlation coefficient tests (α = 0.05) were employed. RESULTS A total of 405 ICU staff from 66 hospitals in Central and South China participated in this study, yielding 395 valid questionnaires. The mean knowledge score was 51.46 ± 5.96 (61.8% scored highly). The mean attitude score was 58.71 ± 2.19 (73.9% scored highly). The mean practice score was 18.15 ± 0.98 (85.1% scored highly). Multiple linear regression analysis indicated that gender, age, years of CRRT practice, ICU category, and CRRT specialist panel membership independently affected the knowledge score; Educational level, years of CRRT practice, and CRRT specialist panel membership independently affected the attitude score; Education level and teaching hospital employment independently affected the practice score. The most effective method for ICU staff to undergo training and daily work experience is within the department. CONCLUSION ICU staff exhibit good knowledge, a positive attitude and appropriately practiced CRRT. Extended CRRT practice time in CRRT, further training in a general ICU or teaching hospital, joining a CRRT specialist panel, and upgraded education can improve CRRT professional level. Considering the convenience of training programs will enhance ICU staff participation. Training should focus on basic CRRT principles, liquid management, and alarm handling.
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Affiliation(s)
- Xiaoyan Yu
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Provincial Center for Critical Care Medicine and Clinical Research in Smart Healthcare, Changsha, Hunan, China
| | - Lin Ouyang
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Provincial Center for Critical Care Medicine and Clinical Research in Smart Healthcare, Changsha, Hunan, China
| | - Jinxiu Li
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Provincial Center for Critical Care Medicine and Clinical Research in Smart Healthcare, Changsha, Hunan, China
| | - Ying Peng
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Provincial Center for Critical Care Medicine and Clinical Research in Smart Healthcare, Changsha, Hunan, China
| | - Dingming Zhong
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Provincial Center for Critical Care Medicine and Clinical Research in Smart Healthcare, Changsha, Hunan, China
| | - Huan Yang
- Blood Purification Center, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Yanyan Zhou
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Hunan Provincial Center for Critical Care Medicine and Clinical Research in Smart Healthcare, Changsha, Hunan, China.
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Koester SW, Cole TS, Kimata AR, Ma KL, Benner D, Catapano JS, Rumalla K, Lawton MT, Ducruet AF, Albuquerque FC. Assessing the volume-outcome relationship of carotid artery stenting in nationwide administrative data: a challenge of patient population bias. J Neurointerv Surg 2023; 15:e305-e311. [PMID: 36539274 DOI: 10.1136/jnis-2022-019695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Studies have shown an association between surgical treatment volume and improved quality metrics. This study evaluated nationwide results in carotid artery stenting (CAS) procedural readmission rates, costs, and length of stay based on hospital treatment volume. METHODS We used the Nationwide Readmissions Database for carotid stenosis from 2010 to 2015. Patients receiving CAS were matched based on demographics, illness severity, and relevant comorbidities. Patients were matched 1:1 between low- and high-volume centers using a non-parametric preprocessing matching program to adjust for parametric causal inferences. Nearest-neighbor propensity score matching was performed using logit distance. RESULTS Low- and high-volume centers admitted a mean (SD) of 4.68 (3.79) and 25.10 (16.86) patients undergoing CAS per hospital, respectively. Comorbidities were significantly different and initially could not be adequately matched. Because of significant differences in baseline patient population characteristics after attempted matching between low- and high-volume centers, we used propensity adjustment with multivariate analysis. Using this alternative approach, no significant differences were observed between low- and high-volume centers for the presence of any complication, postoperative stroke, postoperative myocardial infarction, and readmission at 30 days. CONCLUSION In 1:1 nearest-neighbor matching with a high number of patients, our analysis did not result in well-matched cohorts for the effect of case volume on outcomes. Comparing analytical techniques for various outcomes highlights that outcome disparities may not be related to quality differences based on hospital size, but rather variability in patient populations between low- and high-volume institutions.
