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Evans H, Ogunsanya N, Yii M, Bell R. Critical Lower-Limb Ischemia and Arterial Thrombosis Following Intraarticular Corticosteroid Injection of the Knee. Clin J Sport Med 2024:00042752-990000000-00230. [PMID: 39212482 DOI: 10.1097/jsm.0000000000001269] [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: 02/27/2023] [Accepted: 07/25/2024] [Indexed: 09/04/2024]
Abstract
ABSTRACT We present a case of acute lower-limb arterial thrombosis following intra-articular steroid injection into the knee of a previously fit and active 41-year-old man. Symptoms of acute limb ischemia developed within 24 hours of treatment. Objective assessment with ultrasound arterial duplex and CT angiogram of the lower limb confirmed acute thrombosis of the popliteal artery in the treated leg. Although there is documented evidence of the association between steroid therapy and venous thromboembolic phenomena, there are no cases of arterial thrombosis in the literature. The temporal series of events that we report strongly suggest an association between the corticosteroid injection and the acute thrombotic event, the mechanism of which remains unclear. The patient underwent successful revascularization. It is important to document and disseminate this seemingly rare complication of a commonly associated procedure to increase awareness, invoke caution, and invite others to share similar cases.
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Affiliation(s)
- Hamish Evans
- Department Vascular Surgery, Monash Health, Melbourne, Australia
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Zeng Q, Lu G, Yuan J, Ding J, Chen J, Gao X, Huang Y, Shi T, Yu H, Ni H, Li Y. Prevalence, characteristics, and risk factors of venous thromboembolism in patients with brain tumor undergoing craniotomy: a meta-analysis. Neurol Sci 2024; 45:1565-1580. [PMID: 37947983 DOI: 10.1007/s10072-023-07160-6] [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: 08/24/2023] [Accepted: 10/22/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Brain tumor patients undergoing craniotomy are significantly associated with the development of venous thromboembolism (VTE), while the contributing factors remains controversial. Our study aimed to investigate the prevalence and risk factors for VTE in postoperational brain tumor patients. METHODS We searched the PubMed, Embase, Web of Science, Medline, and Cochrane Library databases from their inception to July 2023. Article selection, data extraction, and study quality assessment were performed independently by two reviewers. Publication bias was assessed using Egger's and Begg's tests. Stata 15.0 software was used for data analysis. RESULTS A total of 25 studies were considered, with a total of 49,620 brain tumor individuals. The pooled prevalence of VTE during hospitalization in postoperational brain tumor patients was 9% [95% CI: (0.08, 0.10)]. Moreover, our results demonstrated that patients with VTE were older than those without VTE [mean difference [MD] = 8.14, 95% CI: (4.97, 11.30)]. The following variables were significantly associated with VTE: prior history of VTE [OR = 7.81, 95% CI: (3.62, 16.88)], congestive heart failure [OR = 2.33, 95% CI: (1.08-5.05)], diabetes [OR = 1.87, 95% CI: (1.12-3.10)], hypertension [OR = 1.27, 95% CI: (1.07-1.50)], steroid use [OR = 1.63, 95% CI: (1.41, 1.88)], high white blood cells counts [MD = 0.32, 95% CI: (0.01, 0.63)], and high fibrinogen levels [MD = 0.19, 95% CI: (0.08, 0.30)]. CONCLUSION This meta-analysis identified risk factors for postoperational VTE in patients with brain tumor, which can serve as a theoretical foundation for medical staff to manage and treat VTE. TRIAL REGISTRATION CRD42023357459.
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Affiliation(s)
- Qingping Zeng
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
- Department of Neuro Intensive Care Unit, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Guangyu Lu
- School of Public Health, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Jing Yuan
- Department of Echocardiography, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Jiali Ding
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
- Department of Neuro Intensive Care Unit, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Juan Chen
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
- Department of Neuro Intensive Care Unit, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xianru Gao
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
- Department of Neuro Intensive Care Unit, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yujia Huang
- Department of Neuro Intensive Care Unit, Clinical Medical College of Yangzhou University, Yangzhou, China
- Neuro-Intensive Care Unit, Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, 225001, Jiangsu, China
| | - Tian Shi
- Department of Neuro Intensive Care Unit, Clinical Medical College of Yangzhou University, Yangzhou, China
- Neuro-Intensive Care Unit, Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, 225001, Jiangsu, China
| | - Hailong Yu
- Department of Neuro Intensive Care Unit, Clinical Medical College of Yangzhou University, Yangzhou, China
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Hongbin Ni
- Department of Neurosurgery, Nanjing Drum Tower Hospital, School of Medicine, Clinical College of Nanjing Medical University, Nanjing, 210008, Jiangsu, China.
| | - Yuping Li
- Department of Neuro Intensive Care Unit, Clinical Medical College of Yangzhou University, Yangzhou, China.
- Neuro-Intensive Care Unit, Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, 225001, Jiangsu, China.
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Stalas J, Morris R, Bu K, von Bargen K, Largmann R, Sanford K, Vandeventer J, Han W, Cheng F. Comparing the risk of deep vein thrombosis of two combined oral contraceptives: Norethindrone/ethinyl estradiol and drospirenone/ethinyl estradiol. Heliyon 2024; 10:e26462. [PMID: 38434341 PMCID: PMC10906292 DOI: 10.1016/j.heliyon.2024.e26462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/11/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
Background Deep vein thrombosis (DVT) has been reported as an adverse event for patients receiving combined oral contraceptives. Norethindrone/ethinyl estradiol (NET/EE) and drospirenone/ethinyl estradiol (DRSP/EE) are two commonly prescribed combined hormonal oral contraceptive agents used in the United States, differing in their progestin component. Objective The purpose of this study was to determine the association between the progestin component of a combined oral contraceptive and the risk of DVT in patients taking oral contraceptives for birth control using data derived from the FDA Adverse Event Reporting System (FAERS). Methods The risk of DVT was compared between patients that had taken NET/EE with those that had taken the DRSP/EE COC formulation for birth control. In addition, age was assessed as a possible confounder and the outcome severity for those diagnosed with DVT were compared between the two groups. Finally, association rule mining was utilized to identify possible drug-drug interactions that result in elevated DVT risk. Results DVT was the fourth most commonly adverse event reported for patients taking DRSP/EE accounting for 8558 cases and the seventeenth most commonly reported adverse event for NET/EE accounting for 298 cases. Age was found to be a significant confounder for users of DRSP/EE with regards to DVT risk across all age groups assessed: 20 40 (ROR = 3.69, 95% CI 3.37-4.04) However, there was only a statistically significant elevated risk in patients over 40 years of age taking NET/EE (ROR = 1.98, 95% CI 1.36-2.88). Patients that had taken DRSP/EE and the corticosteroid prednisone simultaneously had an approximately 3-fold increase in DVT risk (ROR = 2.77, 95% CI 2.43-3.15) relative to individuals that had only taken DRSP/EE. Conclusion Based on this analysis, there is a higher risk of developing DVT when taking DRSP/EE than when taking NET/EE as hormonal contraception. In addition, a possibly significant drug-drug interaction between different COC formulations and prednisone were identified. This interaction may result in elevated DVT risk due to a synergistic impairment of fibrinolysis and a decrease in plasmin production.
