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Adachi K, Hukamdad M, Raymundo A, Jiang SH, Mehta AI. Women in Neurosurgery: Trends in the United States. World Neurosurg 2024; 184:e346-e353. [PMID: 38296039 DOI: 10.1016/j.wneu.2024.01.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE We sought to identify trends in the number of female neurosurgeons across each state and identify state characteristics that affect such values. METHODS The Physician Compare National Downloadable File was queried from the Center for Medicare & Medicaid Services for 2017 and 2023. Physicians indicating "neurosurgery" as their primary specialty were extracted and duplicates were removed. States were ranked based on the number of female neurosurgeons. The percent growth in the number of female neurosurgeons from 2017 to 2023 was calculated for each state. Univariable and multivariable regressions were used to identify the association between state characteristics and the number of female neurosurgeons. RESULTS The number of female neurosurgeons was higher in urban states while rural states saw a greater increase compared to five years ago. Univariable regression showed significant differences in the number of neurosurgery residency programs, neurosurgery hospitals ranked in U.S. News & World Report, paid parental leave law, number and percentage of female physicians, and diversity index score (P < 0.05). The diversity index score independently affected the number of female neurosurgeons (P < 0.05). CONCLUSIONS States with more training programs, female physicians, and paid parental leave policies saw a large number of female neurosurgeons. Diversity in the general population is also crucial to improving the equity in gender representation of neurosurgeons in each state. The increase in female neurosurgery representation in rural states shows that the shortage of neurosurgeons in underserved areas is creating a unique niche for female neurosurgeons to excel.
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Affiliation(s)
- Kaho Adachi
- University of Illinois College of Medicine at Chicago, Chicago, IL
| | - Mishaal Hukamdad
- University of Illinois College of Medicine at Chicago, Chicago, IL
| | - Allison Raymundo
- University of Illinois College of Medicine at Chicago, Chicago, IL
| | - Sam H Jiang
- University of Illinois College of Medicine at Chicago, Chicago, IL
| | - Ankit I Mehta
- University of Illinois College of Medicine at Chicago, Chicago, IL; Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL.
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Jiang SH, Deysher D, Adachi K, Bhaskara M, Almadidy Z, Sadeh M, Mehta AI, Chaudhry NS. Surgical Outcomes in Octogenarians with Central Cord Syndrome: A Propensity-Score Matched Analysis. World Neurosurg 2024; 184:e228-e236. [PMID: 38266996 DOI: 10.1016/j.wneu.2024.01.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE Central cord syndrome (CCS) is a traumatic cervical spine injury that is treated with surgical decompression. In octogenarians (80-89), surgeons often opt for conservative management instead due to fears of postoperative complications and prolonged recovery times. This study aims to assess the in-hospital complications and outcomes in octogenarians undergoing surgery compared to those undergoing nonsurgical management for CCS. METHODS The National Trauma Data Bank was queried from 2017 to 2019 for octogenarians with CCS. Patients who received surgical fusion or decompression were divided into the surgery group and the remaining into the nonsurgical group. The surgery group was sampled and propensity score matched with the non-surgery group. Student t tests and Pearson χ2 tests were used to test for group differences. RESULTS A total of 759 octogenarians with CCS were identified. Following sampling and propensity score matching, 225 patients were identified in each group. The surgery group experienced longer intensive care unit (6.8 days vs. 3.21 days, P < 0.001) and hospital (13.79 days vs. 7.8 days, P < 0.001) lengths of stay and higher rates of deep vein thrombosis (4.89% vs. 0.44%, P = 0.02) and ventilator-associated pneumonia (4% vs. 0%, P = 0.02). Patients did not otherwise differ in mortality rate, other hospital complications, and discharge disposition. CONCLUSIONS Octogenarians undergoing surgery for CCS experience longer length of stay and complications consistent with prolonged hospitalization but otherwise have similar mortality, hospital complications, and discharge disposition compared to non-surgical treatment. Given the relative lack of short-term drawbacks, surgery should be considered first-line management when the long-term benefits are substantive.
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Affiliation(s)
- Sam H Jiang
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA.
| | - Daniel Deysher
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Kaho Adachi
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Mounika Bhaskara
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Zayed Almadidy
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Morteza Sadeh
- Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Ankit I Mehta
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA; Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
| | - Nauman S Chaudhry
- Department of Neurosurgery and Brain Repair, University of South Florida, Lakeland, Florida, USA
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Khalid SI, Sathianathan S, Thomson KB, McGuire LS, Soni MC, Mehta AI. 5-year stroke rates in nonvalvular atrial fibrillation after watchman compared to direct oral anticoagulants. J Cardiol 2024; 83:163-168. [PMID: 37541428 DOI: 10.1016/j.jjcc.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The WATCHMAN device (Boston Scientific; Marlborough, MA, USA) is noninferior to warfarin in preventing ischemic strokes while reducing bleeding risks associated with long term anticoagulation in nonvalvular atrial fibrillation (AFib). The device's performance compared to direct oral anticoagulants (DOAC) is less well known. OBJECTIVE To compare 5-year major bleeding and ischemic stroke rates in patients with nonvalvular AFib who received a WATCHMAN device or DOAC therapy after a major bleeding event. METHODS This retrospective, multicenter, 1:1 matched cohort study was derived from the PearlDiver Mariner database from 2010 to 2020. Patients with nonvalvular AFib on oral anticoagulation who had a major bleeding event were identified. Those who received either WATCHMAN or DOAC after resolution of the bleeding event were selected. The two groups were exactly matched 1:1 based on various comorbidities. Rates of ischemic stroke, transient ischemic attack (TIA), major bleeding, and hemorrhagic stroke were compared over 5 years. RESULTS Each cohort consisted of 2248 patients after 1:1 matching. The mean CHADS2-VASC score was 4.81 ± 1.25. At 5 years, the WATCHMAN cohort had significantly lower rates of major bleeding events [OR 0.24 (0.21, 0.27)], TIAs [OR 0.75 (0.58, 0.95)], and ischemic strokes [OR 0.72 (0.61, 0.86)]. There was no significant difference in hemorrhagic strokes [OR 1.14 (0.83, 1.58)]. CONCLUSION Even in a high-risk population, the WATCHMAN is comparable to DOAC therapy in the primary prevention of hemorrhagic strokes and may provide benefit in the rates of bleeding events, TIAs, and ischemic strokes.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA.
| | - Shyama Sathianathan
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Kyle B Thomson
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL, USA
| | - Laura Stone McGuire
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Mona C Soni
- Department of Cardiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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Solitro GF, Welborn MC, Mehta AI, Amirouche F. How to Optimize Pedicle Screw Parameters for the Thoracic Spine? A Biomechanical and Finite Element Method Study. Global Spine J 2024; 14:187-194. [PMID: 35499547 PMCID: PMC10676166 DOI: 10.1177/21925682221099470] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Pedicle screw study. OBJECTIVE The selection of pedicle screw parameters usually involves the surgeon's analysis of preoperative CT imaging along with anatomical landmarks and tactile examination. However, there is minimal consensus on a standardized guideline for selection methods on pedicle screws. We aimed to determine the effects of thoracic screw diameter to pedicle width on pullout strength determined by cortical bone purchase. METHODS Biomechanical study performed with human cadaveric thoracic vertebrae and experimentally validated three-dimensional finite element model instrumented with pedicle screws of various diameters. We used a variable (SD/PW) ratio to express the screw selection. We hypothesized a positive correlation between the pullout load determined by the bone purchase and the SD/PW. This relationship was first investigated in a validated finite element model considering bone purchase related to the strength of an upper thoracic vertebra. Then, the correlation to the entire spine is evaluated. RESULTS The failure load ranged from 371.3 to 1601.0 N, respectively, for 3 and 6 mm screws. The determinant coefficient was increased to R2=.421 when a linear relationship between pullout load and the SD/PW ratio was used. The peak loads of 1216 and 1288N were found for an SD/PW ratio of .83. CONCLUSION We have found that the screw pullout load is more correlated to SD/PW than other pedicle measures for a maximized SD/PW ratio of .83. This particular value should be considered the upper limit of the indicated SD/PW ratio and a means to determine the optimal screw diameter to enhance pullout strength.
