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Rahman RK, Ginalis EE, Patel Y, San A, Kotrike S, Gajjar AA, Ghani H, Rahman MM. Enhanced recovery after surgery (ERAS) for craniotomies in the treatment of brain tumors: A systematic review. Neurochirurgie 2023; 69:101442. [PMID: 37062467 DOI: 10.1016/j.neuchi.2023.101442] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/30/2023] [Accepted: 04/08/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION Postoperative complications after craniotomy for brain tumors include pain, nausea/vomiting, and infection. A standardized enhanced recovery after surgery (ERAS) protocol is not widely accepted for this common neurosurgical procedure. Few studies have explored its application. METHODS A literature search of PubMed, Cochrane, and Google Scholar databases was performed between January 1992 and March 2023. Original studies that implemented an ERAS protocol for patients that underwent craniotomy for brain tumors were included. The following variables were evaluated: hospital length of stay (LOS), postoperative pain, postoperative nausea and vomiting (PONV) prophylaxis, non-opioid analgesia, and quality of life (QOL). RESULTS Twelve studies with a total of 1309 patients met inclusion criteria, including ten randomized controlled trials, one nonrandomized controlled trial, and one quality control study. Most frequently assessed metrics included hospital LOS, PONV prophylaxis, and non-opioid analgesia. A significant reduction in postoperative LOS was observed in 7 studies with ERAS or ERAS components. ERAS was significantly associated with pain reduction on the visual analog scale and verbal numerical rating scale (n=8). Non-opioid analgesia in ERAS improved postoperative pain control (n=4) and decreased the duration of pain (n=1). Three of six studies found no difference in PONV in ERAS vs. control. No studies reported an increase in postoperative complications using ERAS vs. control. One study showed greater patient satisfaction at 30-day follow-up with improved QOL. CONCLUSION Implementing ERAS protocol may enhance outcomes and quality of life in patients with moderate evidence for improved recovery in those undergoing craniotomy for brain tumors.
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Affiliation(s)
- Raphia K Rahman
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA.
| | - Elizabeth E Ginalis
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Yash Patel
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Ali San
- Kansas City University College of Osteopathic Medicine, Kansas City, MO, USA
| | | | - Avi A Gajjar
- Department of Chemistry, Union College, Schenectady, NY, USA
| | - Hira Ghani
- New York Institute of Technology College of Osteopathic Medicine, Glen Head, NY, USA
| | - Md Moshiur Rahman
- Department of Neurosurgery, Holy Family Red Crescent Medical College, Dhaka, Bangladesh
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2
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Blumenfeld A, Sang HI, Baird R, Brenden M, Bjordahl P. 79 is the new 70: Left digit bias in craniotomy. Am J Surg 2022; 224:1442-1444. [PMID: 36283882 DOI: 10.1016/j.amjsurg.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/31/2022] [Accepted: 10/05/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Left digit bias is the psychological phenomenon in which the difference between values is perceived as larger due to the value of the first digit. For example, an 80 year old may be perceived as much older than a 79 year old. We sought to determine if left digit bias is present in craniotomy for elderly patients with traumatic brain injury. METHODS Patients aged 69, 70, 79, and 80 with traumatic brain injury and an abbreviated injury scale severity of a minimum of 3 were included from the National Trauma Data Bank from the years 2012-2019. 38,908 patients were included. A Chi-squared Test was performed to compare the percentage of patients undergoing craniotomy. RESULTS 79 year olds had higher craniotomy rates than 80 year olds (7.8% vs 6.4%, P < 0.001). There was no difference in craniotomy rates between 69 and 70 year olds (8.2% vs 7.8%, P < 0.2622). CONCLUSION This study suggests the presence of left digit bias in the decision to perform a craniotomy in patients aged 79 vs 80 with traumatic brain injury.
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Affiliation(s)
- Allison Blumenfeld
- University of South Dakota Sanford School of Medicine General Surgery Residency, Health Science Center, 1400 W 22nd St, Sioux Falls, SD, 57105, USA
| | - Hilla I Sang
- Sanford Research, 2301 E 60th St, Sioux Falls, South Dakota, 57104, USA
| | - Rebecca Baird
- Sanford Research, 2301 E 60th St, Sioux Falls, South Dakota, 57104, USA
| | - Misty Brenden
- Sanford USD Medical Center, 1305 W 18th St, Sioux Falls, South Dakota, 57117, USA
| | - Paul Bjordahl
- Sanford USD Medical Center, 1305 W 18th St, Sioux Falls, South Dakota, 57117, USA.