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Affiliation(s)
- Jennifer Stalas
- Taneja College of Pharmacy, University of South Florida, 12901 Bruce B Downs Blvd Tampa, FL, 33612, USA
| | - Robert Morris
- Taneja College of Pharmacy, University of South Florida, 12901 Bruce B Downs Blvd Tampa, FL, 33612, USA
- Department of Biostatistics and Epidemiology, College of Public Health, University of South Florida, Tampa, FL, 33612, USA
| | - Kun Bu
- Department of Mathematics & Statistics, College of Art and Science, University of South Florida, Tampa, FL, 33620, USA
| | - Kevin von Bargen
- Taneja College of Pharmacy, University of South Florida, 12901 Bruce B Downs Blvd Tampa, FL, 33612, USA
| | - Rebekah Largmann
- Taneja College of Pharmacy, University of South Florida, 12901 Bruce B Downs Blvd Tampa, FL, 33612, USA
| | - Kathryn Sanford
- Taneja College of Pharmacy, University of South Florida, 12901 Bruce B Downs Blvd Tampa, FL, 33612, USA
| | - Jacob Vandeventer
- Taneja College of Pharmacy, University of South Florida, 12901 Bruce B Downs Blvd Tampa, FL, 33612, USA
| | - Weiru Han
- Department of Mathematics & Statistics, College of Art and Science, University of South Florida, Tampa, FL, 33620, USA
| | - Feng Cheng
- Taneja College of Pharmacy, University of South Florida, 12901 Bruce B Downs Blvd Tampa, FL, 33612, USA
- Department of Biostatistics and Epidemiology, College of Public Health, University of South Florida, Tampa, FL, 33612, USA
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Liu SH, Cerri-Droz P, Ling K, Loyst RA, Wang KE, Tsouris N, Komatsu DE, Wang ED. Chronic Steroid Use, Complications, and Readmission Following Open Reduction Internal Fixation of Distal Radius Fracture. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:757-762. [PMID: 38106944 PMCID: PMC10721537 DOI: 10.1016/j.jhsg.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/15/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose The increasing incidence of both distal radius fractures (DRFs) and chronic conditions that necessitate long-term steroid use has resulted in a growing intersection between the patient populations of the two. Chronic steroid use is known to increase bone frailty and the likelihood of fractures but may also contribute to poorer outcomes following the repair of DRF. The purpose of this study was to investigate the association between preoperative chronic steroid use, postoperative complications, and readmission after open reduction internal fixation (ORIF) of DRF. Methods The American College of Surgeons National Surgical Quality Improvement database was queried for all patients who underwent DRF ORIF between 2015 and 2021. However, 30-day postoperative complications after DRF ORIF were collected. Multivariate logistic regression analysis was conducted to investigate the relationship among preoperative chronic steroid use, postoperative complications, and patient factors associated with readmission. Results The postoperative complications associated with the steroid cohort were categorized as major, minor, and overall complications. Additionally, pneumonia, stroke, myocardial infarction, bleeding transfusions, deep vein thrombosis, pulmonary embolism, readmission, non-home discharge, and mortality were recorded. Chronic steroid use was found to be independently associated with major , minor, and overall complications, deep vein thrombosis, and readmission. Further investigation of readmission showed that male sex and comorbid chronic obstructive pulmonary disease were the only two patient factors independently associated with a greater likelihood of readmission after DRF ORIF. Conclusions Preoperative chronic steroid use was associated with an increasing rate of postoperative complications after DRF ORIF. Male sex and comorbid chronic obstructive pulmonary disease were characteristics of chronic steroid-use patients independently associated with increased risk of readmission after DRF ORIF. A better understanding of preoperative chronic steroid use as a risk factor for postoperative complications may allow surgeons to improve preoperative risk stratification and patient counseling in the management of DRF. Type of study/level of evidence Prognostic III.
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Affiliation(s)
- Steven H. Liu
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY
| | | | - Kenny Ling
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY
| | - Rachel A. Loyst
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY
| | | | - Nicholas Tsouris
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY
| | - David E. Komatsu
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY
| | - Edward D. Wang
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY
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Soto JM, Nguyen AV, van Zyl JS, Huang JH. Outcomes After Supratentorial Craniotomy for Primary Malignant Brain Tumor Resection in Adult Patients: A National Surgical Quality Improvement Program Analysis. World Neurosurg 2023; 175:e780-e789. [PMID: 37061032 DOI: 10.1016/j.wneu.2023.04.020] [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: 10/28/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND The rate of complications remains significant after craniotomy for supratentorial primary malignant brain tumors despite recent advances. OBJECTIVE The goal of this study is to characterize factors associated with these complications. METHODS Data were extracted from the National Surgical Quality Improvement Program database from 2016 to 2019. Patients who underwent a craniotomy for resection of supratentorial primary malignant brain tumors were included. Covariates included demographics/comorbidities, preoperative laboratory values, American Society of Anesthesiologists (ASA) classification, operative time, and postoperative complications. Multivariable logistic regression with backward and forward selection was used to evaluate independent predictors of death, prolonged hospitalization, postoperative stroke with neurologic deficit (CVA), and unplanned readmission. Predictive fit of the model was evaluated using the area under the receiver operating curve (AUC). RESULTS Of 8965 included cases, the 30-day postoperative risks were 1.9% for CVA, 10.1% for unplanned readmission, 1.2% for prolonged hospitalization, and 2.4% for death. Age, ASA category, disseminated cancer, preoperative functional dependence, and postoperative respiratory complications were predictors of 30-day mortality (AUC, 0.83; P < 0.001). CVA was best predicted by increased operation time (P < 0.001), age, ASA category, and recent weight loss (AUC, 0.63; P = 0.009). Prolonged hospitalization was predicted by nonelective surgery status, time from admission to surgery, reintubation, and postoperative sepsis (AUC, 0.78; P < 0.001). Unplanned readmission was predicted by chronic steroid use, postoperative thrombotic complications after surgery, organ/space surgical site infection, deep vein thrombosis, postoperative systemic sepsis, and septic shock (AUC, 0.68; P < 0.001). CONCLUSIONS Our study identifies predictors of major 30-day complications after craniotomy for this subset of patients with brain tumor.
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Affiliation(s)
- Jose M Soto
- Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center, Temple, Texas, USA; Department of Surgery, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Anthony V Nguyen
- Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center, Temple, Texas, USA; Department of Surgery, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Johanna S van Zyl
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas, USA
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center, Temple, Texas, USA; Department of Surgery, Texas A&M University College of Medicine, Temple, Texas, USA.
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Characterization of perioperative glycemic status and dexamethasone use with associated postoperative complications in glioblastoma patients. Acta Neurochir (Wien) 2023; 165:1031-1040. [PMID: 36879101 DOI: 10.1007/s00701-023-05541-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/21/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE Postoperative morbidity in glioblastoma (GBM) patients can be due to the disease course but can also come from postoperative complications. Our objective was to study the association of dexamethasone use and perioperative hyperglycemia with postoperative complications in GBM patients. METHODS A single-center, retrospective cohort study was conducted in patients who underwent surgery for primary GBM from 2014-2018. Patients with perioperative fasting blood glucose (FBG) measurements and adequate follow-up to assess for complications were included. RESULTS A total of 199 patients were included. More than half (53%) had poor perioperative glycemic control (FBG ≥ 7 mM for ≥ 20% perioperative days). Higher dexamethasone dose (≥ 8 mg) was associated with higher FBG on postoperative days 2-4 and 5 (p = 0.02,0.05,0.004,0.02, respectively). Poor glycemic control was associated with increased odds of 30-day any complication and 30-day infection on univariate analysis (UVA), and 30-day any complication and increased length of stay (LOS) on multivariate analysis (MVA). Higher average perioperative daily dexamethasone dose was associated with increased odds of 30-day any complication and 30-day infection on MVA. Elevated hemoglobin A1c (HgbA1c, ≥ 6.5%) was associated with increased odds of 30-day any complication, 30-day infection, and LOS on UVA. In a multivariate linear regression model, only the diagnosis of diabetes mellitus predicted perioperative hyperglycemia. CONCLUSIONS Perioperative hyperglycemia, higher average dexamethasone use and elevated preoperative HgbA1c are associated with increased risk of postoperative complications in GBM patients. Avoiding hyperglycemia and limiting dexamethasone use in postoperative period may decrease the risk of complications. Select HgbA1c screening may allow the identification of a group of patients at higher risk of complications.
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Denaro N, Garrone O, Morelli A, Pellegrino B, Merlano MC, Vacca D, Pearce J, Farci D, Musolino A, Scartozzi M, Tommasi C, Solinas C. A narrative review of the principal glucocorticoids employed in cancer. Semin Oncol 2022; 49:429-438. [PMID: 36737303 DOI: 10.1053/j.seminoncol.2023.01.004] [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: 09/12/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/29/2023]
Abstract
Glucocorticoids (GCs) are a pharmacological class of drugs widely used in oncology in both supportive and palliative settings. GCs differentially impact organs with immediate and long-term effects; with suppressive effect on the immune system anchoring their use to manage the toxicities of immune checkpoint inhibitors (ICIs). In addition, GCs are often used in the management of symptoms related to cancer or chemotherapy and as adjuvants in the treatment of pain in the management of other. In the palliative setting, GCs, especially administered subcutaneously can be to assist in the control of nausea, dyspnea, asthenia, and anorexia-cachexia syndrome. In this narrative review, we aim to summarize the role of GCs in the different settings (curative, supportive, and palliative) to help clinicians use these important drugs in their daily clinical practice with cancer patients.