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Affiliation(s)
| | - Michelle C. Welborn
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Il, USA
| | - Ankit I. Mehta
- Department of Orthopaedic Surgery, NorthShore University HealthSystem, Evanston, Il, USA
| | - Farid Amirouche
- Department of Orthopaedics, Louisiana State University, Chicago, Il, USA
- College of Medicine, University of Illinois at Chicago, Chicago, Il, USA
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Hersh AM, Pennington Z, Lubelski D, Elsamadicy AA, Dea N, Desai A, Gokaslan ZL, Goodwin CR, Hsu W, Jallo GI, Krishnaney A, Laufer I, Lo SFL, Macki M, Mehta AI, Ozturk A, Shin JH, Soliman H, Sciubba DM. Treatment of intramedullary spinal cord tumors: a modified Delphi technique of the North American Spine Society Section of Spine Oncology. J Neurosurg Spine 2024; 40:1-10. [PMID: 37856379 DOI: 10.3171/2023.8.spine23190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 08/08/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Intramedullary spinal cord tumors (IMSCTs) are rare tumors with heterogeneous presentations and natural histories that complicate their management. Standardized guidelines are lacking on when to surgically intervene and the appropriate aggressiveness of resection, especially given the risk of new neurological deficits following resection of infiltrative tumors. Here, the authors present the results of a modified Delphi method using input from surgeons experienced with IMSCT removal to construct a framework for the operative management of IMSCTs based on the clinical, radiographic, and tumor-specific characteristics. METHODS A modified Delphi technique was conducted using a group of 14 neurosurgeons experienced in IMSCT resection. Three rounds of written correspondence, surveys, and videoconferencing were carried out. Participants were queried about clinical and radiographic criteria used to determine operative candidacy and guide decision-making. Members then completed a final survey indicating their choice of observation or surgery, choice of resection strategy, and decision to perform duraplasty, in response to a set of patient- and tumor-specific characteristics. Consensus was defined as ≥ 80% agreement, while responses with 70%-79% agreement were defined as agreement. RESULTS Thirty-six total characteristics were assessed. There was consensus favoring surgical intervention for patients with new-onset myelopathy (86% agreement), chronic myelopathy (86%), or progression from mild to disabling numbness (86%), but disagreement for patients with mild numbness or chronic paraplegia. Age was not a determinant of operative candidacy except among frail patients, who were deemed more suitable for observation (93%). Well-circumscribed (93%) or posteriorly located tumors reaching the surface (86%) were consensus surgical lesions, and participants agreed that the presence of syringomyelia (71%) and peritumoral T2 signal change (79%) were favorable indications for surgery. There was consensus that complete loss of transcranial motor evoked potentials with a 50% decrease in the D-wave amplitude should halt further resection (93%). Preoperative symptoms seldom influenced choice of resection strategy, while a distinct cleavage plane (100%) or visible tumor-cord margins (100%) strongly favored gross-total resection. CONCLUSIONS The authors present a modified Delphi technique highlighting areas of consensus and agreement regarding surgical management of IMSCTs. Although not intended as a substitute for individual clinical decision-making, the results can help guide care of these patients. Additionally, areas of controversy meriting further investigation are highlighted.
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Affiliation(s)
- Andrew M Hersh
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zach Pennington
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel Lubelski
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Nicolas Dea
- 4Department of Neurosurgery, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Atman Desai
- 5Department of Neurosurgery, Stanford Medicine, Palo Alto, California
| | - Ziya L Gokaslan
- 6Department of Neurosurgery, Brown University, Providence, Rhode Island
| | - C Rory Goodwin
- 7Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Wesley Hsu
- 8Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - George I Jallo
- 9Department of Neurosurgery, Johns Hopkins Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Ajit Krishnaney
- 10Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Ilya Laufer
- 11Department of Neurosurgery, New York University Grossman School of Medicine, New York, New York
| | - Sheng-Fu Larry Lo
- 12Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Mohamed Macki
- 13Department of Neurosurgery, University of California San Francisco School of Medicine, San Francisco, California
| | - Ankit I Mehta
- 14Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Ali Ozturk
- 15Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - John H Shin
- 16Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hesham Soliman
- 12Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Daniel M Sciubba
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- 12Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, New York
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Khalid SI, Mirpuri P, Chilakapati S, Kwak A, Mitchell D, Adogwa O, Mehta AI. The Impact of Preoperative Antithrombotic Therapy on the Risks for Thrombo-ischemic Events and Bleeding among Patients Undergoing Elective Spine Surgery. Asian Spine J 2023; 17:1082-1088. [PMID: 38050357 PMCID: PMC10764144 DOI: 10.31616/asj.2023.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 12/06/2023] Open
Abstract
STUDY DESIGN Retrospective matched analysis. PURPOSE To evaluate the effect of antithrombotic drug therapy on the rates of thrombo-ischemic or bleeding events 90 days following elective spine surgery. OVERVIEW OF LITERATURE Thrombo-ischemic and bleeding complications in patients undergoing spine surgery are major causes of morbidity. Many patients who pursue elective spine surgery are concurrently receiving antithrombotic therapy for unrelated conditions; however, at this time, the effects of preoperative antithrombotic use on postoperative bleeding and thrombosis are unclear. METHODS Using an all-payer claims database, patients who underwent elective cervical and lumbar spine interventions between January 1, 2010, and June 30, 2018, were identified. Individuals were categorized into groups taking and not taking antithrombotics. A 1:1 analysis was constructed based on comorbidities found to be independently associated with bleeding or ischemic complications using logistic regression models. The primary outcomes were the rates of thrombo-ischemic events and bleeding complications. RESULTS A total of 660,866 patients were eligible for inclusion. Following the matching procedure, 56,476 patient records were analyzed, with 28,238 in each group. The antithrombotic agent group had significantly greater odds of developing any 90-day thromboischemic event after surgery: deep vein thrombosis (odds ratio [OR], 3.61; 95% confidence interval [CI], 3.06-4.25), pulmonary embolism (OR, 3.93; 95% CI, 3.34-4.62), myocardial infarction (OR, 6.20; 95% CI, 5.69-6.76), and ischemic stroke (OR, 3.76; 95% CI, 3.31-4.27). In addition, the antithrombotic agent group had an increased likelihood of experiencing hematoma (OR, 1.54; 95% CI, 1.35-1.76) and need for transfusion (OR, 2.61; 95% CI, 2.29-2.96). CONCLUSIONS Patients taking antithrombotic medications before elective surgery of the cervical and lumbar spine had increased risks of both ischemic and bleeding events. Spine surgeons should carefully consider these implications when appraising patients for surgery, given the lack of guidelines on perioperative management of antithrombotic agents.