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Affiliation(s)
- Stefan W Koester
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Anna R Kimata
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Kevin L Ma
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Dimitri Benner
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Kavelin Rumalla
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
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Ramsay IA, Burks JD, Lu VM, Silva M, Abdelsalam A, Starke RM, Luther E. Perioperative Outcomes in Transcarotid Artery Revascularization Versus Carotid Endarterectomy or Stenting Nationwide. Oper Neurosurg (Hagerstown) 2023; 25:453-460. [PMID: 37988322 DOI: 10.1227/ons.0000000000000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/09/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Transcarotid artery revascularization (TCAR) is a newer treatment for carotid stenosis where the carotid artery is accessed directly in the neck for stenting. It is less invasive than carotid endarterectomy (CEA) and has less embolic potential than carotid artery stenting (CAS), but population-level utilization of TCAR and outcomes are currently unknown. Our study compares outcomes of TCAR with those of CEA and CAS. METHODS The National Inpatient Database was used for years 2015 to 2019. A multivariate logistic regression model was used to compare CEA, CAS, and TCAR outcomes with age, sex, race, hospital teaching status, symptomatic carotid disease status, side of procedure, intraoperative monitoring, and the weighted Elixhauser comorbidity score as covariates. RESULTS TCAR comprised 0.69% of these procedures in 2016, rising to 1.35% in 2019. The inpatient rates of death, stroke, and myocardial infarction for TCAR were 0.63% (95% confidence interval: 0.36%, 1.06%), 0.42% (0.21%, 0.80%), and 1.46% (1.04%, 2.05%), respectively. Compared with CEA, TCAR had statistically insignificant difference odds of death, odds ratio (95% CI) for stroke was 0.47 (0.25, 0.87), and for myocardial infarction, it was 0.66 (0.37, 0.94). Compared with CAS, for TCAR, the odds ratio for death was 0.41 (0.24, 0.71), and for stroke, it was 0.48 (0.26, 0.91). CONCLUSION TCAR is underutilized relative to other revascularization techniques yet has favorable outcomes compared with CEA and CAS. TCAR may be preferred to CAS in patients not surgical candidates for CEA and has a less invasive possibility for those eligible for CEA.
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Affiliation(s)
- Ian A Ramsay
- University of Miami Miller School of Medicine MD-MPH Program, Miami , Florida , USA
| | - Joshua D Burks
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami , Florida , USA
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami , Florida , USA
| | - Michael Silva
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami , Florida , USA
| | - Ahmed Abdelsalam
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami , Florida , USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami , Florida , USA
| | - Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami , Florida , USA
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King H, Morell AA, Luther E, Mendez Valdez MJ, Hernandez M, Makhoul V, Shah AH, Eichberg DE, Lu VM, Kader M, Patel N, Higgins D, Komotar RJ, Ivan ME. Evaluating Predictors of Successful Postoperative Day 1 Discharge Following Posterior Fossa Tumor Resection. World Neurosurg 2023; 179:e102-e109. [PMID: 37574194 DOI: 10.1016/j.wneu.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Current trends in surgical neuro-oncology show that early discharges are safe and feasible with shorter lengths of stay (LOS) and fewer thromboembolic complications, fewer hospital-acquired infections, reduced costs, and greater patient satisfaction. Traditionally, infratentorial tumor resections have been associated with longer LOS and limited data exist evaluating predictors of early discharge in these patients. The objective was to assess patients undergoing posterior fossa craniotomies for tumor resection and identify variables associated with postoperative day 1 (POD1) discharge. METHODS A retrospective review of posterior fossa craniotomies for tumor resection at our institution was performed from 2011 to 2020. Laser ablations, nontumoral pathologies, and biopsies were excluded. Demographic, clinical, surgical, and postoperative data were collected. RESULTS One hundred and seventy-three patients were identified and 25 (14.5%) were discharged on POD1. Median length of stay (LOS) was 6 days. The POD1 discharges had significantly better preoperative Karnofsky performance scores (P < 0.001) and modified Rankin scores (P = 0.002) and more frequently presented electively (P = 0.006) and without preoperative neurologic deficits (P = 0.021). No statistically significant difference in 30-day readmissions and rates of PE, UTI, and DVT was found. Univariate logistic regression identified better preoperative functional status, elective admission, and lack of preoperative hydrocephalus as predictors of POD1 discharge, however only the latter remained significant in the multivariable model (P = 0.001). CONCLUSIONS Discharging patients on POD1 is feasible following posterior fossa tumor resection in a select group of patients. Although we found that the only independent predictor for a longer LOS was preoperative hydrocephalus, larger, prospective studies are needed to confirm these findings.