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Affiliation(s)
- Nerina Denaro
- Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Ornella Garrone
- Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Benedetta Pellegrino
- Medical Oncology and Breast Unit, University Hospital of Parma, Italy; Department of Medicine and Surgery, University of Parma, Italy
| | | | - Denise Vacca
- Palliative Care Unit, Ospedale Sirai, Carbonia, ASSL Carbonia, Italy
| | - Josie Pearce
- Harvard Premedical Program, Harvard University, Cambridge, MA, USA
| | - Daniele Farci
- Medical Oncology, Nuova Casa di Cura, Decimomannu, Cagliari, Italy
| | - Antonino Musolino
- Medical Oncology and Breast Unit, University Hospital of Parma, Italy; Department of Medicine and Surgery, University of Parma, Italy
| | - Mario Scartozzi
- Medical Oncology, AOU Cagliari, Policlinico di Monserrato, Cagliari, Italy
| | - Chiara Tommasi
- Medical Oncology and Breast Unit, University Hospital of Parma, Italy; Department of Medicine and Surgery, University of Parma, Italy.
| | - Cinzia Solinas
- Medical Oncology, AOU Cagliari, Policlinico di Monserrato, Cagliari, Italy
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Aziz H, Kwon YIC, Alvi S, Ahmad S, Ganguli S, Goodman M, Kwon YK. Does Chronic Use of Steroids Affect Outcomes After Liver Resection? Analysis of a National Database. J Gastrointest Surg 2022; 26:2093-2100. [PMID: 35776295 DOI: 10.1007/s11605-022-05393-y] [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] [Received: 03/12/2022] [Accepted: 06/04/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION With the increasing age of patients, more patients on chronic preoperative steroids are undergoing liver resections. Our study aimed to assess the relationship between preoperative steroids and outcomes. METHODS We performed a retrospective review of the 2014-2019 NSQIP database of all patients undergoing liver resections. Propensity score matching was utilized to match the two groups (chronic steroids vs. no steroids) based on demographics, preoperative laboratory data, and operative findings. The primary outcome measure was mortality. RESULTS There were 712 patients in the chronic steroid group and 21,751 in the no steroid group. After propensity score matching; there were 420 patients in both groups. Post-match analysis again demonstrated that patients on chronic steroids were at higher risk of cardiac arrest than those not on steroids (OR 2.01, 95% CI 1.02-2.45, p = 0.04). In addition, rates of organ space wound infection (OR 2.66, CI 1.33-5.38, p = 0.03), superficial wound infection (OR 2.79, CI 1.08-5.41, p = 0.035), renal insufficiency (OR 1.25, CI 1.03-1.62, p = 0.02), postoperative sepsis (OR 1.28, CI 1.08-1.82, p = 0.04), DVT (OR 1.7, CI 1.01-2.82, p = 0.04), and bile leakage (OR 1.75, CI 1.24-3.36, p = 0.04) were also increased in patients on steroids. However, the matched cohorts were similar in postoperative mortality rates (OR 0.11, CI 0.6-1.17, p = 0.72). CONCLUSION The study found higher morbidity rates in patients undergoing liver resections on chronic preoperative steroids but no differences in mortality.
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Affiliation(s)
- Hassan Aziz
- Division of Transplant and Hepatobiliary Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St., Boston, MA, USA.
| | - Ye In Christopher Kwon
- Division of Transplant and Hepatobiliary Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St., Boston, MA, USA
| | - Saba Alvi
- Division of Transplant and Hepatobiliary Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St., Boston, MA, USA
| | - Shahzaib Ahmad
- Division of Transplant and Hepatobiliary Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St., Boston, MA, USA
| | - Sangrag Ganguli
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Martin Goodman
- Division of Transplant and Hepatobiliary Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St., Boston, MA, USA
| | - Yong K Kwon
- Division of Transplant and Hepatobiliary Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
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Chen FR, Quan T, Manzi JE, Gu A, Wei C, Tabaie S, Chodos M, Chapman CB, Pryor KO, Liu J. Evaluating the Association between Anesthesia Type and Postoperative Complications for Patients Receiving Total Ankle Arthroplasty. THE IOWA ORTHOPAEDIC JOURNAL 2022; 42:113-119. [PMID: 35821927 PMCID: PMC9210406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Total ankle arthroplasty (TAA) is performed for ankle arthritis and there has been interest investigating which anesthetic method is the best choice in order to optimize perioperative outcomes. In this study, we compared postoperative complications after TAA for patients receiving either 1) general anesthesia alone or 2) general anesthesia plus regional anesthesia. METHODS Patients undergoing primary TAA from 2007 to 2018 were identified in a national database. Patients were stratified into 2 cohorts: general anesthesia and general anesthesia combined with regional anesthesia. In this analysis, 30-day wound, cardiac, pulmonary, renal, thromboembolic, and sepsis complications, as well mortality, postoperative transfusion, urinary tract infection, extended length of stay, and reoperation were assessed. Bivariate analyses and multivariable logistical regression were performed. RESULTS Of 1,084 total patients undergoing TAA, 878 patients (81.0%) had general anesthesia and 206 (19.0%) had general anesthesia combined with regional anesthesia. Following adjustment, there were no increased risk of postoperative complications in the combined general and regional anesthesia group compared to those who only underwent general anesthesia. CONCLUSION Compared to general anesthesia alone, the addition of regional anesthesia to general anesthesia for TAA is not associated with increased risk of complications in the perioperative period. Level of Evidence: III.
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Affiliation(s)
- Frank R. Chen
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, Pennysylvania, USA
| | - Theodore Quan
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Alex Gu
- Department of Orthopaedic Surgery, The George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Chapman Wei
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sean Tabaie
- Department of Orthopaedic Surgery, Children’s National Health System, Washington, DC, USA
| | - Marc Chodos
- Department of Orthopaedic Surgery, The George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Cary B. Chapman
- Miami Orthopedics & Sports Medicine Institute, Coral Gables, Florida, USA
| | - Kane O. Pryor
- Department of Anesthesiology, New York-Presbyterian Hospital/ Weill Cornell Medical Center, New York, New York, USA
| | - Jiabin Liu
- Department of Anesthesiology, New York-Presbyterian Hospital/ Weill Cornell Medical Center, New York, New York, USA
- Department of Regional Anesthesia and Acute Pain Management, Hospital for Special Surgery, New York, New York, USA
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Parmontree P, Ketprathum P, Ladnok T, Meeaium S, Thanaratsiriworakul T, Sonhorm U. Predictive risk factors for venous thromboembolism in neurosurgical patients: A retrospective analysis single center cohort study. Ann Med Surg (Lond) 2022; 77:103628. [PMID: 35638055 PMCID: PMC9142669 DOI: 10.1016/j.amsu.2022.103628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 12/15/2022] Open
Abstract
Background Venous thromboembolism (VTE) has a major effect on morbidity and mortality in neurosurgical patients. However, identifying risk factors that may be useful in practice is a challenge. The purpose of this study was to investigate the incidence and determine the predictors of VTE in patients undergoing neurosurgery. Materials and methods This retrospective, single-center cohort study was conducted on adult patients admitted to a private hospital for a primary elective neurosurgical procedure between January 2015 and December 2020. Univariate analysis was used to examine clinical factors, and multivariable regression analysis was used to identify predictors of VTE. The area under the receiver-operating characteristic (AUROC) curve demonstrated the fitting model and discrimination power. Results A total of 350 patients who underwent neurological surgery were identified. There were 26 patients (7.4%) with VTE. The final predictors were found to be statistically significant in the multivariate binary logistic regression analysis, including non-Asian populations (p value < 0.001, odds ratio [OR]: 6.11, 95% confidence interval [CI] = 2.20–16.89), lack of postoperative ambulation (p value = 0.009, OR: 9.25, 95% CI = 1.17–48.83), and septic shock complication (p value = 0.001, OR: 5.36, 95% CI = 1.46–19.62). The AUROC was 0.708 (95% CI 0.61–0.80). Conclusion Although the incidence of VTE in patients receiving neurosurgery is minimal, it is also higher in non-Asian patients, those who lack of postoperative ambulation, and patients with septic shock complications. This approach may be useful to predict thromboembolism in neurosurgical patients. External validation of the prognostic model requires more investigation. Venous thromboembolism (VTE) complications can be a major cause of morbidity and even death in neurosurgical patients. The standard therapy for the appropriate prophylaxis remains unclear. Whether or not to use pharmacological prophylaxis is determined by a higher-risk category of individuals. Based on information from risk factors, it may be a benefit guide for proper VTE prophylaxis.