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Affiliation(s)
- Syed I. Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL,
USA
| | - Pranav Mirpuri
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL,
USA
| | - Sai Chilakapati
- Department of Neurosurgery, University of Texas Southwestern, Dallas, TX,
USA
| | - Angelika Kwak
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL,
USA
| | - Devon Mitchell
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL,
USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati School of Medicine, Cincinnati, OH,
USA
| | - Ankit I. Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL,
USA
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Khalid SI, Mirpuri P, Thomson K, Elsamadicy A, Massaad E, Deysher D, Khilwani H, Adogwa O, Shin JH, Mehta AI. Outcomes Following 2-Level Cervical Interventions with Cage-and-Plate, Zero-Profile, or Arthroplasty Constructs. World Neurosurg 2023; 180:e607-e617. [PMID: 37797683 DOI: 10.1016/j.wneu.2023.09.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Though cage-and-plate constructs are widely used for disk height restoration in surgery for cervical disc disease, concerns over range of motion limitations and adjacent disc space violations have fueled the development of artificial disc and zero-profile constructs. This study investigated the outcomes of patients undergoing two-level cervical interventions via arthroplasty, cage-and-plate, or zero-profile constructs. METHODS Patients undergoing two-level anterior cervical procedures between 2010 and 2020 were identified using an all-payer claims database. Logistic regression models were utilized to develop criteria for a 1:1:1-exact match procedure. The primary outcome was the need for additional surgery within 30 months, and the secondary outcomes included medical and surgical complications observed within 30 days of index intervention. P values < 0.05 were considered statistically significant. RESULTS 133,831 patients were identified as undergoing two-level anterior cervical interventions. Seven thousand three hundred seventy-one records were analyzed through a 1:1:1 match. Patients who received zero-profile versus cage-and-plate constructs had significantly decreased odds of requiring additional surgery within 30 months (Odds Ratio [OR] 0.64; 95% Confidence Interval [CI] 0.51-0.81). However, postoperative medical complications were increased among patients who received zero-profile constructs compared to cage-and-plate (OR 1.59; 95%CI 1.07-2.37). Patients who underwent arthroplasty also had decreased odds for additional surgery versus cage-and-plate (OR 0.75; 95%CI 0.60-0.93). There was no significant difference between arthroplasty and cage-and-plate constructs in developing postoperative surgical or medical complications. CONCLUSIONS Among patients undergoing two-level interventions, cage-and-plate constructs were associated with increased odds of additional surgery within 30 months following index procedures when compared to zero-profile constructs or arthroplasty.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
| | - Pranav Mirpuri
- Chicago Medical School, Rosalind Franklin School of Medicine and Science, North Chicago, Illinois, USA
| | - Kyle Thomson
- Chicago Medical School, Rosalind Franklin School of Medicine and Science, North Chicago, Illinois, USA
| | - Aladine Elsamadicy
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Elie Massaad
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel Deysher
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Harsh Khilwani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
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Jiang SH, Bhaskara M, Deysher D, Sadeh M, Souter J, Mehta AI. Racial disparities in incidence, treatment, and survival in adult brain metastases: a 10-year national database analysis. Neurosurg Focus 2023; 55:E6. [PMID: 37913546 DOI: 10.3171/2023.8.focus23336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/24/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE The aim of this study was to assess demographic and racial disparities in incidence, treatment, and survival of adults with metastatic malignancy to the brain. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) Program database, the authors identified adults with nonprimary brain metastases between 2010 and 2019. Incidence was calculated for all 10 years while data from 2010 to 2014 were used for survival analysis. The primary outcome measure was all-cause mortality within 5 years, assessed by 6-month, 1-year, 2-year, and 5-year survival rates. Chi-square tests of independence and one-way ANOVA were used to compare categorical and continuous measures, respectively, between non-Hispanic White (NHW), Hispanic White (HW), Black, and Asian/Pacific Islander (API) patients. A multivariable Cox proportional hazards model was developed to evaluate the risk of death within 5 years. RESULTS A total of 64,690 patient records were identified and analyzed following exclusion based on age (patients > 84 years or < 18 years were excluded), missing race data, and missing survival data. Incidences are reported per 100,000 adults. The incidence of brain metastases increased from 2.59 in 2010 to 2.78 in 2019, with an average 10-year incidence of 2.72. API patients had the highest population-adjusted incidence (3.52), followed by NHW (2.99), Black (2.32), and HW (1.59) patients. Black patients were the most likely to have low income and single status, while API patients were the most likely to have high income and married status. Subsequently, Black patients had the shortest survival time (9.05 months vs 9.19 months for NHW vs 12.93 months for HW vs 15.89 months for API patients, p < 0.001). After controlling for the effect of socioeconomic factors on survival, the multivariable analysis showed that Black (HR 0.91, 95% CI 0.88-0.94), HW (HR 0.73, 95% CI 0.69-0.76), and API (HR 0.69, 95% CI 0.66-0.73) patients all had a survival advantage compared with NHW patients. Surgery also conferred a strong survival advantage (HR 0.47, 95% CI 0.44-0.49). CONCLUSIONS The incidence of brain metastases has increased slightly between 2010 and 2019, with the highest rate in API patients. Black patients had the lowest survival, potentially due to poor socioeconomic status and lower rates of surgery and chemotherapy. Black patients were the most likely to not be recommended surgery, suggesting a discrepancy in services offered to these patients. More research is warranted to understand the underlying causes of these disparities.