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Affiliation(s)
- Hunter King
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Alexis A Morell
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Evan Luther
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mynor J Mendez Valdez
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - Melissa Hernandez
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Vivien Makhoul
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ashish H Shah
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel E Eichberg
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Victor M Lu
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael Kader
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nitesh Patel
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dominique Higgins
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo J Komotar
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Sylvester Cancer Center, University of Miami Health System, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Sylvester Cancer Center, University of Miami Health System, Miami, Florida, USA
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Elarjani T, Lu VM, Berry KM, Eichberg DG, Ivan ME, Komotar RJ, Luther EM. Commentary: Invention of an Online Interactive Virtual Neurosurgery Simulator With Audiovisual Capture for Tactile Feedback. Oper Neurosurg (Hagerstown) 2023; 24:e232-e233. [PMID: 36701687 DOI: 10.1227/ons.0000000000000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Turki Elarjani
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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10
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Luther E, Govindarajan V, McCarthy DJ, Burks J, Lu V, Ramsay I, Silva M, Starke RM. Brain Arteriovenous Malformations. Neurosurg Clin N Am 2022; 33:443-448. [DOI: 10.1016/j.nec.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Aldiabat M, Aljabiri Y, Al-Khateeb MH, Yusuf MH, Kilani Y, Horoub A, Farukhuddin F, Mahfouz R, Obeidat AE, Darweesh M, Mansour MM. Effect of Hospital Teaching Status on Mortality and Procedural Complications of Percutaneous Paracentesis in the United States: A Four-Year Analysis of the National Inpatient Sample. Cureus 2022; 14:e26282. [PMID: 35911339 PMCID: PMC9313107 DOI: 10.7759/cureus.26282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives Numerous previous studies investigated the impact of medical training settings on outcomes of hospitalized patients. However, the impact of teaching hospital status on outcomes of percutaneous paracentesis, to the best of our knowledge, has never been studied before. Methods Hospitalized patients who underwent percutaneous paracentesis were identified from the National Inpatient Sample database from 2016 to 2019 across the United States (US) teaching and non-teaching hospitals. Outcomes studied were differences in risk of mortality, postprocedural outcomes, and healthcare resource utilization. Multivariate logistic analysis was performed using STATA software (StataCorp LLC, College Station, Texas, US) and results were adjusted for patient and hospital characteristics and comorbidities. Results Inpatient mortality rates were significantly higher in patients undergoing paracentesis at US teaching hospitals (adjusted odds ratio (aOR) 1.29, 95%CI 1.23-1.35, p<0.001) compared to non-teaching hospitals. Similarly, higher risk of procedural complications including hemoperitoneum (aOR 1.90, 95%CI 1.65-2.20, p<0.001), hollow viscus perforation (aOR 1.97, 95%CI 1.54-2.51, p<0.001), and vessel injury/laceration (aOR 15.3, 95%CI 2.12-110.2, p=0.007) were noticed in the study group when compared to controls. Furthermore, hospital teaching status was associated with prolonged mean length of stay (9.33 days vs 7.42 days, adjusted mean difference (aMD) 1.81, 95%CI 1.68-1.94, p<0.001) and increased charge of care ($106,014 vs $80,493, aMD $24,926, 95%CI $21,617-$28,235, p <0.001) Conclusion Hospitalized patients undergoing paracentesis in US teaching hospitals have an increased risk of mortality, postprocedural complications, prolonged length of stay, and increased charge of care when compared to non-teaching hospitals.
