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Ghaith AK, El-Hajj VG, Sanchez-Garavito JE, Zamanian C, Ghanem M, Bon-Nieves A, Chen B, Drees CN, Miller D, Parker JJ, Almeida JP, Elmi-Terander A, Tatum W, Middlebrooks EH, Bydon M, Van-Gompel JJ, Lundstrom BN, Grewal SS. Trends in the Utilization of Surgical Modalities for the Treatment of Drug-Resistant Epilepsy: A Comprehensive 10-Year Analysis Using the National Inpatient Sample. Neurosurgery 2024:00006123-990000000-01011. [PMID: 38189460 DOI: 10.1227/neu.0000000000002811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/10/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Epilepsy is considered one of the most prevalent and severe chronic neurological disorders worldwide. Our study aims to analyze the national trends in different treatment modalities for individuals with drug-resistant epilepsy and investigate the outcomes associated with these procedural trends in the United States. METHODS Using the National Inpatient Sample database from 2010 to 2020, patients with drug-resistant focal epilepsy who underwent laser interstitial thermal therapy (LITT), open surgical resection, vagus nerve stimulation (VNS), or responsive neurostimulation (RNS) were identified. Trend analysis was performed using piecewise joinpoint regression. Propensity score matching was used to compare outcomes between 10 years prepandemic before 2020 and the first peak of the COVID-19 pandemic. RESULTS This study analyzed a total of 33 969 patients with a diagnosis of drug-resistant epilepsy, with 3343 patients receiving surgical resection (78%), VNS (8.21%), RNS (8%), and LITT (6%). Between 2010 and 2020, there was an increase in the use of invasive electroencephalography monitoring for seizure zone localization (P = .003). There was an increase in the use of LITT and RNS (P < .001), while the use of surgical resection and VNS decreased over time (P < .001). Most of these patients (89%) were treated during the pre-COVID pandemic era (2010-2019), while a minority (11%) underwent treatment during the COVID pandemic (2020). After propensity score matching, the rate of pulmonary complications, postprocedural hematoma formation, and mortality were slightly higher during the pandemic compared with the prepandemic period (P = .045, P = .033, and P = .026, respectively). CONCLUSION This study indicates a relative decrease in the use of surgical resections, as a treatment for drug-resistant focal epilepsy. By contrast, newer, minimally invasive surgical approaches including LITT and RNS showed gradual increases in usage.
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Affiliation(s)
- Abdul Karim Ghaith
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor Gabriel El-Hajj
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Cameron Zamanian
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Marc Ghanem
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Antonio Bon-Nieves
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Baibing Chen
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - David Miller
- Department of Diagnostic Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jonathon J Parker
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Joao Paulo Almeida
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - William Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie J Van-Gompel
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Sanjeet S Grewal
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
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Sawka AM, Ghai S, Rotstein L, Irish JC, Pasternak JD, Gullane PJ, Monteiro E, Zahedi A, Gooden E, Eskander A, Chung J, Devon K, Su J, Xu W, Jones JM, Gafni A, Baxter NN, Goldstein DP. Gender Differences in Fears Related to Low-Risk Papillary Thyroid Cancer and Its Treatment. JAMA Otolaryngol Head Neck Surg 2023; 149:803-810. [PMID: 37410454 PMCID: PMC10326729 DOI: 10.1001/jamaoto.2023.1642] [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: 03/11/2023] [Accepted: 05/16/2023] [Indexed: 07/07/2023]
Abstract
Importance Fear is commonly experienced by individuals newly diagnosed with papillary thyroid cancer (PTC). Objective To explore the association between gender and fears of low-risk PTC disease progression, as well as its potential surgical treatment. Design, Setting, and Participants This single-center prospective cohort study was conducted at a tertiary care referral hospital in Toronto, Canada, and enrolled patients with untreated small low risk PTC (<2 cm in maximal diameter) that was confined to the thyroid. All patients had a surgical consultation. Study participants were enrolled between May 2016 and February 2021. Data analysis was performed from December 16, 2022, to May 8, 2023. Exposures Gender was self-reported by patients with low-risk PTC who were offered the choice of thyroidectomy or active surveillance. Baseline data were collected prior to the patient deciding on disease management. Main Outcomes and Measures Baseline patient questionnaires included the Fear of Progression-Short Form and Surgical Fear (referring to thyroidectomy) questionnaires. The fears of women and men were compared after adjustment for age. Decision-related variables, including Decision Self-Efficacy, and the ultimate treatment decisions were also compared between genders. Results The study included 153 women (mean [SD] age, 50.7 [15.0] years) and 47 men (mean [SD] age, 56.3 [13.8] years). There were no significant differences in primary tumor size, marital status, education, parental status, or employment status between the women and men. After adjustment for age, there was no significant difference observed in the level of fear of disease progression between men and women. However, women reported greater surgical fear compared with men. There was no meaningful difference observed between women and men with respect to decision self-efficacy or the ultimate treatment choice. Conclusions and Relevance In this cohort study of patients with low-risk PTC, women reported a higher level of surgical fear but not fear of the disease compared with men (after adjustment for age). Women and men were similarly confident and satisfied with their disease management choice. Furthermore, the decisions of women and men were generally not significantly different. The context of gender may contribute to the emotional experience of being diagnosed with thyroid cancer and its treatment perception.