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Affiliation(s)
- Porntip Parmontree
- Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
- Corresponding author. Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, 20131, Thailand.
| | | | - Teeraphat Ladnok
- Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
| | - Supanut Meeaium
- Faculty of Pharmaceutical Sciences, Burapha University, Chonburi, Thailand
| | | | - Ukrit Sonhorm
- Pharmacy Department, Bangkok Hospital Pattaya, Chonburi, Thailand
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11
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Greisman JD, Olmsted ZT, Crorkin PJ, Dallimore CA, Zhigin V, Shlifer A, Bedi AD, Kim JK, Nelson P, Sy HL, Patel KV, Ellis JA, Boockvar J, Langer DJ, D'Amico RS. Enhanced Recovery After Surgery (ERAS) for Cranial Tumor Resection: A Review. World Neurosurg 2022; 163:104-122.e2. [PMID: 35381381 DOI: 10.1016/j.wneu.2022.03.118] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 11/15/2022]
Abstract
Enhanced Recovery After Surgery (ERAS) protocols describe a standardized method of preoperative, perioperative, and postoperative care to enhance outcomes and minimize complication risks surrounding elective surgical intervention. A growing body of evidence is being generated as we learn to apply principles of ERAS standardization to neurosurgical patients. First applied in spinal surgery, ERAS protocols have been extended to cranial neuro-oncological procedures. This review synthesizes recent findings to generate evidence-based guidelines to manage neurosurgical oncology patients with standardized systems and assess ability of these systems to coordinate multidisciplinary, patient-centric care efforts. Furthermore, we highlight the potential utility of multimedia, app-based communication platforms to facilitate patient education, autonomy, and team communication within each of the three settings.
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Affiliation(s)
- Jacob D Greisman
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY.
| | - Zachary T Olmsted
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Patrick J Crorkin
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Colin A Dallimore
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Vadim Zhigin
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Artur Shlifer
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Anupama D Bedi
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Jane K Kim
- Department of Anesthesiology, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Priscilla Nelson
- Department of Anesthesiology, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Heustein L Sy
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Kiran V Patel
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Jason A Ellis
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - John Boockvar
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - David J Langer
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
| | - Randy S D'Amico
- Department of Neurosurgery, Lenox Hill Hospital/Northwell Health, New York, NY
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12
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Ayodele OA, Cabral HJ, McManus DD, Jick SS. Glucocorticoids and Risk of Venous Thromboembolism in Asthma Patients Aged 20-59 Years in the United Kingdom's CPRD 1995-2015. Clin Epidemiol 2022; 14:83-93. [PMID: 35082533 PMCID: PMC8786344 DOI: 10.2147/clep.s341048] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Glucocorticoids, the class of steroids used in management of asthma, have been observed to be associated with adverse events such as increased coagulation and inhibition of fibrinolysis. This study evaluated the risk of VTE in relation to the use of glucocorticoids in patients with asthma. METHODS We conducted a nested case-control study among patients aged 20-59 years with asthma who received at least one glucocorticoid prescription during 1995-2015 in the UK-based Clinical Practice Research Datalink GOLD. We used descriptive analyses and conditional logistic regression to evaluate the risk of VTE associated with glucocorticoid use. RESULTS The adjusted ORs (aORs) (95% CI) for VTE in patients exposed to glucocorticoids were 1.9 (1.6-2.3), 1.4 (1.1-1.8), and 1.2 (0.9-1.5) for current, recent, and past glucocorticoid users, respectively, compared to the unexposed. The aORs (95% CI) for VTE in patients exposed to systemic glucocorticoid and inhaled glucocorticoids, compared to the unexposed, were 3.5 (2.7-4.5) and 1.5 (1.3-1.8), respectively. CONCLUSION Current and systemic glucocorticoid use was associated with a dose-response increased risk of incident idiopathic VTE.
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Affiliation(s)
- Olulade A Ayodele
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Biostatistics and Research Design Program, Boston University Clinical and Translational Science Institute, Boston, MA, USA
| | - David D McManus
- Department of Medicine, University of Massachusetts Chan Medical School, Boston, MA, USA
| | - Susan S Jick
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Boston Collaborative Drug Surveillance Program, Lexington, MA, USA
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13
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Go RC, Nyirenda T, Bojarian M, Hosseini DK, Rahim M, Kim K, Rose KM. Methylprednisolone, venous thromboembolism, and association with heparin to 30 days in hospital survival in severe Covid-19 pneumonia. BMC Pulm Med 2022; 22:6. [PMID: 34986821 PMCID: PMC8731184 DOI: 10.1186/s12890-021-01810-1] [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] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/21/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Mortality in severe COVID-19 pneumonia is associated with thrombo-inflammation. Corticosteroids are given to attenuate the inflammation, but they are associated with thrombosis. The aims of this study were to determine the risk of venous thromboembolism between no methylprednisolone and methylprednisolone (dose versus duration) and to evaluate any synergistic dose-dependent association of heparin and methylprednisolone to 30 days in hospital survival. METHODS This was a secondary analysis of a retrospective cohort. Patients included in this study were ≥ 18 years of age and admitted for severe COVID-19 pneumonia between March and June 2020 in 13 hospitals in New Jersey, United States. A propensity score analysis between administration of methylprednisolone and no methylprednisolone was fitted for 11 variables and Youden Index Method was used to determine cut-off between low dose and high dose methylprednisolone. Multivariate cox regression was to assess risk. RESULTS In 759 patients, the incidence of venous thromboembolism was 9% of patients who received methylprednisolone and 3% of patients who did not receive methylprednisolone with a [RR 2.92 (95% CI 1.54, 5.55 P < 0.0001)]. There was a higher incidence of mechanical ventilation in the methylprednisolone group. The median d-dimer between patients with venous thromboembolism was higher compared to those without (P < 0.0003). However, the d-dimer was not statistically significant between those who had venous thromboembolism between methylprednisolone and no methylprednisolone groups (P = 0.40). There was no higher risk in high dose versus low dose [RR = 0.524 (95% CI 0.26, 1.06 P 0.4)]; however, the risk for venous thromboembolism between methylprednisolone for > 7 days and ≤ 7 days was statistically significant (RR 5.46 95% CI 2.87, 10.34 P < 0.0001). Patients who received low dose methylprednisolone and therapeutic heparin had a trend towards higher risk of mortality compared to prophylactic heparin (HR 1.81 95% CI 0.994 to 3.294) (P = 0.0522). There was no difference in 30 days in hospital survival between high dose methylprednisolone with prophylactic or therapeutic heparin (HR 0.827 95% CI 0.514 to 1.33) (P = 0.4335). CONCLUSION Methylprednisolone for > 7 days had a higher association of venous thromboembolism. There was no added benefit of therapeutic heparin to methylprednisolone on mechanically ventilated patients.
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Affiliation(s)
- Ronaldo C Go
- Hackensack Meridian School of Medicine, Nutley, NJ, USA.
- Hackensack Meridian School of Medicine and Department of Critical Care, Hackensack University Medical Center, Hackensack, NJ, USA.
| | - Themba Nyirenda
- Hackensack Meridian School of Medicine, Nutley, NJ, USA
- Office of Research Administration, Hackensack Meridian Health, Hackensack, NJ, USA
| | - Maryam Bojarian
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Davood K Hosseini
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Mehek Rahim
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Kevin Kim
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Keith M Rose
- Hackensack Meridian School of Medicine, Nutley, NJ, USA
- Hackensack Meridian School of Medicine and Department of Critical Care, Hackensack University Medical Center, Hackensack, NJ, USA
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14
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Rastoder E, Sivapalan P, Eklöf J, Saeed MI, Jordan AS, Meteran H, Tønnesen L, Biering-Sørensen T, Løkke A, Seersholm N, Lynghøj Nielsen T, Carlsen J, Janner J, Godtfredsen N, Bodtger U, Laursen CB, Hilberg O, Knop FK, Priemé H, Ingebrigtsen TS, Gottlieb V, Wilcke JT, Stæhr Jensen JU. Systemic Corticosteroids and the Risk of Venous Thromboembolism in Patients with Severe COPD: A Nationwide Study of 30,473 Outpatients. Biomedicines 2021; 9:biomedicines9080874. [PMID: 34440079 PMCID: PMC8389624 DOI: 10.3390/biomedicines9080874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Due to frequent exacerbations, many patients with chronic obstructive pulmonary disease (COPD) are exposed to oral corticosteroids (OCS), which may be thrombogenic. We evaluated the risk of hospitalisation with venous thromboembolism (VTE) and death in patients with acute exacerbation of COPD (AECOPD) treated with long and short OCS regimens. In this nationwide cohort study of 30,473 COPD outpatients treated for AECOPD, we compared the risk of VTE hospitalisation and all-cause mortality within 6 months in OCS dose of >250 mg vs. ≤250 mg. A multivariable Cox proportional hazard regression was used to estimate the risk. The incidence of VTE hospitalisations was 0.23%. A long OCS treatment course was associated with an increased risk of VTE compared to a short course (hazard ratio (HR) 1.69, [95% confidence interval (CI) 1.05 to 2.72], p < 0.031). A higher risk of all-cause mortality was seen in the group of COPD patients treated with a long OCS course (HR 1.71, [95% CI 1.63 to 1.79], p < 0.0001). The risk of reported VTE hospitalisation was higher among AECOPD patients treated with long courses of OCS, but the absolute risk was low, suggesting under-reporting of the condition.