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Luther E, Kaur G, Komotar RJ, Ivan ME. Commentary: An Update of Neuroanesthesia for Intraoperative Brain Mapping Craniotomy. Neurosurgery 2022; 90:e1-e2. [PMID: 33733271 DOI: 10.1093/neuros/nyab065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, Miller School of Medicine, University of Miami , Miami , Florida , USA
| | - Gurvinder Kaur
- Department of Neurological Surgery, Miller School of Medicine, University of Miami , Miami , Florida , USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, Miller School of Medicine, University of Miami , Miami , Florida , USA.,Sylvester Comprehensive Cancer Center , Miami , Florida , USA
| | - Michael E Ivan
- Department of Neurological Surgery, Miller School of Medicine, University of Miami , Miami , Florida , USA.,Sylvester Comprehensive Cancer Center , Miami , Florida , USA
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13
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Luther E, Lu VM, Morell AA, Elarjani T, Mansour S, Echeverry N, Gaztanaga W, King H, McCarthy D, Eichberg DG, Shah A, Burks J, Kaur G, Ivan ME, Komotar RJ. Supralesional Ablation Volumes Are Feasible in the Posterior Fossa and May Provide Enhanced Symptomatic Relief. Oper Neurosurg (Hagerstown) 2021; 21:418-425. [PMID: 34528092 DOI: 10.1093/ons/opab332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/18/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) for posterior fossa lesions remains rare as the small size of the infratentorial compartment, proximity to the brainstem, and thickness/angulation of the occipital bone creates barriers to procedural success. Furthermore, evaluation of the effect of ablation volume on outcomes is limited. OBJECTIVE To analyze our institutional experience with LITT in the posterior fossa stratifying perioperative and long-term outcomes by ablation volumes. METHODS Seventeen patients with posterior fossa lesions treated with LITT from 2013 to 2020 were identified. Local progression-free survival (PFS), overall survival, steroid dependence, and edema reduction were evaluated with Kaplan-Meier analysis grouped by ablation volume. Preoperative, postoperative, and last known Karnofsky Performance Status (KPS) were compared using a matched paired t test. RESULTS No differences in pathology, preoperative KPS, or preoperative lesion volume were found between patients with total (100%-200% increase in pre-LITT lesion volume) versus radical (>200% increase in pre-LITT lesion volume) ablations. Patients who underwent radical ablation had a higher postoperative KPS (93 vs 82, P = .02) and higher KPS (94 vs 87, P = .04) and greater reduction in perilesional edema at last follow-up (P = .01). Median follow-up was 80.8 wk. CONCLUSION Despite obvious anatomical challenges, our results demonstrate that radical ablations are both feasible and safe in the posterior fossa. Furthermore, radical ablations may lead to greater decreases in perilesional edema and improved functional status both immediately after surgery and at last follow-up. Thus, LITT should be considered for patients with otherwise unresectable or radioresistant posterior fossa lesions.
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Affiliation(s)
- Evan Luther
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA
| | - Victor M Lu
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA
| | - Alexis A Morell
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA
| | - Turki Elarjani
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA
| | - Samuel Mansour
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA
| | - Nikolas Echeverry
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA
| | - Wendy Gaztanaga
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA
| | - Hunter King
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - David McCarthy
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Daniel G Eichberg
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA
| | - Ashish Shah
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA
| | - Joshua Burks
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA
| | - Gurvinder Kaur
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA
| | - Michael E Ivan
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida, USA
| | - Ricardo J Komotar
- University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida, USA
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14
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Luther E, Kader M, Higgins D, Patel NV, Eichberg DG, Berry K, Wu EM, Morell A, Komotar R, Ivan M. Commentary: Resection of a Dumbbell-Shaped Facial Nerve Schwannoma With Preservation of Facial Nerve Function Through the Extended Middle Fossa Approach: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E532-E533. [PMID: 34560782 DOI: 10.1093/ons/opab358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael Kader
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dominique Higgins
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nitesh V Patel
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel G Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Katherine Berry
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eva M Wu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alexis Morell
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Michael Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
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15
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Luther E, Kaur G, Komotar R, Ivan ME. Commentary: Resection of a Medulla Oblongata Hemangioblastoma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E436-E437. [PMID: 34409995 DOI: 10.1093/ons/opab295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gurvinder Kaur
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
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16
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Luther E, Kaur G, Komotar R, Ivan ME. Commentary: The Infratemporal Retro-Eustachian Transposition of the Temporoparietal Fascial Flap for Clival Reconstruction After Endoscopic Endonasal Approach: An Anatomic Conceptual Technique. Oper Neurosurg (Hagerstown) 2021; 21:E171-E172. [PMID: 33956986 DOI: 10.1093/ons/opab147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/14/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gurvinder Kaur
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
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17
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Luther E, Kaur G, Komotar R, Ivan ME. Commentary: Concomitant Embolization and Microsurgical Resection of a Giant, Hypervascular Skull Base Meningioma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E99-E100. [PMID: 34015826 DOI: 10.1093/ons/opab164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gurvinder Kaur
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
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18
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Luther E, Kaur G, Komotar R, Ivan ME. Commentary: Infra-Occipital Supra-Tentorial Approach for Resection of Low-Grade Tumor of the Left Lingual Gyrus: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E259-E260. [PMID: 34270754 DOI: 10.1093/ons/opab210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/04/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gurvinder Kaur