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3
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Raghib MF, Khalid MU, Imran N, Sajid MI, Abdullah UEH, Tanwir A, Enam SA. Risk Factors and Outcomes of Redo Craniotomy: A Tertiary Care Center Analysis. Cureus 2022; 14:e21440. [PMID: 35223225 PMCID: PMC8860674 DOI: 10.7759/cureus.21440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/05/2022] Open
Abstract
Background and aim Reoperation rate is defined as the percentage of patients returning to the operating room (OR) within 30 days of an initial craniotomy and undergoing a repeat (redo) craniotomy procedure. It is a key factor of quality-of-care assessments and has implications for outcomes, especially in oncological cases. Redo craniotomies are associated with improvement in neurological status and decreased mortality rate compared to non-surgical interventions but are associated with higher costs and risk of complications. It is important to gauge the indications and frequency of redo craniotomies as an index of quality of healthcare to improve patient outcomes. This study aimed to identify the indications, frequency, and outcomes of reoperation following an initial craniotomy in neurosurgical patients at a tertiary care hospital. Methods This retrospective cohort study was conducted at a tertiary care center in Pakistan and included all patients who underwent unplanned reoperation within 30 days of initial craniotomy from January 1, 2010, to December 31, 2017. Demographics, indications for index surgery as well as reoperation, and outcomes in the form of complications, neurological status, and mortality were collected from medical charts and analyzed. Results The study comprised 111 patients who underwent reoperations. Median age of the patients was 36 years (interquartile range {IQR}: 33 years). From a total of more than 1900 annual cases, the frequency of unplanned reoperations was 3.5%. The most common indication of unplanned reoperation based on MRI/CT was hemorrhage (40%, subdural hemorrhage was most common), followed by hydrocephalus (22%), cerebral edema (13%), and residual tumor (13%). The most common clinical reason for unplanned reoperation was a drop in Glasgow Coma Scale (GCS) (59%), whereas anisocoria was seen in 10.8% of patients. The highest mortality rate was observed in patients who were reoperated from post-operative day two to post-operative day seven (56%). Hypertension (p=0.014) and thrombocytopenia (p<0.001) showed significant associations with developing intracranial hemorrhage. Seventy-eight percent of patients showed significant improvement in their Karnofsky Performance Score (KPS) whereas 22% showed deterioration in their KPS. Conclusion The delivery of consistent quality healthcare relies on early detection and intervention in at-risk patients. Our center’s reoperation rate is consistent with the average range among other centers globally. Hypertension, anticoagulation, and antiplatelet therapy were common risk factors for redo craniotomies within 30 days. Patients with these conditions need special care to prevent returns to the operating room. Patients also need to be monitored for hemorrhage in the short term (one to two days) and hydrocephalus in the long term (two to 30 days) to intervene early if needed.
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4
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Haddad AF, DiGiorgio AM, Lee YM, Lee AT, Burke JF, Huang MC, Dhall SS, Manley GT, Tarapore PE. The Morbidity and Mortality of Surgery for Traumatic Brain Injury in Geriatric Patients: A Study of Over 100 000 Patient Cases. Neurosurgery 2021; 89:1062-1070. [PMID: 34624082 DOI: 10.1093/neuros/nyab359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 07/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Geriatric patients have the highest rates of Traumatic Brain Injury (TBI)-related hospitalization and death. This contributes to an assumption of futility in aggressive management in this population. OBJECTIVE To evaluate the effect of surgical intervention on the morbidity and mortality of geriatric patients with TBI. METHODS A retrospective analysis of patients ≥80 yr old with TBI from 2003 to 2016 was performed using the National Trauma Data Bank. Univariate and multivariate analyses were performed to compare outcomes between surgery and nonsurgery groups. RESULTS A total of 127 129 patient incidents were included: 121 185 (95.3%) without surgery and 5944 (4.7%) with surgery. The surgical group was slightly younger (84.0 vs 84.3, P < .001) and predominantly male (60.2% vs 44.4%, P < .001). Mean emergency department (ED) Glasgow Coma Scale (GCS) was lower in surgical patients (12.4 vs 13.7, P < .001). Complications (OR = 1.91, CI:1.80-2.02, P < .001) and hospital length of stay (LOS, ß = 5.25, CI:5.08-5.42, P < .001) were independently associated with surgery. Intensive care unit (ICU) LOS (ß = 3.19, CI:3.05-3.34, P < .001), ventilator days (ß = 1.57, CI:1.22-1.92, P < .001), and reduced discharge home (OR = 0.434, CI:0.400-0.470, P < .001) were also independently associated with surgery. However, surgery was not independently associated with mortality on multivariate analysis (OR = 1.03, CI:0.955-1.12, P = .423). Recursive partitioning analysis identified ED GCS and injury severity score (ISS) as prognosticators of mortality following surgical intervention. CONCLUSION Surgical treatment of geriatric patients with TBI is associated with increased complications, hospital LOS, ICU LOS, and ventilator days as well as reduced discharge to home. However, surgery is not associated with increased mortality. ISS and ED GCS are prognosticators of mortality following surgical intervention.
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Affiliation(s)
- Alexander F Haddad
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA
| | - Anthony M DiGiorgio
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA
| | - Young M Lee
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA
| | - Anthony T Lee
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA
| | - John F Burke
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA
| | - Michael C Huang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA
| | - Sanjay S Dhall
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA
| | - Phiroz E Tarapore
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.,Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California, USA
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Sharma S, Bansal H, Singh J, Chaudhary A. Outcome and its predictors in traumatic brain injury in elderly population: Institutional study from Northern India. J Family Med Prim Care 2021; 10:289-294. [PMID: 34017742 PMCID: PMC8132831 DOI: 10.4103/jfmpc.jfmpc_1559_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/29/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Survival and functional outcome is significantly poor in the elderly population. There is a need to develop better geriatric specific prognostic models and evidence-based geriatric traumatic brain injury management protocols for better treatment, rehabilitation, and prevention. Aims and objectives: To study the frequency, outcome and correlates of traumatic brain injury in elderly patients. Material and Methods: Frequency, outcome and correlates of traumatic brain injury in patients more than 65 years of age admitted in tertiary care hospital were studied in 160 patients admitted between 1st January 2016 and 31st December 2016 (retrospective analysis) and between 1st January 2017 and 30th June 2018 (prospective analysis). Institutional ethical committee approval was taken. Results: This study concluded that road side accident was the most common cause of traumatic brain injury in elderly in this study. Incidence of traumatic brain injury in elderly was found to be 11.45%. Both non-reacting pupils and low Glasgow coma scale on arrival were significantly associated with poor outcome in terms of mortality. Most of the patients who expired or were discharged against medical advice had associated skull bone fractures, cerebral infarct, diffuse brain edema, subarachnoid hemorrhage, midline shift, lower hemaglobin, higher random blood sugar and higher creatinine as compared to patients who were discharged. All these findings were statistically significant. Conclusion: Low Glasgow coma scale on arrival, non reacting pupils, low hemoglobin, high random blood sugar, high creatinine and intubation on arrival are associated with increased mortality. Associated skull bone fractures, cerebral infarct, diffuse brain edema are predictors of poor outcome. Anticoagulants and associated co-morbidities do not increase the risk of mortality in traumatic brain injury in elderly.