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Affiliation(s)
- Sam H Jiang
- 1University of Illinois College of Medicine at Chicago; and
| | | | - Daniel Deysher
- 1University of Illinois College of Medicine at Chicago; and
| | - Morteza Sadeh
- 2Department of Neurosurgery, University of Illinois, Chicago, Illinois
| | - John Souter
- 2Department of Neurosurgery, University of Illinois, Chicago, Illinois
| | - Ankit I Mehta
- 1University of Illinois College of Medicine at Chicago; and
- 2Department of Neurosurgery, University of Illinois, Chicago, Illinois
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Khalid SI, Deysher D, Khilwani H, Mirpuri P, Thomson K, Maynard M, Mehta AI. Gastrostomy Sequence With Ventriculoperitoneal Shunting-Does It Matter? Neurosurgery 2023; 93:1154-1159. [PMID: 37283524 DOI: 10.1227/neu.0000000000002553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/12/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Neurological injury requiring ventriculoperitoneal shunt (VPS) placement often necessitates gastrostomy for nutritional support. The sequence of these procedures is debated over concerns for shunt infection and displacement requiring revisional surgery as a consequence of gastrostomy. OBJECTIVE To determine the optimal sequence of VPS shunt and gastrostomy tube placement in adults. METHODS In an all-payer database, adult patients undergoing gastrostomy and VPS placement were identified within 15 days between January 2010 and October 2021. Patients were categorized as receiving gastrostomy before, on the same day as, or after shunt placement. The primary outcomes of this study were rates of revision and infection. All outcomes were evaluated within 30 months after index shunting. RESULTS In total, 3015 patients were identified as undergoing VPS and gastrostomy procedures within 15 days. After a 1:1:1 match, 1080 patient records were analyzed. Revision rates at 30 months were significantly lower among patients who received VPS and gastrostomy procedures on the same day compared with gastrostomy after VPS (odds ratio [OR] 0.61, 95% CI 0.39-0.96). In addition, patients who received gastrostomy before VPS compared with those after had lower revision rates (OR 0.61, 95% CI 0.39-0.96) and infection (OR 0.46, 95% CI 0.21-0.99). No significant differences were noted in mechanical complication or shunt displacement rates. CONCLUSION Patients requiring VPS and gastrostomy may benefit from undergoing both procedures concurrently or with gastrostomy before VPS placement, secondary to lower revision rates. Patients undergoing gastrostomy before VPS have the added benefit of decreased infection rates.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
| | - Daniel Deysher
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
| | - Harsh Khilwani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
| | - Pranav Mirpuri
- Chicago Medical School, Rosalind Franklin School of Medicine and Science, North Chicago , Illinois , USA
| | - Kyle Thomson
- Chicago Medical School, Rosalind Franklin School of Medicine and Science, North Chicago , Illinois , USA
| | - Marquis Maynard
- Case Western Reserve School of Medicine, Cleveland , Ohio , USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
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Jiang SH, Hukamdad M, Gould A, Bhaskara M, Chiu RG, Sadeh M, Mehta AI. Effect of perioperative anticoagulant prophylaxis in patients with traumatic subdural hematoma and a history of anticoagulant use: a propensity-matched National Trauma Data Bank analysis. Neurosurg Focus 2023; 55:E3. [PMID: 37778050 DOI: 10.3171/2023.7.focus23346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/26/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE The use of anticoagulation to prevent venous thromboembolism (VTE) is controversial in the setting of neurosurgical decompression for traumatic subdural hematoma (SDH). In these patients, there is concern that anticoagulation may cause secondary hemorrhage, increasing the risk of death and other complications. Patients with a history of anticoagulant use are at further risk of VTE, but the effect of VTE prophylaxis (VTEP) following neurosurgery for SDH has not been thoroughly investigated in this population. This study aims to investigate the differences in in-hospital outcomes in patients with SDH and preexisting anticoagulant use who received VTEP following neurosurgical intervention compared with those who did not. METHODS The National Trauma Data Bank was queried from 2017 to 2019 for all patients with preexisting anticoagulant use presenting with an SDH who subsequently underwent neurosurgical intervention. Patients who received VTEP were propensity score matched with patients who did not based on demographics, insurance type, injury severity, and comorbidities. Paired Student t-tests, Pearson's chi-square tests, and Benjamini-Hochberg multiple comparisons correction were used to compare differences in in-hospital complications, length of stay (LOS), and mortality rate between the two groups. A logistic regression model was developed to identify risk factors for in-hospital mortality. RESULTS Two thousand seven hundred ninety-four patients matching the inclusion criteria were identified, of whom 950 received VTEP. Following one-to-one matching and multiple comparisons correction, the VTEP group had a lower mortality rate (18.53% vs 34.53%, p < 0.001) but longer LOS (14.09 vs 8.57 days, p < 0.001) and higher rates of pressure ulcers (2.11% vs 0.53%, p = 0.01), unplanned intensive care unit admission (9.05% vs 3.47%, p < 0.001), and unplanned intubation (9.47% vs 6.11%, p = 0.021). The multivariable logistic regression showed that use of unfractionated heparin (UH; OR 0.36, p < 0.001) and low-molecular-weight heparin (LMWH; OR 0.3, p < 0.001) were associated with lower odds of in-hospital mortality. CONCLUSIONS In patients with traumatic SDH and a history of anticoagulant use, perioperative VTEP was associated with increased LOS but provided a mortality benefit. LMWH and UH use were the strongest predictors of survival.
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Affiliation(s)
- Sam H Jiang
- 1University of Illinois College of Medicine at Chicago, Illinois
| | - Mishaal Hukamdad
- 1University of Illinois College of Medicine at Chicago, Illinois
| | - Andrew Gould
- 1University of Illinois College of Medicine at Chicago, Illinois
| | - Mounika Bhaskara
- 1University of Illinois College of Medicine at Chicago, Illinois
| | - Ryan G Chiu
- 2Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas
- 3Department of Neurosurgery, Parkland Memorial Hospital, Dallas, Texas; and
| | - Morteza Sadeh
- 4Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Ankit I Mehta
- 1University of Illinois College of Medicine at Chicago, Illinois
- 4Department of Neurosurgery, University of Illinois at Chicago, Illinois
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11
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Jiang SH, Nico E, Bhaskara M, Patil S, Edgar MC, Sadeh M, Chiu RG, Mehta AI. Characteristics of work-related spine injury in the USA: a National Trauma Data Bank analysis. Acta Neurochir (Wien) 2023; 165:3097-3106. [PMID: 37606797 DOI: 10.1007/s00701-023-05731-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/19/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Workplace injury is a commonplace occurrence in the USA. Spine injuries are especially devastating as they can cause chronic pain and limit mobility which prevents patients from returning to work. Gaining a better understanding of the patients, mechanisms, and treatments associated with these injuries can aid in improving outcomes. The purpose of this study is to characterize the nature of work-related spine injuries. METHODS The National Trauma Data Bank was queried from 2017 to 2019 for all diagnoses involving the cervical, thoracic, lumbar, and sacral spine. Patient demographics, comorbidities, injury characteristics, spinal diagnoses, and procedures were identified for each occupation. Occupational industries, patient demographics, mechanisms of injury, diagnoses, and spinal procedures were characterized. RESULTS A total of 100,842 work-related injuries were identified between 2017 and 2019. Of those, 19,002 (19%) were spine injuries, and subsequently, 3963 (21%) required spinal surgery. Eight thousand twenty-nine (42%) cases were seen among construction workers, which had the highest proportion of Hispanic patients (36%). Smoking was prevalent in labor-intensive occupations with high rates of spine injury such as building and grounds maintenance. The most common mechanism of injury was a fall from a roof. The most common injury diagnoses were L1, L2, and L3 fractures, and the most common procedures were T12-L1 fusion, multilevel thoracic fusion, and multilevel lumbar fusion. CONCLUSION Spine injuries represent a significant portion of work-related injuries in the USA and a considerable portion require neurosurgical intervention. Initial efforts should focus on the prevention and management of lumbar spine injuries in the construction industry.
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Affiliation(s)
- Sam H Jiang
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA
| | - Elsa Nico
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA
| | - Mounika Bhaskara
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA
| | - Shashank Patil
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA
| | - Michael C Edgar
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA
| | - Morteza Sadeh
- Department of Neurosurgery, University of Illinois at Chicago, 912 S. Wood, Chicago, IL, 60612, USA
| | - Ryan G Chiu
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, TX, 75390, USA
- Department of Neurosurgery, Parkland Hospital, Dallas, TX, 75235, USA
| | - Ankit I Mehta
- University of Illinois College of Medicine at Chicago, Chicago, IL, 60612, USA.