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
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19
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Luther E, Kaur G, Komotar R, Ivan M. Commentary: Total Petrosectomy for the Total Resection of Sphenopetroclival Meningioma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E24-E25. [PMID: 33930165 DOI: 10.1093/ons/opab091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/24/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gurvinder Kaur
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Michael Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
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20
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Evaluation of the impact of residents’ participation on free flap reconstruction. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01832-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Luther E, Kaur G, Komotar R, Dinh C, Ivan ME. Commentary: Interposition Grafting of the Facial Nerve After Resection of a Large Facial Nerve Schwannoma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E342-E343. [PMID: 34235543 DOI: 10.1093/ons/opab254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/02/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gurvinder Kaur
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Christine Dinh
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
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22
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Luther E, Kaur G, Komotar R, Ivan ME. Commentary: Early Experience With Virtual and Synchronized Augmented Reality Platform for Preoperative Planning and Intraoperative Navigation: A Case Series. Oper Neurosurg (Hagerstown) 2021; 21:E300-E301. [PMID: 34171918 DOI: 10.1093/ons/opab201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/02/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Gurvinder Kaur
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA.,Sylvester Comprehensive Cancer Center, Miami, Florida, USA
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23
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Perioperative Complications in Endoscopic Endonasal versus Transcranial Resections of Adult Craniopharyngiomas. World Neurosurg 2021; 152:e729-e737. [PMID: 34153480 DOI: 10.1016/j.wneu.2021.06.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Adult craniopharyngiomas are low-grade tumors of the pituitary infundibulum that can be locally aggressive and frequently present with profound visual deficits and endocrinopathies. Surgical resection remains the preferred initial treatment for these lesions, and recently endoscopic endonasal approaches (EEAs) have become increasingly used. However, minimal data exist comparing these techniques with traditional transcranial (TC) methods. The purpose of this study was to evaluate perioperative differences in EEA and TC approaches for adult craniopharyngiomas over the past several decades. METHODS Craniopharyngioma surgeries in the Nationwide Inpatient Sample from 1998 to 2014 were identified. Complication rates, mortality rates, and annual treatment trends were stratified by procedure. Annual caseload was assessed with linear regression, and multivariate logistic regression models were created to determine predictors of inpatient mortality and perioperative complications. RESULTS From 1998-2014, a significant increase in EEAs for craniopharyngiomas (+4.36/year, r2 = 0.80, P < 0.0001) was observed. In contrast, no increase in TC surgeries for these lesions was seen. In multivariate analysis, EEAs were more likely to experience postoperative cerebrospinal fluid leak (odds ratio = 2.61, P < 0.0001). However, EEAs were protective against all other perioperative complications including diabetes insipidus, panhypopituitarism, visual impairment, and even mortality (odds ratio = 0.41, P = 0.0007). CONCLUSIONS Over the past several decades, utilization of EEAs to resect adult craniopharyngiomas has increased. EEAs appear to be associated with lower rates of perioperative mortality and complications. However, long-term, prospective studies controlling for tumor size, location, and preoperative symptomatology are needed to determine when one approach should be used preferentially over the other.
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24
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Elayat A, Jena SS, Nayak S, Sahu RN, Tripathy S. "Enhanced recovery after surgery - ERAS in elective craniotomies-a non-randomized controlled trial". BMC Neurol 2021; 21:127. [PMID: 33740911 PMCID: PMC7977578 DOI: 10.1186/s12883-021-02150-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/09/2021] [Indexed: 02/07/2023] Open
Abstract
Background Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care bundle aimed at the early recovery of patients. Well accepted in gastric and pelvic surgeries, there is minimal evidence in neurosurgery and neurocritical care barring spinal surgeries. We wished to compare the length of intensive care unit (ICU) or high dependency unit (HDU) stay of patients undergoing elective craniotomy for supratentorial neurosurgery: ERAS protocol versus routine care. The secondary objective was to compare the postoperative pain scores, opioid use, glycemic control, and the duration of postoperative hospital stay between the two groups. Methods In this pragmatic non-randomized controlled trial (CTRI/2017/07/015451), consenting adult patients scheduled for elective supratentorial intracranial tumor excision were enrolled prospectively after institutional ethical clearance and consent. Elements-of-care in the ERAS group were- Preoperative –family education, complex-carbohydrate drink, flupiritine; Intraoperative – scalp blocks, limited opioids, rigorous fluid and temperature regulation; Postoperative- flupiritine, early mobilization, removal of catheters, and initiation of feeds. Apart from these, all perioperative protocols and management strategies were similar between groups. The two groups were compared with regards to the length of ICU stay, pain scores in ICU, opioid requirement, glycemic control, and hospital stay duration. The decision for discharge from ICU and hospital, data collection, and analysis was by independent assessors blind to the patient group. Results Seventy patients were enrolled. Baseline demographics – age, sex, tumor volume, and comorbidities were comparable between the groups. The proportion of patients staying in the ICU for less than 48 h after surgery, the cumulative insulin requirement, and the episodes of VAS scores > 4 in the first 48 h after surgery was significantly less in the ERAS group – 40.6% vs. 65.7%, 0.6 (±2.5) units vs. 3.6 (±8.1) units, and one vs. ten episodes (p = 0.04, 0.001, 0.004 respectively). The total hospital stay was similar in both groups. Conclusion The study demonstrated a significant reduction in the proportion of patients requiring ICU/ HDU stay > 48 h. Better pain and glycemic control in the postoperative period may have contributed to a decreased stay. More extensive randomized studies may be designed to confirm these results. Trial registration Clinical Trial Registry of India (CTRI/2018/04/013247), registered retrospectively on April 2018.