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Affiliation(s)
- Saurabh Sharma
- Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Hanish Bansal
- Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Jagminder Singh
- Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ashwani Chaudhary
- Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Aromatario M, Torsello A, D’Errico S, Bertozzi G, Sessa F, Cipolloni L, Baldari B. Traumatic Epidural and Subdural Hematoma: Epidemiology, Outcome, and Dating. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57020125. [PMID: 33535407 PMCID: PMC7912597 DOI: 10.3390/medicina57020125] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 04/09/2023]
Abstract
Epidural hematomas (EDHs) and subdural hematomas (SDHs), or so-called extra-axial bleedings, are common clinical entities after a traumatic brain injury (TBI). A forensic pathologist often analyzes cases of traumatic EDHs or SDHs due to road accidents, suicides, homicides, assaults, domestic or on-the-job accidents, and even in a medical responsibility scenario. The aim of this review is to give an overview of the published data in the medical literature, useful to forensic pathologists. We mainly focused on the data from the last 15 years, and considered the most updated protocols and diagnostic-therapeutic tools. This study reviews the epidemiology, outcome, and dating of extra-axial hematomas in the adult population; studies on the controversial interdural hematoma are also included.
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Affiliation(s)
| | - Alessandra Torsello
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D’Avanzo, Via degli Aviatori 1, 71100 Foggia, Italy; (A.T.); (F.S.); (L.C.)
| | - Stefano D’Errico
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy;
| | - Giuseppe Bertozzi
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D’Avanzo, Via degli Aviatori 1, 71100 Foggia, Italy; (A.T.); (F.S.); (L.C.)
- Correspondence:
| | - Francesco Sessa
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D’Avanzo, Via degli Aviatori 1, 71100 Foggia, Italy; (A.T.); (F.S.); (L.C.)
| | - Luigi Cipolloni
- Section of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Ospedale Colonnello D’Avanzo, Via degli Aviatori 1, 71100 Foggia, Italy; (A.T.); (F.S.); (L.C.)
| | - Benedetta Baldari
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, 00186 Rome, Italy;
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Lau D, Dalle Ore CL, Tarapore PE, Huang M, Manley G, Singh V, Mummaneni PV, Beattie M, Bresnahan J, Ferguson AR, Talbott JF, Whetstone W, Dhall SS. Value of aggressive surgical and intensive care unit in elderly patients with traumatic spinal cord injury. Neurosurg Focus 2020; 46:E3. [PMID: 30835676 DOI: 10.3171/2018.12.focus18555] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/06/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe elderly are a growing subpopulation within traumatic spinal cord injury (SCI) patients. Studies have reported high morbidity and mortality rates in elderly patients who undergo surgery for SCI. In this study, the authors compare the perioperative outcomes of surgically managed elderly SCI patients with those of a younger cohort and those reported in the literature.METHODSData on a consecutive series of adult traumatic SCI patients surgically managed at a single institution in the period from 2007 to 2017 were retrospectively reviewed. The cohort was divided into two groups based on age: younger than 70 years and 70 years or older. Assessed outcomes included complications, in-hospital mortality, intensive care unit (ICU) stay, hospital length of stay (LOS), disposition, and neurological status.RESULTSA total of 106 patients were included in the study: 83 young and 23 elderly. The two groups were similar in terms of imaging features (cord hemorrhage and fracture), operative technique, and American Spinal Injury Association Impairment Scale (AIS) grade. The elderly had a significantly higher proportion of cervical SCIs (95.7% vs 71.1%, p = 0.047). There were no significant differences between the young and the elderly in terms of the ICU stay (13.1 vs 13.3 days, respectively, p = 0.948) and hospital LOS (23.3 vs 21.7 days, p = 0.793). Elderly patients experienced significantly higher complication (73.9% vs 43.4%, p = 0.010) and mortality (13.0% vs 1.2%, p = 0.008) rates; in other words, the elderly patients had 1.7 times and 10.8 times the rate of complications and mortality, respectively, than the younger patients. No elderly patients were discharged home (0.0% vs 18.1%, p = 0.029). Discharge AIS grade and AIS grade change were similar between the groups.CONCLUSIONSElderly patients had higher complication and mortality rates than those in younger patients and were less likely to be discharged home. However, it does seem that mortality rates have improved compared to those in prior historical reports.
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Affiliation(s)
| | | | - Phiroz E Tarapore
- Departments of1Neurological Surgery.,2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California
| | - Michael Huang
- Departments of1Neurological Surgery.,2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California
| | | | - Vineeta Singh
- 2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California.,4Neurology
| | | | - Michael Beattie
- 2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California
| | - Jacqueline Bresnahan
- 2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California
| | - Adam R Ferguson
- 2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California
| | - Jason F Talbott
- 2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California.,5Radiology, and
| | - William Whetstone
- 3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California.,6Emergency Medicine
| | - Sanjay S Dhall
- Departments of1Neurological Surgery.,2San Francisco General Hospital; and.,3TRACK-SCI, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, California
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8
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Dharia A, Lacci JV, Gupte N, Seifi A. Multiple significant trauma with craniotomy: What impacts mortality? Clin Neurol Neurosurg 2019; 186:105448. [DOI: 10.1016/j.clineuro.2019.105448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/19/2019] [Accepted: 07/15/2019] [Indexed: 11/30/2022]
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Brown E, Tohira H, Bailey P, Fatovich D, Pereira G, Finn J. A comparison of major trauma patient transport destination in metropolitan Perth, Western Australia. Australas Emerg Care 2019; 23:90-96. [PMID: 31668941 DOI: 10.1016/j.auec.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/25/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite evidence of a lower risk of death, major trauma patients are not always transported to Trauma Centres. This study examines the characteristics and outcomes of major trauma patients between transport destinations. METHODS A retrospective cohort study of major trauma patients (Injury Severity Score >15) transported by ambulance was undertaken. Cases were divided into transport destination groups: (1) Direct, those transported to the Trauma Centre directly from the scene; (2) Indirect, those transported to another hospital prior to Trauma Centre transfer and (3) Non-transfers, those transported to a non-Trauma Centre and never subsequently transferred. Median and interquartile range (IQR) were used to describe the groups and differences were assessed using the Kruskal-Wallis test for continuous variables and Pearson chi-square for categorical. RESULTS A total of 1625 patients were included. The median age was oldest in the non-transfers cohort (72 years IQR 46-84). This group had the highest proportion of falls from standing and head injuries (n = 298/400, 75%, p < 0.001). The non-transfers had the highest proportion of 30-day mortality (n = 134/400, 34%). CONCLUSIONS There were significant differences between the groups with older adults, falls and head injuries over-represented in the non-transfer group. Considering the ageing population, trauma systems will need to adapt.