- Department of Neurosurgery, University of Illinois at Chicago, 912 S. Wood, Chicago, IL, 60612, USA.
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12
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Deysher D, Jiang SH, Khilwani H, Patnam M, Bhaskara M, Khalid S, Chiu RG, Mehta AI. Racial Disparities in Time to Decompression in Central Cord Syndrome: A National Trauma Database Analysis. World Neurosurg 2023:S1878-8750(23)00775-1. [PMID: 37301533 DOI: 10.1016/j.wneu.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Cervical cord syndrome (CCS) is the most common type of incomplete spinal cord injury. Prompt surgical decompression within 24 hours increases neurologic function and rates of home discharge. Racial disparities exist in spinal cord injury, with Black patients experiencing longer lengths of stay and higher rates of complications than White patients. This study aims to investigate potential racial disparities in time to surgical decompression in patients with CCS. METHODS The National Trauma Data Bank was queried from 2017 to 2019 for patients who underwent surgery for CCS. The primary outcome was time from hospital admission to surgery. Student's t-test and Pearson's chi-squared test were used to evaluate differences in categorical and continuous variables, respectively. An uncensored Cox proportional hazards regression model was developed to assess the effect of race on surgical timing while adjusting for potential confounders. RESULTS 1076 patients with CCS resulting in cervical spinal cord surgery were included in the analysis. Regression analysis results showed that Black patients (HR=0.85, p=0.03), female patients (HR=0.81, p<0.01), and patients treated at community hospitals (HR=0.82, p=0.01) were less likely to receive early surgery. CONCLUSIONS Though the advantages of early surgical decompression in the setting of CCS have been detailed in medical literature, Black and female patients experience lower rates of prompt surgery following hospital admission and higher rates of adverse outcomes. This disproportionately increased time to intervention exemplifies demographic disparities in the timely provision of treatment to patients with spinal cord injuries.
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Affiliation(s)
- Daniel Deysher
- University of Illinois College of Medicine at Chicago, Chicago, IL
| | - Sam H Jiang
- University of Illinois College of Medicine at Chicago, Chicago, IL
| | - Harsh Khilwani
- University of Illinois College of Medicine at Chicago, Chicago, IL
| | - Mehul Patnam
- University of Illinois College of Medicine at Chicago, Chicago, IL
| | - Mounika Bhaskara
- University of Illinois College of Medicine at Chicago, Chicago, IL
| | - Syed Khalid
- Department of Neurosurgery, University of Illinois, Chicago, IL
| | - Ryan G Chiu
- Department of Neurosurgery, University of Illinois, Chicago, IL
| | - Ankit I Mehta
- University of Illinois College of Medicine at Chicago, Chicago, IL; Department of Neurosurgery, University of Illinois, Chicago, IL.
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Khalid SI, Deysher D, Thompson K, Ostrov PB, Hossa J, Mirpuri P, Adogwa O, Mehta AI. Outcomes of patients undergoing single-level arthroplasty versus anterior lumbar interbody fusion. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05616-4. [PMID: 37178246 DOI: 10.1007/s00701-023-05616-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Compared to vertebral body fusion, artificial discs are thought to lessen the risks of adjacent segment disease and the need for additional surgery by maintaining spinal mobility as they mimic the intervertebral disc structure. No studies have compared the rates of postoperative complications and the requirement for secondary surgery at adjacent segments among patients who have undergone anterior lumbar interbody fusions (ALIF) versus those undergoing lumbar arthroplasty. METHODS An all-payer claims database identified 11,367 individuals who underwent single-level ALIF and lumbar arthroplasty for degenerative disc disease (DDD) between January 2010 and October 2020. Rates of complications following surgery, the need for additional lumbar surgeries, length of stay (LOS), and postoperative opioid utilization were assessed in matched cohorts based on logistic regression models. Kaplan-Meyer plots were created to model the probability of additional surgery. RESULTS Following 1:1 exact matching, 846 records of patients who had undergone ALIF or lumbar arthroplasty were analyzed. All-cause readmission within 30-30 days following surgery was significantly higher in patients undergoing ALIF versus arthroplasty (2.6% vs. 0.71%, p = 0.02). LOS was significantly lower among the patients who had undergone ALIF (1.043 ± 0.21 vs. 2.17 ± 1.7, p < .001). CONCLUSIONS ALIF and lumbar arthroplasty procedures are equally safe and effective in treating DDD. Our findings do not support that single-level fusions may biomechanically necessitate revisional surgeries.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 451N - MC 799, Chicago, IL, 60612, USA.
| | - Daniel Deysher
- Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 451N - MC 799, Chicago, IL, 60612, USA
| | - Kyle Thompson
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Philip B Ostrov
- Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 451N - MC 799, Chicago, IL, 60612, USA
| | - Jessica Hossa
- Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 451N - MC 799, Chicago, IL, 60612, USA
| | - Pranav Mirpuri
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati School of Medicine, Cincinnati, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 451N - MC 799, Chicago, IL, 60612, USA
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14
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Khalid SI, Jiang S, Khilwani H, Thomson K, Mirpuri P, Mehta AI. Postoperative Opioid Use Among Opioid-Naive Cannabis Users Following Single-Level Lumbar Fusions. World Neurosurg 2023:S1878-8750(23)00475-8. [PMID: 37030484 DOI: 10.1016/j.wneu.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/01/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND As the literature grows on opioid use, the impact of simultaneous cannabis use has hitherto been mostly unexplored. In this study, we assessed the effects of cannabis use on postoperative opioid utilization in opioid-naive patients undergoing single level fusions of the lumbar spine. METHODS Using an all-payer claims database, the medical records of 91 million patients were analyzed to identify patients who had undergone single level lumbar fusions between January 2010 and October 2020. Rates of opioid utilization at 6 months following index procedure (morphine milligram equivalents/day), the development of opioid use disorder, and the rates of opioid overuse were assessed. RESULTS Following examination of 87,958 patient records, 454 patients were matched and distributed equally into cannabis user and non-cannabis user cohorts. At six months following index procedure, cannabis users were equal to non-users in their rates of prescribed opioid utilization (49.78%, p>.99). Cannabis users used smaller daily dosages compared to non-users (51.1±35.05 vs. 59.72±41, p=.003). On the other hand, the proportion of patients diagnosed with opioid use disorder was found to be significantly higher among patients using cannabis (18.94% vs. 3.96%, p<.0001). CONCLUSION Compared to non-cannabis users, opioid-naive patients who are cannabis users undergoing lumbar spinal fusions are at a higher risk of developing opioid dependence following surgery, despite having decreased daily dosages of opioids overall. Further studies should explore the factors associated with the development of opioid use disorder and the details of concurrent marijuana use to effectively treat pain while limiting the potential for abuse.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery University of Illinois at Chicago, Chicago, Illinois, USA.