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Affiliation(s)
- Ema Rastoder
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (M.I.S.); (A.S.J.); (H.M.); (L.T.); (N.S.); (V.G.); (J.T.W.); (J.U.S.J.)
- Correspondence:
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (M.I.S.); (A.S.J.); (H.M.); (L.T.); (N.S.); (V.G.); (J.T.W.); (J.U.S.J.)
| | - Josefin Eklöf
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (M.I.S.); (A.S.J.); (H.M.); (L.T.); (N.S.); (V.G.); (J.T.W.); (J.U.S.J.)
| | - Mohamad Isam Saeed
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (M.I.S.); (A.S.J.); (H.M.); (L.T.); (N.S.); (V.G.); (J.T.W.); (J.U.S.J.)
| | - Alexander Svorre Jordan
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (M.I.S.); (A.S.J.); (H.M.); (L.T.); (N.S.); (V.G.); (J.T.W.); (J.U.S.J.)
| | - Howraman Meteran
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (M.I.S.); (A.S.J.); (H.M.); (L.T.); (N.S.); (V.G.); (J.T.W.); (J.U.S.J.)
| | - Louise Tønnesen
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (M.I.S.); (A.S.J.); (H.M.); (L.T.); (N.S.); (V.G.); (J.T.W.); (J.U.S.J.)
| | - Tor Biering-Sørensen
- Section of Cardiovascular Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark;
| | - Anders Løkke
- Department of Medicine, Hospital Lillebælt, 7100 Vejle, Denmark; (A.L.); (O.H.)
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Niels Seersholm
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (M.I.S.); (A.S.J.); (H.M.); (L.T.); (N.S.); (V.G.); (J.T.W.); (J.U.S.J.)
| | - Thyge Lynghøj Nielsen
- Section of Respiratory Medicine and Infectious Disease, Nordsjællands Hospital, 3400 Hillerød, Denmark;
| | - Jørn Carlsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark;
| | - Julie Janner
- Section of Respiratory Medicine, Amager and Hvidovre Hospital, 2650 Hvidovre, Denmark; (J.J.); (N.G.)
| | - Nina Godtfredsen
- Section of Respiratory Medicine, Amager and Hvidovre Hospital, 2650 Hvidovre, Denmark; (J.J.); (N.G.)
| | - Uffe Bodtger
- Section of Respiratory Medicine, Næstved Hospital, 4700 Næstved, Denmark;
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of South Denmark, 5000 Odense, Denmark;
| | - Ole Hilberg
- Department of Medicine, Hospital Lillebælt, 7100 Vejle, Denmark; (A.L.); (O.H.)
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Filip K. Knop
- Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, 2900 Hellerup, Denmark;
- Steno Diabetes Center Copenhagen, Gentofte Hospital, 2900 Hellerup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Helene Priemé
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2730 Herlev, Denmark;
| | | | - Vibeke Gottlieb
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (M.I.S.); (A.S.J.); (H.M.); (L.T.); (N.S.); (V.G.); (J.T.W.); (J.U.S.J.)
| | - Jon Torgny Wilcke
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (M.I.S.); (A.S.J.); (H.M.); (L.T.); (N.S.); (V.G.); (J.T.W.); (J.U.S.J.)
| | - Jens Ulrik Stæhr Jensen
- Section of Respiratory Medicine, Herlev-Gentofte Hospital, 2900 Hellerup, Denmark; (P.S.); (J.E.); (M.I.S.); (A.S.J.); (H.M.); (L.T.); (N.S.); (V.G.); (J.T.W.); (J.U.S.J.)
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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15
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Zhang H, Wang X. Risk Factors of Venous Thromboembolism in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:693927. [PMID: 34262920 PMCID: PMC8273255 DOI: 10.3389/fmed.2021.693927] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/31/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Patients suffering from chronic inflammatory disorders, such as inflammatory bowel disorder, are at higher risk of developing thromboembolism. The chronic inflammatory nature of inflammatory bowel disease has been identified as a predominant reason for a state of Virchow's triad (i.e., endothelial dysfunction, stasis, and general hypercoagulability), eventually leading to the onset of venous thromboembolism. Recent studies show that certain factors, such as demographics, medication history, and history of surgical intervention may increase thromboembolism risk in patients with inflammatory bowel disease. However, to date, no study has attempted to evaluate the effect of different risk factors associated with the development of venous thromboembolism in inflammatory bowel disease patients. Objective: To evaluate the risk factors that can influence the incidence of venous thromboembolism in patients with inflammatory bowel disease. Methods: Academic literature was systematically searched based on the PRISMA guidelines across five databases: Web of Science, EMBASE, CENTRAL, Scopus, and MEDLINE. A random-effect meta-analysis was conducted to evaluate the hazard ratio for the risk factors (i.e., aging, gender, steroid therapy, surgery, and ulcerative colitis) that can influence the incidence of venous thromboembolism in patients with inflammatory bowel disease. Results: From a total of 963 studies, 18 eligible studies with 1,062,985 (44.59 ± 10.18 years) patients suffering from inflammatory bowel disease were included in the review. A meta-analysis revealed a higher risk of aging (Hazard's ratio: 2.19), steroids (1.87), surgery (1.48), and ulcerative colitis (2.06) on venous thromboembolism in patients with inflammatory bowel disease. We also found that the female gender (0.92) did not increase the incidence of venous thromboembolism in inflammatory bowel disease patients. Conclusion: The study provides preliminary evidence regarding high risks associated with ulcerative colitis, steroid consumption, and aging for the development of venous thromboembolism in patients with inflammatory bowel disease. The findings from this study may contribute to developing awareness among clinicians, better risk stratification and prevention of venous thromboembolic complications in patients with inflammatory bowel disease.
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Affiliation(s)
- Hua Zhang
- Department of Nursing, Xiangya Second Hospital of Central South University, Changsha, China
| | - Xuehong Wang
- Department of Gastroenterology, Xiangya Second Hospital of Central South University, Changsha, China
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16
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The incidence and risk factors for venous thromboembolic events in patients with psoriasis and psoriatic arthritis. Semin Arthritis Rheum 2021; 51:547-552. [PMID: 33895651 DOI: 10.1016/j.semarthrit.2021.04.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/02/2021] [Accepted: 04/15/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The risk of arterial vascular events is increased in patients with psoriatic disease (PsD), however, limited information exists about the risk of venous thromboembolism (VTE) in these patients. We assessed the incidence and risk factors for VTE in patients with PsD. METHODS A multicentre cohort study was conducted involving patients with PsD followed prospectively from 1994 to 2020. Information about VTE, including pulmonary embolism (PE) and deep venous thrombosis (DVT), was obtained from provincial hospitalization databases. The incidence rate and cumulative probability of developing VTE were computed. Cox proportional hazards models were used to assess the association between risk factors, including comorbidities and disease-related factors, and the first VTE. RESULTS A total 2,433 patients with PsD were analysed with 26 incident VTE (7 DVT alone, 12 PE alone, and 7 both PE and DVT). The incidence rates of the first VTE, DVT, and PE were 12, 6.5, and 8.8 events per 10,000 patient-years, respectively. The cumulative proportion of individuals developing VTE was 4.6% by 80 years of age. Independent predictors for VTE included older age, diabetes mellitus, and corticosteroid usage (all p<0.05). CONCLUSION Older patients with PsD, those with diabetes, and those using corticosteroids are at a higher risk of developing VTE. Risk stratification of patients with these identified risk factors for VTE will allow for more individualized patient management and improved medication selection.