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Affiliation(s)
- Elizabeth Brown
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA 6845, Australia; St John Western Australia, 209 Great Eastern Hwy, Bentley, WA, Australia.
| | - Hideo Tohira
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA 6845, Australia; Division of Emergency Medicine, The University of Western Australia, Bentley, WA, Australia.
| | - Paul Bailey
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA 6845, Australia; St John Western Australia, 209 Great Eastern Hwy, Bentley, WA, Australia.
| | - Daniel Fatovich
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA 6845, Australia; Emergency Medicine, Royal Perth Hospital, University of Western Australia, Bentley, WA, Australia; Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, WA, Australia.
| | - Gavin Pereira
- School of Public Health, Curtin University, Bentley, WA, Australia; Telethon Kids Institute, WA, Australia.
| | - Judith Finn
- Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA 6845, Australia; St John Western Australia, 209 Great Eastern Hwy, Bentley, WA, Australia; Division of Emergency Medicine, The University of Western Australia, Bentley, WA, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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10
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Bah AB, Souaré IS, Diawara S, Boubane D, Saran KO. [Surgical treatment of chronic subdural hematoma in Guinea: Analysis of 22 cases at the Kipe hospital of Conakry]. Neurochirurgie 2019; 65:83-88. [PMID: 30953620 DOI: 10.1016/j.neuchi.2019.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 03/06/2019] [Accepted: 03/20/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We report the results of surgical treatment of chronic subdural hematoma in the Kipe Hospital in Conakry, Guinea, for the period July 2012 to November 2015. MATERIAL AND METHOD Clinical, radiological and therapeutic data from 22 cases were collected retrospectively and analyzed, with a mean follow-up of 61.6 days. Univariate analysis screened for factors for neurological outcome on the Markwalder Grading Scale (MGS; 0=normal to 4=coma). RESULTS Male-female sex ratio was 2.6:1. Mean age at diagnosis was 71.09±8 years, with peak incidence of CSDH in the 60-79 age group. Traumatic brain injury was identified as causal in 40.9% of cases. Burrhole trepanation was used in 86.36% of cases, under local anesthesia in 76%, and with postoperative drainage in all cases. No recurrences were recorded. At follow-up, mean postoperative MGS was 0.59 (up from 3.08 preoperatively); 54.54% of patients had normal neurological examination (grade 0). Age 60-79 years, time to diagnosis>12 weeks and preoperative MGS≥3 had significant negative impact on outcome (respective P-values: 0.03, 0.001, 0.001). CONCLUSION Our data were similar to those of the literature, but with longer time to diagnosis and poorer initial clinical status, with negative impact on clinical progression.
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Affiliation(s)
- A B Bah
- Service de neurochirurgie, hôpital de l'amitié sino-guinéenne de Kipé, Conakry, Guinée; Service de chirurgie générale, CHU Ignace Deen, Kaloum, Conakry, Guinée.
| | - I S Souaré
- Service de neurochirurgie, hôpital de l'amitié sino-guinéenne de Kipé, Conakry, Guinée
| | - S Diawara
- Service de neurochirurgie, hôpital de l'amitié sino-guinéenne de Kipé, Conakry, Guinée; Service de neurochirurgie, CHU Donka, Donka, Conakry, Guinée
| | - D Boubane
- Service de neurochirurgie, hôpital de l'amitié sino-guinéenne de Kipé, Conakry, Guinée
| | - K O Saran
- Service de neurochirurgie, hôpital de l'amitié sino-guinéenne de Kipé, Conakry, Guinée
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Lau D, Osorio JA, Deviren V, Ames CP. The relationship of older age and perioperative outcomes following thoracolumbar three-column osteotomy for adult spinal deformity: an analysis of 300 consecutive cases. J Neurosurg Spine 2018; 28:593-606. [PMID: 29624129 DOI: 10.3171/2017.10.spine17374] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Three-column osteotomies are increasingly being used in the elderly population to correct rigid spinal deformities. There is hesitation, however, in performing the technique in older patients because of the high risk for blood loss, longer operative times, and complications. This study assesses whether age alone is an independent risk factor for complications and length of stay. METHODS All patients with thoracolumbar adult spinal deformity (ASD) who underwent 3-column osteotomy (vertebral column resection or pedicle subtraction osteotomy) performed by the senior author from 2006 to 2016 were identified. Demographics, clinical baseline, and surgical details were collected. Outcomes of interest included perioperative complication, ICU stay, and hospital stay. Bivariate and multivariate analyses were used to assess the association of age with outcomes of interest. RESULTS A total of 300 patients were included, and 38.3% were male. The mean age was 63.7 years: 10.3% of patients were younger than 50 years, 36.0% were 50-64 years, 45.7% were 65-79 years, and 8.0% were 80 years or older. The overall mean EBL was 1999 ml. The overall perioperative complication rate was 24.7%: 18.0% had a medical complication and 7.0% had a surgical complication. There were no perioperative or 30-day deaths. Age was associated with overall complications (p = 0.002) and medical-specific complications (p < 0.001); there were higher rates of overall and medical complications with increased age: 9.7% and 6.5%, respectively, for patients younger than 50 years; 16.7% and 10.2%, respectively, for patients 50-64 years; 31.4% and 22.6%, respectively, for patients 65-79 years; and 41.7% and 41.7%, respectively, for patients 80 years or older. However, after adjusting for relevant covariates on multivariate analysis, age was not an independent factor for perioperative complications. Surgical complication rates were similar among the 4 age groups. Longer ICU and total hospital stays were observed in older age groups, and age was an independent factor associated with longer ICU stay (p = 0.028) and total hospital stay (p = 0.003). ICU stays among the 4 age groups were 1.6, 2.3, 2.0, and 3.2 days for patients younger than 50 years, 50-64 years, 65-79 years, and 80 years or older, respectively. The total hospital stays stratified by age were 7.3, 7.7, 8.2, and 11.0 days for patients younger than 50 years, 50-64 years, 65-79 years, and 80 years or older, respectively. CONCLUSIONS Older age was associated with higher perioperative complication rates, but age alone was not an independent risk factor for complications following the 3-column osteotomy for ASD. Comorbidities and other unknown variables that come with age are likely what put these patients at higher risk for complications. Older age, however, is independently associated with longer ICU and hospital stays.