| | - Sam Jiang
- Department of Neurosurgery University of Illinois at Chicago, Chicago, Illinois, USA
| | - Harsh Khilwani
- Department of Neurosurgery University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kyle Thomson
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Pranav Mirpuri
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery University of Illinois at Chicago, Chicago, Illinois, USA
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15
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Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Spinal chordomas are rare primary malignant neoplasms of the primitive notochord. They are slow growing but locally aggressive lesions that have high rates of recurrence and metastasis after treatment. Gold standard treatment remains en-bloc surgical resection with questionable efficacy of adjuvant therapies such as radiation and chemotherapy. Here we provide a comprehensive analysis of prognostic factors, treatment modalities, and survival outcomes in patients with spinal chordoma. METHODS Patients with diagnosis codes specific for chordoma of spine, sacrum, and coccyx were queried from the National Cancer Database (NCDB) during the years 2004-2016. Outcomes were investigated using Cox univariate and multivariate regression analyses, and survival curves were generated for comparative visualization. RESULTS 1,548 individuals were identified with a diagnosis of chordoma, 60.9% of which were at the sacrum or coccyx and 39.1% at the spine. The mean overall survival of patients in our cohort was 8.2 years. Increased age, larger tumor size, and presence of metastases were associated with worsened overall survival. 71.2% of patients received surgical intervention and both partial and radical resection were associated with significantly improved overall survival (P < 0.001). Neither radiotherapy nor chemotherapy administration improved overall survival; however, amongst patients who received radiation, those who received proton-based radiation had significantly improved overall survival compared to traditional radiation. CONCLUSION Surgical resection significantly improves overall survival in patients with spinal chordoma. In those patients receiving radiation, those who receive proton-based modalities have improved overall survival. Further studies into proton radiotherapy doses are required.
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Affiliation(s)
- Saavan Patel
- Department of Neurosurgery, University of Illinois at
Chicago, IL, USA
| | - Ravi S. Nunna
- Department of Neurosurgery, University of Illinois at
Chicago, IL, USA
| | - James Nie
- Department of Neurosurgery, University of Illinois at
Chicago, IL, USA
| | - Darius Ansari
- Department of Neurosurgery, University of Illinois at
Chicago, IL, USA
| | | | - Ankit I. Mehta
- Department of Neurosurgery, University of Illinois at
Chicago, IL, USA,Ankit I. Mehta, Department of Neurosurgery,
University of Illinois at Chicago, 912 South Wood Street, 451-N, Chicago, IL,
60612, USA.
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16
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Khalid SI, Hunter BM, Shah P, Patel A, Thomson KB, LoPresti MA, Roblin DW, Lam S, Mehta AI. The Impact of Social Determinants of Health in Pediatric Shunted Hydrocephalus. Neurosurgery 2023; 92:1066-1072. [PMID: 36749102 DOI: 10.1227/neu.0000000000002333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/27/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Social risk factors have been shown to negatively affect health outcomes in children. However, this has not been characterized regarding pediatric shunted hydrocephalus. OBJECTIVE To explore the impact of social risk factors on outcomes in pediatric shunted hydrocephalus with the goal of identifying specific areas of intervention that might improve the outcomes of children undergoing cerebrospinal fluid (CSF) diversion. METHODS In an all-payer administrative database, records between January 2010 and October 2020 were analyzed to identify children undergoing CSF shunting procedures. Children with social risk factors were compared with those without regarding rates of infection, shunt-related interventions, and mortality within 5 years of their shunting procedure. RESULTS Among the 5420 children who underwent first-time shunting procedures, 263 (4.9%) were identified to have social risk factors. Children with identified social risk factors had increased odds of central nervous system infection (odds ratio [OR] 2.06, 95% CI 1.45-2.91), revision (OR 2.43, 95% I 1.89-3.12), and mortality (OR 2.86, 95% CI 1.23-5.72). The mean numbers of computed tomography studies (14.60 ± 17.78 vs 6.34 ± 6.10), MRI studies (18.76 ± 24.37 vs 7.88 ± 24.37), and shunt series X-rays (17.22 ± 19.04 vs 7.66 ± 8.54) were increased among children with social risk factors. CONCLUSION Children with social risk factors had increased rates of central nervous system infection, shunt-related interventions, and mortality within 5 years of CSF shunting. We underscore the importance of characterizing the impact of social risk factors in specific conditions, such as pediatric shunted hydrocephalus, and look to future directions aimed to mitigate these risk factors with coordination and direction of individualized resources, encouragement of advocacy, and community partnership.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Brittany M Hunter
- Division of Hospital-Based Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Pal Shah
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Aashka Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kyle B Thomson
- Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois, USA
| | - Melissa A LoPresti
- Department of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Douglas W Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente, Rockville, Maryland, USA
| | - Sandi Lam
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
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17
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Fuentes AM, Khalid SI, Mehta AI. Predictors of Subsequent Intervention After Middle Meningeal Artery Embolization for Treatment of Subdural Hematoma: A Nationwide Analysis. Neurosurgery 2023; 92:144-149. [PMID: 36129273 DOI: 10.1227/neu.0000000000002151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/16/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Middle meningeal artery (MMA) embolization has recently emerged as an effective technique to treat subdural hematomas (SDHs). Studies to date have been limited, largely, to single-center studies with limited follow-up and have not assessed subsequent surgical interventions and factors associated with these interventions. OBJECTIVE To evaluate rates of retreatment for SDH after MMA embolization and patient-specific factors that may be important predictors for these interventions. METHODS Using an all-payer claims database, Mariner, patients who underwent MMA embolization between January 2010 and October 2020 after the diagnosis of SDH were identified. Rates of post-MMA embolization surgical interventions, including craniotomy and burr hole drainage, were accessed within 5 years following. Patient-specific contributors to the rates of these interventions were studied using Gaussian logistic regression models. RESULTS A total of 322 patients were included. Of this cohort, 55 (17.1%) required subsequent intervention within 5 years, with 36 (11.2%) receiving burr hole evacuation and 19 (5.9%) receiving craniotomy. Factor Xa inhibitor use was independently associated with subsequent interventions after MMA embolization procedures (odds ratio: 1.20 [95% CI: 1.02-1.40]). Of the other patient factors evaluated, including age, sex, comorbidity status, and use of vitamin K antagonists, antiplatelets, and factor Xa inhibitors, none were found to be significantly associated with future interventions. CONCLUSION Although previous literature has shown MMA embolization to be safe and successful in preventing recurrent SDH, patients undergoing this procedure still carry a risk of future interventions. Patients taking factor Xa inhibitors are at especially high risk of subsequent intervention after MMA embolization.