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17
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Global trends in the evaluation and management of cerebrospinal fluid shunt infection: a cooperative ISPN survey. Childs Nerv Syst 2020; 36:2949-2960. [PMID: 32519130 DOI: 10.1007/s00381-020-04699-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/21/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Ventriculoperitoneal shunts (VPS) is commonly performed by pediatric neurosurgeons and there is no consensus in management of VPS infection as it relates to diagnosis and treatment. OBJECTIVE We utilized an international practitioner-based survey to study the variability in VPS infection diagnostic and therapeutic measures. METHODS A survey gauging practice patterns of pediatric neurosurgeons regarding VPS and its complication management was distributed. Survey endpoints were analyzed by VPS case volume and pediatric-focused case volume regarding diagnostic measures, use of cerebrospinal fluid (CSF) profile, microbiology, and treatment. RESULTS A total of 439 surveys were distributed, with a response rate of 31%. Responders ranged from Americas (44.9%), European (31.4%), Asian (18.6%), African (2.5%), to Australian continents (2.5%). Practitioners were stratified based on number and percentage pediatric VPS performed. Institutions performing highest VPS and percentage pediatric case volumes had lower rate of VPS infection. Shunt tap was the most widely used diagnostic study. Overall CSF profile did not affect decision making towards VPS internalization, except for leukocyte count ≤ 20 × 109/L. Practitioners utilized 3 negative cultures prior to VPS internalization. Discrepancies in surgical management were noted amongst centers with high versus low VPS volume and proportion of pediatric-focused case volume. Practice patterns were not noted to be organism dependent. Antibiotic-impregnated shunts were utilized in the Americas and Europe over other regions but only in one third of all initial VPS or as a preventive strategy after a VPS infection has been resolved respectively. DISCUSSION Survey results from 6 continents in VPS management revealed patterns of lower infection in high-volume centers, 3 negative cultures prior to internalization and aggressive surgical VPS infection management in high-volume institutions.
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18
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Lee R, Lee D, Gowda NB, Iweala U, Weinreb JH, Falk DP, Yu W, O'Brien JR. Increased Rates of Septic Shock, Cardiac Arrest, and Mortality Associated With Chronic Steroid Use Following Anterior Cervical Discectomy and Fusion for Cervical Stenosis. Int J Spine Surg 2020; 14:649-656. [PMID: 33046542 DOI: 10.14444/7095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is an established treatment modality for cervical spondylosis. Many patients are on immunosuppressant therapy in the management of various inflammatory spinal pathologies and other comorbid conditions. The impact of chronic steroid use on postoperative complications has not been examined in cervical fusion procedures. The objective of this study was to identify specific postoperative complications associated with steroid/immunosuppressant use following ACDF for cervical stenosis. METHODS A multi-institutional surgical registry was queried to identify 5377 patients with ACDF diagnosed with cervical stenosis. Patients were stratified into cohorts with a history of steroid/immunosuppressant use for chronic conditions (n = 198, 3.3%) versus those who did not (n = 5179, 96.7%). Propensity-score matching without replacement was implemented to control for preoperative demographics and comorbidities. Pearson χ2 and Fischer exact tests were used in comparing the prevalence of demographics, comorbidities, and complication rates. RESULTS Upon propensity matching, increased rates of pulmonary embolisms (0.51% vs 0.00%, P = .025), cardiac arrest requiring resuscitation (1.01% vs 0.10%, P = .020), septic shock (0.51% vs 0.00%, P = .025), and mortality (1.52% vs 0.20%, P = .009) in the postoperative 30-day period in patients on chronic steroid/immunosuppressant use were observed. CONCLUSIONS The results indicate that steroid use/immunosuppression in patients with ACDF has a higher associated rate of pulmonary embolisms, cardiac arrest, septic shock, and mortality. The risk of mortality and these other complications should be carefully considered prior to operative intervention. Future research may investigate steroid-tapering protocols that reduce the rate of infection and other postoperative complications in the subset of immunosuppressed ACDF patients. CLINICAL RELEVANCE By elucidating the complication rates of ACDF patients on steroids for cervical stenosis, orthopedic surgeons can better stratify patients for risk of postoperative morbidity. Surgeons may have deeper risk-benefit discussions with these specific patients before they elect to have the operation.
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Affiliation(s)
- Ryan Lee
- The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Danny Lee
- The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Nikhil B Gowda
- The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Uchechi Iweala
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, District of Columbia
| | - Jeffrey H Weinreb
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, District of Columbia
| | - David P Falk
- Department of Orthopaedic Surgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Warren Yu
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, District of Columbia
| | - Joseph R O'Brien
- Washington Spine and Scoliosis Clinic, OrthoBethesda, Bethesda, Maryland
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19
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Readmission with venous thromboembolism after surgical treatment by primary cancer site. Surg Oncol 2020; 35:268-275. [PMID: 32942082 DOI: 10.1016/j.suronc.2020.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a common, high-mortality condition among surgical cancer patients. Comprehensive analyses of VTE among postoperative cancer patients are lacking. We sought to determine the association between readmission with VTE and primary cancer diagnosis in a nationwide database at 90- and 180-days after initial admission for cancer surgery. METHODS Retrospective analyses of post-surgical cancer patients readmitted with VTE were conducted using data from the Nationwide Readmissions Database (NRD) (2010-2014). Multivariate logistic regression models adjusting for patient and hospital factors were used to determine 90- and 180-day readmission rates for VTE by cancer type. Patient factors associated with readmission were also examined. RESULTS Among a sample of 535,992 cancer patients undergoing tumor resection, readmission with VTE occurred in 1.7% within 90-days and 2.3% within 180-days. Patients readmitted for VTE experienced a 7% mortality rate. Highest rates of VTE readmission at 180 days occurred in brain (6.7%), pancreatic (5.6%), and respiratory and intrathoracic cancers (4.4%). Using pancreatic cancer as reference, brain cancer had the highest odds of readmission at 180-days (OR 2.23, 95% CI [1.95-2.55]). CONCLUSION Readmission with VTE among surgical cancer patients occurred in 2.3% of patients within 180 days. Among cancer types, primary brain cancer was independently associated with readmission with VTE.
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Ruehl M, Lynch AM, O'Toole TE, Morris B, Rush J, Couto CG, Hmelo S, Sonnenshein S, Butler A, Guillaumin J. Outcome and treatments of dogs with aortic thrombosis: 100 cases (1997-2014). J Vet Intern Med 2020; 34:1759-1767. [PMID: 33463770 PMCID: PMC7517508 DOI: 10.1111/jvim.15874] [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: 11/25/2019] [Revised: 07/21/2020] [Accepted: 07/30/2020] [Indexed: 01/30/2023] Open
Abstract
Background Aortic thrombosis (ATh) is an uncommon condition in dogs, with limited understanding of risks factors, outcomes, and treatments. Objectives/Hypothesis To describe potential risk factors, outcome, and treatments in dogs with ATh. Animals Client‐owned dogs with a diagnosis of ATh based on ultrasonographic or gross necropsy examination. Method Multicentric retrospective study from 2 academic institutions. Results One hundred dogs were identified. Anti‐thrombin diagnosis, 35/100 dogs were nonambulatory. The dogs were classified as acute (n = 27), chronic (n = 72), or unknown (n = 1). Fifty‐four dogs had at least one comorbidity thought to predispose to ATh, and 23 others had multiple comorbidities. The remaining 23 dogs with no obvious comorbidities were classified as cryptogenic. Concurrent illnesses potentially related to the development of ATh included protein‐losing nephropathy (PLN) (n = 32), neoplasia (n = 22), exogenous corticosteroid administration (n = 16), endocrine disease (n = 13), and infection (n = 9). Dogs with PLN had lower antithrombin activity than those without PLN (64% and 82%, respectively) (P = .04). Sixty‐five dogs were hospitalized with 41 subsequently discharged. Sixteen were treated as outpatient and 19 euthanized at admission. In‐hospital treatments varied, but included thrombolytics (n = 12), alone or in combination with thrombectomy (n = 9). Fifty‐seven dogs survived to discharge. Sixteen were alive at 180 days. Using regression analysis, ambulation status at the time of presentation was significantly correlated with survival‐to‐discharge (P < .001). Conclusions/Clinical Importance Dogs with ATh have a poor prognosis, with nonambulatory dogs at the time of presentation having worse outcome. Although the presence of comorbid conditions associated with hypercoagulability is common, an underlying cause for ATh was not always identified.