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Affiliation(s)
| | | | - Vedat Deviren
- 2Orthopedic Surgery, University of California, San Francisco, California
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12
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Sumiyoshi K, Hayakawa T, Yatsushige H, Shigeta K, Momose T, Enomoto M, Sato S, Takasato Y. Outcome of traumatic brain injury in patients on antiplatelet agents: a retrospective 20-year observational study in a single neurosurgery unit. Brain Inj 2017; 31:1445-1454. [DOI: 10.1080/02699052.2017.1377349] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Kyoko Sumiyoshi
- Division of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan
| | - Takanori Hayakawa
- Division of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan
| | - Hiroshi Yatsushige
- Division of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan
| | - Keigo Shigeta
- Division of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan
| | - Toshiya Momose
- Division of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan
| | - Masaya Enomoto
- Division of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan
| | - Shin Sato
- Division of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan
| | - Yoshio Takasato
- Division of Neurosurgery, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, Japan
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13
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Bernotas G, Simaitis K, Bunevičius A, Tamašauskas A. Safety and efficacy of stereotactic aspiration with fibrinolysis for deep-seated spontaneous intracerebral hemorrhages: A single-center experience. MEDICINA-LITHUANIA 2017; 53:303-309. [PMID: 28838850 DOI: 10.1016/j.medici.2017.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 06/26/2017] [Accepted: 07/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate feasibility and safety of stereotactic aspiration with fibrinolysis of deep-seated intracerebral hemorrhages (ICH). MATERIALS AND METHODS From March 1995 until December 2016, 58 adult patients (34 men and 24 women; mean age of 56.8±11.8 years) presenting with deep-seated spontaneous supratentorial ICH were treated using a minimally invasive technique. Intracerebral hematomas were aspirated until obvious resistance to free-hand suction and subsequent clot fibrinolysis was done using either streptokinase or recombinant tissue-type plasminogen activator. CT scans were performed at intervals ranging from 24 to 72h. At discharge, functional outcomes were evaluated using the Glasgow outcome scale (GOS). The 30-day mortality rate was evaluated in all patients. RESULTS The average ICH volume on initial CT scan was 34.7±11.1cm3 (range, 20-90cm3). Mean residual hematoma volume after the treatment was 8.0±5.1cm3 (range, 3-32cm3). There was statistically significant reduction of ICH volume after the treatment (P<0.001). Median ICH reduction rate was 5cm3/d (range, 1.5-16.0cm3/d) and 17.2%/d (range, 5.27-40.0%/d). Median discharge GOS score was 3 (range, 1-4). Six (10.9%) patients died during the 30-day follow-up period. Treatment related complications were observed in three (5.5%) patients. In two patients asymptomatic increase of ICH volume occurred and one patient was diagnosed with CNS infection. CONCLUSIONS Stereotactic clot aspiration with subsequent fibrinolytic therapy is safe and feasible treatment procedure associated with significant hematoma resolution rates and acceptable patient outcomes.
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Affiliation(s)
- Giedrimantas Bernotas
- Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Karolis Simaitis
- Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Adomas Bunevičius
- Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Arimantas Tamašauskas
- Neuroscience Institute, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Freire-Aragón MD, Rodríguez-Rodríguez A, Egea-Guerrero JJ. Update in mild traumatic brain injury. Med Clin (Barc) 2017; 149:122-127. [PMID: 28571951 DOI: 10.1016/j.medcli.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 05/01/2017] [Indexed: 01/15/2023]
Abstract
There has been concern for many years regarding the identification of patients with mild traumatic brain injury (TBI) at high risk of developing an intracranial lesion (IL) that would require neurosurgical intervention. The small percentage of patients with these characteristics and the exceptional mortality associated with mild TBI with IL have led to the high use of resources such as computerised tomography (CT) being reconsidered. The various protocols developed for the management of mild TBI are based on the identification of risk factors for IL, which ultimately allows more selective indication or discarding both the CT application and the hospital stay for neurological monitoring. Finally, progress in the study of brain injury biomarkers with prognostic utility in different clinical categories of TBI has recently been incorporated by several clinical practice guidelines, which has allowed, together with clinical assessment, a more accurate prognostic approach for these patients to be established.