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Affiliation(s)
- Angelica M Fuentes
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
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18
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Khalid SI, Nie JW, Thomson KB, Nie JZ, Patil SN, Zakrzewski V, Souter J, Smith JS, Mehta AI. Five-Year Outcomes After Decompression and Fusion Versus Decompression Alone in the Treatment of Lumbar Synovial Cysts. World Neurosurg 2022; 166:e23-e33. [PMID: 35691521 DOI: 10.1016/j.wneu.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/02/2022] [Accepted: 06/02/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Spinal synovial cysts are acquired, fluid-filled lesions of the facet joint that most commonly occur in the lumbar spine. They are thought to arise from degenerative changes and to result from segmental instability. Although the treatment of these lesions has been studied, the long-term implications and effects of the different strategies for surgical intervention (i.e., decompression and fusion vs. decompression alone) have not yet been elucidated or established. METHODS Using an all-payer database with 53 million patient records (MARINER-53), patients with a diagnosis of lumbar synovial cysts were identified. Patients who had undergone lumbar fusion versus laminectomy were matched 1:1 using binomial and gaussian logistic regression models to evaluate the need for future lumbar surgery within 5 years after their index procedure. RESULTS No statistically significant differences were noted between the 5-year rates of subsequent intervention, additional laminectomy, or fusion among patients who had undergone index decompression and fusion (n = 51; 10.5%) versus decompression alone (n = 43; 8.8%; P = 0.39). Furthermore, no significant differences were found in the odds of intervention type after index decompression and fusion versus decompression alone (subsequent laminectomy: odds ratio, 0.59; 95% confidence interval, 0.32-1.09; subsequent fusion: odds ratio, 1.14; 95% confidence interval, 0.64-2.02). CONCLUSIONS Patient-specific factors and surgeon-patient-shared decision-making should be used when planning interventions for these lesions. However, synovial cysts might not require a fusion procedure for presumed instability. Further investigation is required, using randomized and prospective studies, to further evaluate the effective treatment of this entity.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - James W Nie
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kyle B Thomson
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Jeffrey Z Nie
- School of Medicine, Southern Illinois University, Springfield, Illinois, USA
| | - Shashank N Patil
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Victoria Zakrzewski
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - John Souter
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jennifer S Smith
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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19
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Nunna R, Patel S, Karuparti S, Ortiz-Torres M, Ryoo J, Ansari D, Carr S, Mehta AI. Chordoma of the Skull Base: A National Cancer Database Analysis of Current Practice Patterns and Outcomes. World Neurosurg 2022; 168:e260-e268. [PMID: 36184046 DOI: 10.1016/j.wneu.2022.09.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Chordomas of the skull base are aggressive, locally destructive tumors that arise from the remnants of the fetal notochord. Current guidelines recommend maximal safe surgical resection followed by adjuvant radiation therapy. However, owing to the rarity of these tumors, the optimal radiotherapeutic regimen with regards to dose and modality is unclear. METHODS The National Cancer Database (NCDB) was queried from 2004-2016. Data from adult patients were extracted, including tumor characteristics, comorbidity indices, and details of treatment (surgery, radiation, and chemotherapy). The primary outcome of interest was overall survival (OS), which was evaluated for specific treatment cohorts using Cox univariate and multivariate regression constructs along with associated survival curves. RESULTS We identified 798 patients with a diagnosis of skull base chordoma. Mean OS in this cohort was 9.57 years. The majority of patients received surgical resection (89.1%), with 53.9% receiving radiotherapy and 6.5% receiving chemotherapy. After adjusting for baseline characteristics using multivariate regression, advanced age and increased tumor size were associated with decreased OS. Surgical resection was associated with increased OS, while neither radiotherapy nor chemotherapy were associated with OS. However, in patients that did receive radiation, dosage > 6,000 cGy was associated with increased OS (HR 0.51; p=0.038); OS did not vary significantly between traditional and proton-based methods. CONCLUSIONS Our multi-institutional analysis supports the use of partial and radical surgical resection to improve survival in patients with skull base chordomas. Among patients who receive radiotherapy, higher radiation dose is associated with improved survival.
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Affiliation(s)
- Ravi Nunna
- Department of Neurosurgery, University of Missouri Columbia, MO 65212
| | - Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago Chicago, IL 60612
| | - Sasi Karuparti
- College of Medicine, University of Missouri Columbia, MO 65212
| | | | - James Ryoo
- Department of Neurosurgery, New York University New York, NY 10016
| | - Darius Ansari
- Department of Neurological Surgery, University of Wisconsin Madison, WI 53792
| | - Steven Carr
- Department of Neurosurgery, University of Missouri Columbia, MO 65212
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago Chicago, IL 60612.
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20
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Khalid SI, Nunna RS, Smith JS, Shanker RM, Cherney AA, Thomson KB, Chilakapati S, Mehta AI, Adogwa O. The role of bone mineral density in adult spinal deformity patients undergoing corrective surgery: a matched analysis. Acta Neurochir (Wien) 2022; 164:2327-2335. [PMID: 35922723 DOI: 10.1007/s00701-022-05317-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/12/2022] [Indexed: 12/14/2022]
Abstract
STUDY DESIGN Retrospective cohort. BACKGROUND Over 44 million adults are estimated to have either osteoporosis or osteopenia. Adult spinal deformity (ASD) is estimated to affect between 32 and 68% of the elderly population. OBJECTIVE Retrospective investigation comparing rates of postoperative complications following thoracolumbar scoliosis surgery in patients with normal bone mineral density (BMD) to those with osteopenia or osteoporosis in addition to analyzing the effects of pretreatment with anti-osteoporotic medications in patients with low BMD. METHODS Using administrative database of Humana beneficiaries, ICD-9 and ICD-10 diagnosis codes were used to identify ASD patients undergoing multilevel thoracolumbar fusions between 2007 and 2017. RESULTS The propensity matched population analyzed in this study contained 1044 patients equally represented by those with a history of osteopenia, osteoporosis, or normal BMD. Osteopenia and osteoporosis were associated with increased odds of revision surgery (OR 2.01 95% CI 1.36-2.96 and OR 1.57, 95% CI 1.05-2.35), respectively. Similarly, there was an almost twofold increased odds of proximal and distal junctional kyphosis in patients with osteopenia and osteoporosis (OR 1.95, 95% CI 1.40-2.74 and OR 1.88, 95% CI 1.34-2.64), respectively. A total of 258 (37.1%) patients with osteoporosis were pretreated with anti-osteoporotic medications and there was no statistically significant decrease in odds of proximal or distal junctional kyphosis or revision surgery in these patients. CONCLUSION Patients with ASD undergoing multilevel thoracolumbar fusion surgery have significantly higher rates of postoperative pseudarthrosis, proximal and distal junctional kyphosis, and revision surgery rates compared to patients with normal BMD.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois, Chicago, IL, USA.