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Affiliation(s)
- Anirudh Elayat
- All India Institute of Medical Sciences, Bhubaneswar, India.,Department of Anesthesia and Critical Care, AIIMS Bhubaneswar, Bhubaneswar, India
| | - Sritam S Jena
- All India Institute of Medical Sciences, Bhubaneswar, India.,Department of Anesthesia and Critical Care, AIIMS Bhubaneswar, Bhubaneswar, India
| | - Sukdev Nayak
- Department of Anesthesia and Critical Care, AIIMS Bhubaneswar, Bhubaneswar, India
| | - R N Sahu
- Department of Neurosurgery, AIIMS Bhubaneswar, Bhubaneswar, India
| | - Swagata Tripathy
- All India Institute of Medical Sciences, Bhubaneswar, India. .,Department of Anesthesia and Critical Care, AIIMS Bhubaneswar, Bhubaneswar, India. .,Fellow Neuroanesthesia, Walton Centre, Liverpool, UK.
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25
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Luther E, Burks J, Eichberg DG, Basil G, Berry K, Lu V, Shah A, Kaur G, Ivan M, Komotar R. Neuro-oncology practice guidelines from a high-volume surgeon at the COVID-19 epicenter. J Clin Neurosci 2020; 85:1-5. [PMID: 33581778 PMCID: PMC7834482 DOI: 10.1016/j.jocn.2020.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/27/2020] [Accepted: 12/07/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND During the coronavirus 19 (COVID-19) pandemic, physicians have begun adapting their daily practices to prevent transmissions. In this study we aimed to provide surgical neuro-oncologists with practice guidelines during the COVID-19 pandemic based on objective data from a high-volume brain tumor surgeon at the current COVID-19 epicenter. METHODS All outpatient visits and surgeries performed by the senior author during the COVID-19 pandemic were compared between the initial quarantine (3/23/20-5/4/20), the plateau period following quarantine (5/5/20-6/27/20), and the second peak (6/28/20-7/20/20). In-person and telemedicine visits were evaluated for crossovers. Surgeries were subdivided based on lesion type and evaluated across the same time period. RESULTS From 3/23/20-7/20/20, 469 clinic visits and 196 surgeries were identified. After quarantine was lifted, face-to-face visits increased (P < 0.01) yet no change in telehealth visits occurred. Of 327 telehealth visits, only 5.8% converted to in-person during the 4-month period with the most cited reason being patient preference (68.4%). Of the 196 surgeries performed during the pandemic, 29.1% occurred during quarantine, 49.0% during the plateau, and 21.9% occurred in the second peak. No COVID negative patients developed symptoms at follow-up. 55.6% were performed on malignant tumors and 31.6% were benign with no difference in case volumes throughout the pandemic. CONCLUSIONS Despite exceptional challenges, we have maintained a high-volume surgical neuro-oncology practice at the epicenter of the COVID-19 pandemic. We provide the protocols implemented at our institution in order to maximize neuro-oncology care while mitigating risk of COVID-19 exposure to both patients and providers.
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Affiliation(s)
- Evan Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Joshua Burks
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel G Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gregory Basil
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katherine Berry
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Victor Lu
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ashish Shah
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gurvinder Kaur
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ricardo Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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