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Li LF, Lui WM, Wong HHT, Yuen WK, Leung GKK. Outcome after operative intervention for traumatic brain injuries in the elderly. Asian J Neurosurg 2017; 12:37-43. [PMID: 28413530 PMCID: PMC5379801 DOI: 10.4103/1793-5482.148787] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The management of traumatic brain injuries in the elderly (age ≥ 65 years) is a constant dilemma. The aim of this study is to investigate for factors that may predict outcome of operative treatment in this group of patients. MATERIALS AND METHODS A retrospective analysis was conducted on 68 elderly patients who had been operated in a designated center from 2006 to 2010. Patients' age, Glasgow Coma score (GCS), pupillary responses, imaging findings, medical conditions, and the use of anticoagulant/antiplatelet agents on patient outcomes were studied. RESULTS The overall mortality rate was 55.9%. Older age, abnormal pupillary response, low GCS, the presence of midline shift and cistern obliteration on computerized tomography were associated with poor survival. Patient aged 75-84 with normal bilateral pupillary response still had an overall survival rate of 52.6% and good outcomes (Glasgow outcome score: 4 or 5) in 36.8% of patients. Abnormal pupillary response in at least one eye and preoperative GCS ≤ 12 were associated with very poor prognosis. CONCLUSIONS More advanced age was found to be associated with progressively worse outcome. A subgroup patients aged below 85 would survive and could achieve good clinical outcome. The prognosis of those aged over 85 with moderate or severe head injuries was extremely poor.
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Affiliation(s)
- Lai-Fung Li
- Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Wai-Man Lui
- Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Heidi Hay-Tai Wong
- Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Wai-Kei Yuen
- Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Gilberto Ka-Kit Leung
- Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Abstract
Aim Major trauma (MT) has traditionally been viewed as a disease of young men caused by high-energy transfer mechanisms of injury, which has been reflected in the configuration of MT services. With ageing populations in Western societies, it is anticipated that the elderly will comprise an increasing proportion of the MT workload. The aim of this study was to describe changes in the demographics of MT in a developed Western health system over the last 20 years. Methods The Trauma Audit Research Network (TARN) database was interrogated to identify all cases of MT (injury severity score >15) between 1990 and the end of 2013. Age at presentation, gender, mechanism of injury and use of CT were recorded. For convenience, cases were categorised by age groups of 25 years and by common mechanisms of injury. Longitudinal changes each year were recorded. Results Profound changes in the demographics of recorded MT were observed. In 1990, the mean age of MT patients within the TARN database was 36.1, the largest age group suffering MT was 0–24 years (39.3%), the most common causative mechanism was road traffic collision (59.1%), 72.7% were male and 33.6% underwent CT. By 2013, mean age had increased to 53.8 years, the single largest age group was 25–50 years (27.1%), closely followed by those >75 years (26.9%), the most common mechanism was low falls (39.1%), 68.3% were male and 86.8% underwent CT. Conclusions This study suggests that the MT population identified in the UK is becoming more elderly, and the predominant mechanism that precipitates MT is a fall from <2 m. Significant improvements in outcomes from MT may be expected if services targeting the specific needs of the elderly are developed within MT centres.
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Affiliation(s)
- A Kehoe
- Emergency Department, Derriford Hospital, Plymouth, UK Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - J E Smith
- Emergency Department, Derriford Hospital, Plymouth, UK Centre for Clinical Trials and Population Studies, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Medical Directorate, Birmingham, UK
| | - A Edwards
- Trauma Audit Research Network (TARN), University of Manchester, Hope Hospital, Salford, UK
| | - D Yates
- Trauma Audit Research Network (TARN), University of Manchester, Hope Hospital, Salford, UK
| | - F Lecky
- Trauma Audit Research Network (TARN), University of Manchester, Hope Hospital, Salford, UK EMRiS Group, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Kehoe A, Smith JE, Bouamra O, Edwards A, Yates D, Lecky F. Older patients with traumatic brain injury present with a higher GCS score than younger patients for a given severity of injury. Emerg Med J 2016; 33:381-5. [DOI: 10.1136/emermed-2015-205180] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 12/29/2015] [Indexed: 11/03/2022]
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18
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Lee L, Ker J, Ng HY, Munusamy T, King NKK, Kumar D, Ng WH. Outcomes of chronic subdural hematoma drainage in nonagenarians and centenarians: a multicenter study. J Neurosurg 2015; 124:546-51. [PMID: 26162032 DOI: 10.3171/2014.12.jns142053] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chronic subdural hemorrhage (SDH) or hematoma is a condition that affects elderly individuals. With advances in medical care, the number of nonagenarians and centenarians will increase. However, surgical treatments in this age group are associated with high rates of morbidity and mortality. Because no data are available on the rates of survival among elderly patients with chronic SDHs who undergo surgical drainage or receive only conservative care, the goal of this study was to determine survival rates in patients 90 years of age or older with symptomatic chronic SDHs. METHODS The authors conducted a retrospective analysis of patient data that were collected at 3 hospitals over a 13-year period (from January 2001 to June 2013). The data from patients 90 years or older with symptomatic chronic SDHs and who were offered surgical treatment were included in the analysis. Patients who underwent surgical treatment were included in the surgical group and patients who declined an operation were included in the conservative care group. The patients' Charlson Comorbidity Index score, Karnofsky Performance Scale score, dates of death, presenting symptoms, Glasgow Coma Scale score, length of stay in the hospital, discharge location, side of the SDH, and neurological improvements at 30-day and 6-month follow-ups were recorded. Data were statistically analyzed with Fisher exact test, Kaplan-Meier curves, and logistic regression. RESULTS In total, 101 patients met the inclusion criteria of this study; 70 of these patients underwent surgical drainage, and 31 received conservative care. Patients in the surgical group had statistically significantly (p < 0.001) higher survival at both the 30-day and 6-month follow-ups, with 92.9% and 81.4% of the patients in this group surviving for at least 30 days and 6 months, respectively, versus 58.1% and 41.9%, respectively, in the conservative care group. Moreover, the mean overall length of survival of 34.4 ± 28.7 months was longer in the surgical group than it was in the conservative care group (11.3 ± 16.6 months). Overall, 95.7% of patients in the surgical group exhibited an improvement in neurological status after the SDH drainage, whereas none of the patients in the conservative care group showed any neurological improvement during their hospital stay. The surgical complication rate was 11.4%, and the overall rate of chronic SDH recurrence after surgery was 12.9%. CONCLUSIONS Surgical drainage of chronic SDHs in nonagenarians and centenarians is associated with lower incidence of inpatient death and higher 30-day and 6-month survival rates.