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Affiliation(s)
| | - Alex M Lynch
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Therese E O'Toole
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - Bari Morris
- VCA Shoreline Veterinary Referral and Emergency Center, Shelton, Connecticut, USA
| | - John Rush
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | | | | | | | - Amy Butler
- Critical Consults, LLC, Pittsburgh, Pennsylvania, USA
| | - Julien Guillaumin
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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Kawai T, Goto K, Kuroda Y, Matsuda S. Lower Activity and Function Scores Are Associated with a Higher Risk of Preoperative Deep Venous Thrombosis in Patients Undergoing Total Hip Arthroplasty. J Clin Med 2020; 9:jcm9051257. [PMID: 32357497 PMCID: PMC7287730 DOI: 10.3390/jcm9051257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 11/26/2022] Open
Abstract
This study was performed to investigate the relationship between patients’ activity and function levels and the incidence of preoperative deep venous thrombosis (DVT) prior to total hip arthroplasty (THA). We retrospectively reviewed 500 patients admitted for primary or revision THA from July 2014 to October 2018. The diagnosis of DVT was confirmed using Doppler ultrasonography 1 month before THA. The patients’ activity and hip function were evaluated using several clinical scores: the Harris Hip Score (HHS), Oxford Hip Score (OHS), University of California Los Angeles (UCLA) activity score, and visual analog scale (VAS) score. Those scores and the medical history were examined for correlations with preoperative DVT using univariate and multivariate models. Univariate regression analysis showed that older age, current steroid use, anticoagulant use, a history of DVT, collagen disease, a lower UCLA activity score, and a lower OHS were associated with an elevated risk of preoperative DVT. The multivariate analyses showed that a higher UCLA activity score (odds ratio (OR): 0.0049–0.012) and higher OHS (OR: 0.0012–0.0088) were associated with a lower risk of preoperative DVT in each model. Age (OR: 1.07 in both models), current steroid use (OR: 9.32–10.45), and a history of DVT (OR: 27.15–74.98) were associated with a higher risk of preoperative DVT in both models. Older age, current steroid use, a history of DVT, a lower UCLA activity score, and a lower OHS were risk factors for preoperative DVT before THA, even when controlling for potential confounders. Patients exhibiting low activity and low function levels were more likely to have DVT, even before surgery.
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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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Buchanan IA, Lin M, Donoho DA, Patel A, Ding L, Amar AP, Giannotta SL, Mack WJ, Attenello F. Predictors of Venous Thromboembolism After Nonemergent Craniotomy: A Nationwide Readmission Database Analysis. World Neurosurg 2018; 122:e1102-e1110. [PMID: 30465948 DOI: 10.1016/j.wneu.2018.10.237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is responsible for many hospital readmissions each year, particularly among postsurgical cohorts. Because early and indiscriminate VTE prophylaxis carries catastrophic consequences in postcraniotomy cohorts, identifying factors associated with a high risk for thromboembolic complications is important for guiding postoperative management. OBJECTIVE To determine VTE incidence in patients undergoing nonemergent craniotomy and to evaluate for factors that predict 30-day and 90-day readmission with VTE. METHODS The 2010-2014 cohorts of the Nationwide Readmissions Database were used to generate a large heterogeneous craniotomy sample. RESULTS There were 89,450 nonemergent craniotomies that met inclusion criteria. Within 30 days, 1513 patients (1.69%) were readmitted with VTE diagnoses; among them, 678 (44.8%) had a diagnosis of deep vein thrombosis alone, 450 (29.7%) had pulmonary embolism alone, and 385 (25.4%) had both. The corresponding 30-day deep vein thrombosis and pulmonary embolism incidences were 1.19% and 0.93%, respectively. In multivariate analysis, several factors were significantly associated with VTE readmission, namely, craniotomy for tumor, corticosteroids, advanced age, greater length of stay, and discharge to institutional care. CONCLUSIONS Craniotomies for tumor, corticosteroids, advanced age, prolonged length of stay, and discharge to institutional care are significant predictors of VTE readmission. The implication of steroids, coupled with their ubiquity in neurosurgery, makes them a potentially modifiable risk factor and a prime target for VTE reduction in craniotomy cohorts. Furthermore, the fact that dose is proportional to VTE risk in the literature suggests that careful consideration should be given toward decreasing regimens in situations in which use of a lower dose might prove equally sufficient.
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Affiliation(s)
- Ian A Buchanan
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA; Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
| | - Michelle Lin
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Daniel A Donoho
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA; Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Arati Patel
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Li Ding
- Departments of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Arun P Amar
- Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Steven L Giannotta
- Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - William J Mack
- Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Frank Attenello
- Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Celińska-Löwenhoff M, Zabczyk M, Iwaniec T, Plens K, Musiał J, Undas A. Reduced plasma fibrin clot permeability is associated with recurrent thromboembolic events in patients with antiphospholipid syndrome. Rheumatology (Oxford) 2018; 57:1340-1349. [DOI: 10.1093/rheumatology/key089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Affiliation(s)
| | - Michal Zabczyk
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Teresa Iwaniec
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Plens
- Data Analysis Center, Krakow Cardiovascular Research Institute, Krakow, Poland
| | - Jacek Musiał
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Anetta Undas
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- John Paul II Hospital, Center for Research and Medical Technologies, Krakow, Poland
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Nakano F, Matsubara T, Ishigaki T, Hatazaki S, Mouri G, Nakatsuka Y, Suzuki H. Incidence and risk factor of deep venous thrombosis in patients undergoing craniotomy for brain tumors: A Japanese single-center, retrospective study. Thromb Res 2018; 165:95-100. [DOI: 10.1016/j.thromres.2018.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/20/2018] [Accepted: 03/24/2018] [Indexed: 02/06/2023]
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Senders JT, Muskens IS, Cote DJ, Goldhaber NH, Dawood HY, Gormley WB, Broekman MLD, Smith TR. Thirty-Day Outcomes After Craniotomy for Primary Malignant Brain Tumors: A National Surgical Quality Improvement Program Analysis. Neurosurgery 2018; 83:1249-1259. [DOI: 10.1093/neuros/nyy001] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 01/24/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Joeky T Senders
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivo S Muskens
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David J Cote
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicole H Goldhaber
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hassan Y Dawood
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William B Gormley
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marike L D Broekman
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Timothy R Smith
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Hoskote SS, Yadav H, Jagtap P, Wigle DA, Daniels CE. Chylothorax as a Risk Factor for Thrombosis in Adults: A Proof-of-Concept Study. Ann Thorac Surg 2018; 105:1065-1070. [PMID: 29452999 DOI: 10.1016/j.athoracsur.2017.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 09/18/2017] [Accepted: 11/04/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Postoperative chylothorax in children is associated with an increased risk of vascular thrombosis, hypothesized to be from loss of antithrombin into chylous fluid resulting in a hypercoagulable state. In adults, an increased thrombotic risk with chylothorax has not been described. Adults undergoing Ivor-Lewis esophagogastrectomy have two strong thrombotic risk factors-active malignancy and postoperative state-allowing for relative homogeneity in baseline thrombotic risk; therefore, we studied the association of chylothorax with thrombosis in this population. METHODS We performed a single-center retrospective cohort study at a tertiary care academic center. Patients included adults undergoing Ivor-Lewis esophagogastrectomy between January 1, 2006, and December 31, 2012. We collected demographics, pleural fluid characteristics, and relevant imaging within 30 days after the operation. Using nominal logistic regression, we studied the effects of chylothorax, age, sex, body mass index, American Society of Anesthesiologists Physical Status Classification, operative duration, and hospital length of stay on the incidence of postoperative thrombosis. RESULTS We identified 608 patients who underwent Ivor-Lewis esophagogastrectomy. Of these, 524 (86.2%) had no pleural fluid analysis, 48 (7.9%) had nonchylous effusions, and 36 (5.9%) had chylothoraces, with incident acute vascular thrombosis within 30 days postoperatively occurring in 22 of 524 (4.2%), 2 of 48 (4.2%), and 8 of 36 (22.2%), respectively (p = 0.001). In multivariate analyses, after adjusting for the above factors, chylothorax was associated with significantly higher odds of any vascular thrombosis (odds ratio, 5.46; p = 0.0013) and deep venous thrombosis/pulmonary embolism (odds ratio, 6.76; p = 0.0016). CONCLUSIONS Chylothorax is associated with a significantly higher incidence of vascular thrombosis in adults undergoing Ivor-Lewis esophagogastrectomy. Vascular thrombosis was associated with a significantly higher 90-day mortality rate.