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Affiliation(s)
- Anna M. Sawka
- Division of Endocrinology, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network–Mount Sinai Hospital–Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Lorne Rotstein
- Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C. Irish
- Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Jesse D. Pasternak
- Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Patrick J. Gullane
- Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology and Head and Neck Surgery, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Afshan Zahedi
- Division of Endocrinology, Women’s College Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Everton Gooden
- Department of Otolaryngology and Head and Neck Surgery, North York General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology and Head and Neck Surgery, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada
| | - Janet Chung
- Department of Otolaryngology and Head and Neck Surgery, Trillium Health Partners and University of Toronto, Toronto, Ontario, Canada
| | - Karen Devon
- Division of Endocrinology, Women’s College Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Jie Su
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer M. Jones
- Department of Psychosocial Oncology, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Amiram Gafni
- Centre for Health Economics and Policy Analysis, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nancy N. Baxter
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - David P. Goldstein
- Department of Otolaryngology–Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Karabulut N, Gürçayır D, Abi Ö, Kızıloğlu Ağgül B, Söylemez N. Does surgery cause anxiety, stress and fear in geriatric patients? Psychogeriatrics 2023; 23:808-814. [PMID: 37433670 DOI: 10.1111/psyg.13000] [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: 04/27/2023] [Revised: 05/09/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Because of physiological changes in geriatric patients, their surgical process differs from that of young adults. In this regard, the perioperative period is an extremely risky time for geriatric patients. The present study examined preoperative fear, anxiety, and perceived stress levels as well as the factors affecting them in elderly patients prior to surgical intervention. METHODS This study adopted a cross-sectional descriptive design. The study sample consisted of geriatric patients (n = 407) scheduled for elective laparoscopic cholecystectomy in a research and training hospital in northeast Turkey. Data were collected by the researchers using the personal information form, Perceived Stress Scale (PSS-10), Surgical Fear Questionnaire (SFQ) and Anxiety Specific to Surgery Questionnaire (ASSQ). In the data analysis, descriptive statistics, the t-test in independent groups, one-way analysis of variance (ANOVA), correlation analysis and Bonferroni tests for post hoc analyses were used. RESULTS On the PSS-10, the mean score was higher for the 75-and-older age group, single patients, patients with a disease requiring medication, and those who had previously undergone surgery (P < 0.05). On the ASSQ, the mean score was lower for patients aged 65-69, university graduates, patients without children, and those without a disease requiring medication (P < 0.05). On the SFQ, the mean score was higher for the 75-and-older age group, primary school graduates, and single patients (P < 0.05). CONCLUSION It was determined that being single, having a chronic disability, and advancing age had an effect on the patients' surgery-specific anxiety, perceived stress, and fear of surgery. Long-standing chronic diseases can negatively affect both stress and anxiety levels of individuals.
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Affiliation(s)
| | - Dilek Gürçayır
- The Nursing Faculty, Atatürk University, Erzurum, Turkey
| | - Özlem Abi
- The Health Sciences Faculty, Iğdır University, Erzurum, Turkey
| | | | - Nilgün Söylemez
- The Health Sciences Faculty, Munzur University, Erzurum, Turkey
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