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Affiliation(s)
- Lester Lee
- Department of Neurosurgery, National Neuroscience Institute, Tan Tock Seng Hospital;,Department of Neurosurgery, Singapore General Hospital; and.,Division of Neurosurgery, National Neuroscience Institute, Changi General Hospital, Singapore
| | - Justin Ker
- Division of Neurosurgery, National Neuroscience Institute, Changi General Hospital, Singapore
| | - Hui Yu Ng
- Division of Neurosurgery, National Neuroscience Institute, Changi General Hospital, Singapore
| | | | - Nicolas Kon Kam King
- Department of Neurosurgery, National Neuroscience Institute, Tan Tock Seng Hospital;,Department of Neurosurgery, Singapore General Hospital; and
| | - Dinesh Kumar
- Department of Neurosurgery, National Neuroscience Institute, Tan Tock Seng Hospital;,Department of Neurosurgery, Singapore General Hospital; and.,Division of Neurosurgery, National Neuroscience Institute, Changi General Hospital, Singapore
| | - Wai Hoe Ng
- Department of Neurosurgery, National Neuroscience Institute, Tan Tock Seng Hospital;,Department of Neurosurgery, Singapore General Hospital; and.,Division of Neurosurgery, National Neuroscience Institute, Changi General Hospital, Singapore
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Zheng XR, Chen T, Yang YF, Rao W, Wang GY, Zhang SH, Fei Z. Unplanned Reoperations in Neurosurgical Patients Due to Postoperative Bleeding: A Single-Center Experience and Literature Review. Medicine (Baltimore) 2015; 94:e739. [PMID: 26061301 PMCID: PMC4616491 DOI: 10.1097/md.0000000000000739] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study is to investigate the incidence of unplanned reoperations from all causes due to bleeding in neurosurgical patients. The medical records of patients who received neurosurgical procedures at our hospital were retrospectively reviewed and data of patients who received reoperations were extracted and summarized. A literature review was conducted of the Medline, Cochrane, EMBASE, and Google Scholar databases up to November 2013. The main outcome measure was the rate of unplanned reoperations due to bleeding. At our hospital, 68 patients with a mean age of 41.5 ± 21.5 years (range, 7 months to 76 years) received an unplanned reoperation. More than 70% of the patients were older than 18 years, 64.7% were males, and 94.1% had cranial surgery. Almost 60% of the patients received >1 blood transfusion (58.8%) after the first surgery. Of the 68 patients, 35 (51.5%) received a second operation due to bleeding. Univariate logistic regression analysis only showed that an increasing time interval between the first and second surgery was associated with a decreased chance of the reoperation being performed due to bleeding (odds ratio [OR] = 0.843, 95% confidence interval [CI]: 0.720-0.987; P = .033). Of 229 studies identified, 5 retrospective reports with a total of 1375 patients were included in the analysis. The rate of reoperations for bleeding in the 5 studies ranged from 4.2% to 31.5%. Employing measures to reduce postoperative bleeding may help reduce the rate of unplanned neurosurgical reoperations.
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Affiliation(s)
- Xin-Rui Zheng
- From the Department of Neurosurgery (X-RZ, TC, Y-FY, WR, ZF); Department of Medical affairs and training, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, PR China (G-YW, S-HZ)
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Wang WH, Hu LS, Lin H, Li J, Luo F, Huang W, Lin JM, Cai GP, Liu CC. Risk Factors for Post-Traumatic Massive Cerebral Infarction Secondary to Space-Occupying Epidural Hematoma. J Neurotrauma 2014; 31:1444-50. [PMID: 24773559 DOI: 10.1089/neu.2013.3142] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wen-hao Wang
- Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Lian-shui Hu
- Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Hong Lin
- Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Jun Li
- Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Fei Luo
- Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Wei Huang
- Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Jun-ming Lin
- Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Gen-ping Cai
- Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
| | - Chang-chun Liu
- Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou, China
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Mulligan P, Raore B, Liu S, Olson JJ. Neurological and functional outcomes of subdural hematoma evacuation in patients over 70 years of age. J Neurosci Rural Pract 2013; 4:250-6. [PMID: 24250154 PMCID: PMC3821407 DOI: 10.4103/0976-3147.118760] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Subdural hematoma (SDH) is a common disease entity treated by neurosurgical intervention. Although the incidence increases in the elderly population, there is a paucity of studies examining their surgical outcomes. OBJECTIVES To determine the neurological and functional outcomes of patients over 70 years of age undergoing surgical decompression for subdural hematoma. MATERIALS AND METHODS We retrospectively reviewed data on 45 patients above 70 years who underwent craniotomy or burr holes for acute, chronic or mixed subdural hematomas. We analyzed both neurological and functional status before and after surgery. RESULTS Forty-five patients 70 years of age or older were treated in our department during the study period. There was a significant improvement in the neurological status of patients from admission to follow up as assessed using the Markwalder grading scale (1.98 vs. 1.39; P =0.005), yet no improvement in functional outcome was observed as assessed by Glasgow Outcome Score. Forty-one patients were admitted from home, however only 20 patients (44%) were discharged home, 16 (36%) discharged to nursing home or rehab, 6 (13%) to hospice and 3 (7%) died in the postoperative period. Neurological function improved in patients who were older, had a worse pre-operative neurological status, were on anticoagulation and had chronic or mixed acute and chronic hematoma. However, no improvement in functional status was observed. CONCLUSION Surgical management of SDH in patients over 70 years of age provides significant improvement in neurological status, but does not change functional status.