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Affiliation(s)
- Sumedh S Hoskote
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Hemang Yadav
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Prashant Jagtap
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Dennis A Wigle
- Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Craig E Daniels
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
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Senders JT, Goldhaber NH, Cote DJ, Muskens IS, Dawood HY, De Vos FYFL, Gormley WB, Smith TR, Broekman MLD. Venous thromboembolism and intracranial hemorrhage after craniotomy for primary malignant brain tumors: a National Surgical Quality Improvement Program analysis. J Neurooncol 2018; 136:135-145. [PMID: 29039075 PMCID: PMC5754452 DOI: 10.1007/s11060-017-2631-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/29/2017] [Indexed: 12/21/2022]
Abstract
Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), frequently complicates the postoperative course of primary malignant brain tumor patients. Thromboprophylactic anticoagulation is commonly used to prevent VTE at the risk of intracranial hemorrhage (ICH). We extracted all patients who underwent craniotomy for a primary malignant brain tumor from the National Surgical Quality Improvement Program (NSQIP) registry (2005-2015) to perform a time-to-event analysis and identify relevant predictors of DVT, PE, and ICH within 30 days after surgery. Among the 7376 identified patients, the complication rates were 2.6, 1.5, and 1.3% for DVT, PE, and ICH, respectively. VTE was the second-most common major complication and third-most common reason for readmission. ICH was the most common reason for reoperation. The increased risk of VTE extends beyond the period of hospitalization, especially for PE, whereas ICH occurred predominantly within the first days after surgery. Older age and higher BMI were overall predictors of VTE. Dependent functional status and longer operative times were predictive for VTE during hospitalization, but not for post-discharge events. Admission two or more days before surgery was predictive for DVT, but not for PE. Preoperative steroid usage and male gender were predictive for post-discharge DVT and PE, respectively. ICH was associated with various comorbidities and longer operative times. This multicenter study demonstrates distinct critical time periods for the development of thrombotic and hemorrhagic events after craniotomy. Furthermore, the VTE risk profile depends on the type of VTE (DVT vs. PE) and clinical setting (hospitalized vs. post-discharge patients).
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Affiliation(s)
- Joeky T Senders
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
- Department of Neurosurgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Nicole H Goldhaber
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
| | - David J Cote
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Ivo S Muskens
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
- Department of Neurosurgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Hassan Y Dawood
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Filip Y F L De Vos
- Department of Medical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - William B Gormley
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Timothy R Smith
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Marike L D Broekman
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA.
- Department of Neurosurgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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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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30
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Cote DJ, Dasenbrock HH, Muskens IS, Broekman MLD, Zaidi HA, Dunn IF, Smith TR, Laws ER. Readmission and Other Adverse Events after Transsphenoidal Surgery: Prevalence, Timing, and Predictive Factors. J Am Coll Surg 2017; 224:971-979. [PMID: 28279778 DOI: 10.1016/j.jamcollsurg.2017.02.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/08/2017] [Accepted: 02/08/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transsphenoidal surgery is a common neurosurgical procedure for accessing the pituitary and anterior skull base, yet few multicenter analyses have evaluated outcomes after this procedure. STUDY DESIGN Patients undergoing transsphenoidal surgery from 2006 to 2015 were extracted from the American College of Surgeons NSQIP database. Logistic regression was used to identify predictors of 30-day complications. RESULTS Of 1,240 patients included in this analysis, 6.9% experienced a major complication, and 9.4% experienced any complication within 30 days. Other adverse events included death in 0.7% and nonroutine hospital discharge in 5.3%. Most adverse events occurred within the first 2 weeks postoperatively; 82.9% of patients experienced their first complication during the initial hospital stay. Multivariable analysis demonstrated that predictors of hospital stay longer than 4 days included American Society of Anesthesiologists classification III to V (p = 0.015), insulin-dependent diabetes mellitus (p < 0.001), and operative time in the third and fourth quartiles (both p < 0.001). American Society of Anesthesiologists classification III to V and operative time in the fourth quartile were also predictors of any adverse event (p = 0.01 and p = 0.005, respectively). Among these patients, 3.7% underwent reoperation, the most common reason for which was postoperative cerebrospinal fluid leak (63.6%). Readmission occurred after 8.5% of cases at a median of 11.0 days post-discharge. The most common cause of readmission was hyponatremia (29.5%), followed by delayed postoperative cerebrospinal fluid leak (16.0%). CONCLUSIONS Overall rates of adverse events in patients undergoing transsphenoidal surgery are relatively low, and most occur before discharge from the hospital. Post-discharge complications associated with transsphenoidal surgery include deep vein thrombosis, pulmonary embolism, and urinary tract infection. Delayed postoperative cerebrospinal fluid leak is the major cause of reoperation, and hyponatremia is the major cause of readmission.
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Affiliation(s)
- David J Cote
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Hormuz H Dasenbrock
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ivo S Muskens
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery, University Medical Center, Utrecht, The Netherlands
| | - Marike L D Broekman
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Neurosurgery, University Medical Center, Utrecht, The Netherlands
| | - Hasan A Zaidi
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ian F Dunn
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Timothy R Smith
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Edward R Laws
- Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Risk factors for post-operative respiratory failure among 94,621 neurosurgical patients from 2006 to 2013: a NSQIP analysis. Acta Neurochir (Wien) 2016; 158:1639-45. [PMID: 27339268 DOI: 10.1007/s00701-016-2871-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Post-operative respiratory failure can occur after neurosurgical operations. Identification of risk factors for respiratory failure after neurosurgery may help guide clinical decision-making, decrease length of stay, improve patient outcomes, and lower costs. METHODS We performed a search of the ACS-NSQIP database for all patients undergoing operations with a neurosurgeon from 2006 to 2013. We analyzed demographics, past medical history, and post-operative respiratory failure, defined as unplanned intubation and/or ventilator dependence for more than 48 h post-operatively. RESULTS Of 94,621 NSQIP-reported neurosurgical patients from 2006 to 2013, 2325 (2.5 %) developed post-operative respiratory failure. Of these patients, 1270 (54.6 %) were male, with an overall mean age of 60.59 years; 571 (24.56 %) were current smokers and 756 (32.52 %) were ventilator-dependent. Past medical history included dyspnea in 204 patients (8.8 %), COPD in 198 (8.5 %), and congestive heart failure in 66 (2.8 %). The rate of post-operative respiratory failure decreased from 4.1 % in 2006 to 2.1 % in 2013 (p < 0.001). Of the 2325 patients with respiratory failure, 1061 (45.6 %) underwent unplanned intubation post-operatively and 1900 (81.7 %) were ventilator-dependent for more than 48 h. The rate of both unplanned intubation (p < 0.001) and ventilator dependence (p < 0.001) decreased significantly from 2006 to 2013. Multivariate analysis demonstrated that significant risk factors for respiratory failure included inpatient status (p < 0.001, OR = 0.165), age (p < 0.001, OR = 1.014), diabetes (p = 0.001, OR = 1.489), functional dependence prior to surgery (p < 0.001, OR = 2.081), ventilator dependence (p < 0.001, OR = 10.304), hypertension requiring medication (p = 0.005, OR = 1.287), impaired sensorium (p < 0.001, OR = 2.054), CVA/stroke with or without neurological deficit (p < 0.001, OR = 2.662; p = 0.002, OR = 1.816), systemic sepsis (p < 0.001, OR = 1.916), prior operation within 30 days (p = 0.026, OR = 1.439), and operation type (cranial relative to spine, p < 0.001, OR = 4.344, Table 4). CONCLUSIONS Based on the NSQIP database, risk factors for respiratory failure after neurosurgery include pre-operative ventilator dependence, alcohol use, functional dependence prior to surgery, stroke, and recent operation. The overall rate of respiratory failure decreased from 4.1 % in 2006 to 2.1 % in 2013 according to these data.
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Predictors of Stroke and Coma After Neurosurgery: An ACS-NSQIP Analysis. World Neurosurg 2016; 93:299-305. [DOI: 10.1016/j.wneu.2016.06.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/03/2016] [Accepted: 06/06/2016] [Indexed: 11/18/2022]
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