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Affiliation(s)
- Patrick Mulligan
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
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22
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Lau D, Leach MR, Than KD, Ziewacz J, La Marca F, Park P. Independent predictors of complication following surgery for spinal metastasis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:1402-7. [PMID: 23392558 DOI: 10.1007/s00586-013-2706-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 01/30/2013] [Indexed: 01/10/2023]
Abstract
PURPOSE Surgery for spinal metastasis is often associated with significant morbidity. Despite a number of preoperative scoring systems/scales and identified variables that have been reported to predict complication risk, clinical studies that directly evaluate this issue using multivariate analysis are scarce. The goal of our study was to assess independent predictors of complication after surgery for spinal metastasis. METHODS We queried electronic medical records to identify a consecutive population of adult patients who underwent surgery for spinal metastasis for the period June 2005 through June 2011. Utilizing multivariate logistic regression, we assessed independent predictors of perioperative and postoperative adverse events. RESULTS A total of 106 patients were included in the final analysis. Overall complication rate was 21.7 %. Independent predictors for higher rates of complication were age greater than 40 years [40-65 years had odds ratio (OR) 1.91, 95 % confidence interval (CI) 1.02-16.78 and >65 years had OR 5.17, 95 % CI 1.54-29.81] and metastatic lesions involving three or more contiguous levels of the spine (OR 2.76, 95 % CI 1.09-9.61). CONCLUSIONS Patients older than 40 years or patients who have metastatic lesions involving three or more contiguous vertebral levels appear to be at higher risk for complication. Patients older than 65 years have the greatest likelihood of complication.
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Affiliation(s)
- Darryl Lau
- University of Michigan Medical School, Ann Arbor, MI, USA
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Lang SS, Kofke WA, Stiefel MF. Monitoring and intraoperative management of elevated intracranial pressure and decompressive craniectomy. Anesthesiol Clin 2012; 30:289-310. [PMID: 22901611 DOI: 10.1016/j.anclin.2012.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Elevated intracranial pressure can be caused by a variety of underlying conditions. Several physiologic and pharmacologic factors have a significant impact on intracranial hypertension, mostly caused by changes on cerebral blood volume, flow, and oxygenation. There are many therapies that can be used to decrease intracranial pressure ranging from pharmacologic to the surgical decompressive removal of the calvarium. Special consideration is made for the anesthetic management of these patients perioperatively.
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Affiliation(s)
- Shih-Shan Lang
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Mak CHK, Wong SKH, Wong GK, Ng S, Wang KKW, Lam PK, Poon WS. Traumatic Brain Injury in the Elderly: Is it as Bad as we Think? CURRENT TRANSLATIONAL GERIATRICS AND EXPERIMENTAL GERONTOLOGY REPORTS 2012; 1:171-178. [PMID: 24014175 PMCID: PMC3758513 DOI: 10.1007/s13670-012-0017-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Traumatic brain injury in elderly patients is a neglected global disease burden. The main cause is fall, followed by motor vehicle accidents. This review article summarizes different aspects of geriatric traumatic brain injury, including epidemiology, pathology, and effects of comorbidities and pre-injury medications such as antiplatelets and anticoagulants. Functional outcome with or without surgical intervention, cognitive outcome, and psychiatric complications are discussed. Animal models are also reviewed in attempt to explain the relationship of aging and outcome, together with advances in stem cell research. Though elderly people in general did fare worse after traumatic brain injury, certain "younger elderly" people, aged 65-75 years, could have a comparable outcome to younger adults after minor to moderate head injury.
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Affiliation(s)
- Calvin H. K. Mak
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Stephen K. H. Wong
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - George K. Wong
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Stephanie Ng
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Kevin K. W. Wang
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
- Center for Neuroproteomics and Biomarkers Research, The Department of Psychiatry and Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL 32611 USA
| | - Ping Kuen Lam
- Chow Tai Fook-Cheung Yu Tung Surgical Stem Cell Research Center, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Wai Sang Poon
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Walcott BP, Nahed BV, Sheth SA, Yanamadala V, Caracci JR, Asaad WF. Bilateral hemicraniectomy in non-penetrating traumatic brain injury. J Neurotrauma 2012; 29:1879-85. [PMID: 22452418 DOI: 10.1089/neu.2012.2382] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traumatic brain injury is a heterogeneous entity that encompasses both surgical and non-surgical conditions. Surgery may be indicated with traumatic lesions such as hemorrhage, fractures, or malignant cerebral edema. However, the neurological exam may be clouded by the effects of medications administered in the field, systemic injuries, and inaccuracies in hyperacute prognostication. Typically, neurological injury is considered irreversible if diffuse loss of grey/white matter differentiation or if brainstem hemorrhage (Duret hemorrhage) exists. We aim to characterize a cohort of patients undergoing bilateral hemicraniectomy for severe traumatic brain injury. A retrospective consecutive cohort of adult patients undergoing craniectomy for trauma was established between the dates of January 2008 and November 2011. The primary outcome of the study was in-hospital mortality. Secondary outcomes were ICU length of stay, surgical complications, and Glasgow Outcome Score at most recent follow-up. During the study period, 210 patients undergoing craniectomy for traumatic mass-occupying lesion (epidural hematoma, subdural hematoma, or parenchymal contusion) were analyzed. Of those, 9 met study criteria. In-hospital mortality was 67% (6 of 9 patients). The average ICU length of stay was 12 days. The GOS score was 3 in surviving patients. Bilateral hemicraniectomy is a heroic intervention for patients with severe TBI, but can be a life-saving procedure.
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Affiliation(s)
- Brian P Walcott
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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