| | - Ravi S Nunna
- Department of Neurosurgery, University of Illinois, Chicago, IL, USA
| | - Jennifer S Smith
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Rachyl M Shanker
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Alecia A Cherney
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Kyle B Thomson
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Sai Chilakapati
- Department of Neurosurgery, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois, Chicago, IL, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinatti, Cincinnati, OH, USA
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Khalid SI, Eldridge C, Singh R, Shanker RM, MacDonald AM, Chilakapati S, Smith J, Mehta AI, Adogwa O. The impact of smoking and smoking cessation interventions on outcomes following single-level anterior cervical discectomy and fusion procedures. Clin Neurol Neurosurg 2022; 219:107319. [DOI: 10.1016/j.clineuro.2022.107319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
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22
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Khalid SI, Nunna RS, Shanker RM, Thomson KB, Parola R, Adogwa O, Mehta AI. Bone Morphogenetic Protein in Anterior Lumbar Interbody Fusions: A Propensity-Matched Medicare Outcome Analysis. Int J Spine Surg 2022; 16:8301. [PMID: 35705214 PMCID: PMC9421204 DOI: 10.14444/8301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Bone morphogenetic protein (BMP) is a costly agent commonly used in spine surgery. Its effectiveness and complication profile have never been studied in a large, propensity-matched population following its approval by the Food and Drug Administration for use in single-level anterior lumbar interbody fusion (ALIF) surgeries. OBJECTIVE To investigate the rate of symptomatic pseudarthrosis or need for revision surgery after single-level stand-alone ALIFs with and without the use of BMP. METHODS Medicare Standard Analytic files derived from Medicare parts A and B were used to identify adult patients who underwent single-level ALIF procedures with and without use of BMP between 2004 and 2014. Patients were propensity matched based on their age, gender, and history of diabetes mellitus, hypertension, chronic kidney disease, body mass index greater than 30 kg/m2, smoking, rheumatoid arthritis, and osteoporosis. Sensitivity analysis using adjusted multivariate logistic regression models was also performed. The primary outcomes were the rates of symptomatic pseudarthrosis or need for revision surgery. RESULTS The propensity-matched population analyzed in this study contained 22,380 patients undergoing single-level ALIF (8971 [40.6%] with BMP and 13,139 [59.4%] without BMP). Both patient groups were balanced at baseline. The rate of symptomatic pseudarthrosis in the propensity-matched analysis was higher in the BMP group (1.9% vs 1.4%, P < 0.05). BMP use during single-level ALIFs was associated with 44% increased odds of developing pseudarthrosis (OR 1.44, 95% CI 1.16-1.76). However, there was no statistically significant difference in the rate of revision surgery between groups (3.7% vs 3.5%, P = 0.49). CONCLUSIONS BMP use in single-level ALIFs may be associated with increased risk of symptomatic pseudarthrosis. Large prospective pragmatic trials are needed to corroborate our findings. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
- Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Ravi S Nunna
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | | | | | - Rown Parola
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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Ikwuegbuenyi CA, Patil SN, Nie JW, Bankole OB, Mehta AI. Effects of COVID-19 on Neurosurgical Service: Perspective from a Tertiary Medical Center in Nigeria. J Neurosci Rural Pract 2022; 13:398-402. [PMID: 35946013 PMCID: PMC9357510 DOI: 10.1055/s-0042-1744472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background
The outbreak of COVID-19 caused a significant impact on neurosurgical case volume in Nigeria due to the widespread recommendation to minimize elective procedures and redistribute healthcare resources to support COVID-19 patients. This study aims to analyze the effect of COVID-19 in one tertiary care Nigerian hospital on the demographic characteristics, diagnostic classes, and elective/non-elective procedure statuses.
Methods
A retrospective single-center chart review study was conducted to review all patients undergoing a neurosurgical procedure between March to June in 2019 and 2020. Descriptive data on patient age, gender, sex, diagnosis, surgical procedure, elective/non-elective surgery status, and month and year of admission were recorded. Diagnoses were categorized into one of seven types by author review. Pearson's Chi-Square and Fisher's Exact Tests were utilized to test for independence of the categorical variables to the year of patient admission, and a Welch two-sample t-test was used to test for a significant difference in mean age between the two cohorts.
Results
A total of 143 cases were reviewed. There was a 59.8% reduction in overall neurosurgical case volume with an 82% reduction in elective procedures (39 vs. 7, p = 0.017, 95% CI: 1.15 – 8.77) between 2019 and 2020. No significant differences were noted in patient cohorts when comparing demographic characteristics, diagnosis type, or month of admission between the two years.
Conclusion
There was a significant reduction in elective neurosurgical procedures during the early months of COVID-19 in Nigeria. Further studies should consider examining the effects of COVID-19 into 2021.
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Affiliation(s)
| | - Shashank N. Patil
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, United States
| | - James W. Nie
- Department of Neurosurgery, College of Medicine University of Lagos, Lagos, Nigeria
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Olufemi B. Bankole
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Ankit I. Mehta
- Department of Neurosurgery, College of Medicine University of Lagos, Lagos, Nigeria
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, United States
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Patel S, Chiu RG, Chaker AN, Rosinski CL, Nunna RS, Behbahani M, Mehta AI. Current Trends and Socioeconomic Disparities in the Utilization of Spine Augmentation for Patients With Osteoporotic Vertebral Compression Fracture: A Nationwide Inpatient Sample Analysis From 2012 to 2016. Int J Spine Surg 2022; 16:490-497. [PMID: 35728830 DOI: 10.14444/8262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Osteoporotic vertebral compression fracture (OVCF) is a growing health care problem in today's aging population. Since the advent of kyphoplasty and vertebroplasty, these interventions have been commonly utilized in the treatment of symptomatic OVCF. However, the use of these interventions varies because there is not a standard of care for the management of OVCF. There remain disparities in the use of these procedures as treatment for OVCFs in the United States. METHODS The 2012 to 2016 Nationwide Inpatient Sample was queried for all patients admitted for OVCF. These patients were then grouped based on whether they received conservative vs surgical (kyphoplasty/vertebroplasty) management and compared with respect to various socioeconomic factors including race, insurance coverage, income quartile, hospital control, and geography. Propensity score matching was utilized to control for potential baseline confounders as well as the influence of other endpoints. RESULTS The search criteria identified 35,199 patients admitted with OVCF, of whom 7900 (22.4%) received spine augmentation. Blacks/African Americans (risk ratios [RR] = 0.79, P < 0.001), Hispanics/Latinos (RR = 0.82, P < 0.001), Asians/Pacific Islanders (RR = 0.81, P = 0.048), and unknown/other races (RR = 0.88, P = 0.037) were less likely to receive surgical management than whites/Caucasians. When compared with Medicare patients, those with Medicaid (RR = 0.76, P < 0.001) were less likely to receive surgery while privately insured patients were more likely (RR = 1.06, P = 0.42). Patients in the West (RR = 0.90, P < 0.001) were less likely to receive surgery for OVCF than those in the Northeast. CONCLUSIONS A wide variety of socioeconomic disparities exists in the use of spinal augmentation for the management of OVCF in the United States, limiting patient access to a potentially beneficial procedure. CLINICAL RELEVANCE Retrospective Analysis. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Ryan G Chiu
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Anisse N Chaker
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Clayton L Rosinski
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Ravi S Nunna
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Mandana Behbahani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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Khalid SI, Thomson KB, Maasarani S, Wiegmann AL, Smith J, Adogwa O, Mehta AI, Dorafshar AH. Materials Used in Cranial Reconstruction: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 164:e945-e963. [PMID: 35623608 DOI: 10.1016/j.wneu.2022.05.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cranioplasty is a common neurological procedure with complication rates ranging from 20% to 50%. It is hypothesized that the risks of various complications are impacted by which material is used for cranioplasty. OBJECTIVE To evaluate existing literature comparing rates of complications following cranioplasty using different materials including autologous bone, hydroxyapatite, methyl methacrylate (MMA), demineralized bone matrix, polyetheretherketone, titanium, or composite materials. METHODS PubMed/MEDLINE database was searched for relevant articles published between 2010 and 2020. After screening, 35 articles were included. Outcomes included infection, wound problems, poor cosmesis, overall complications, duration of surgery, and length of stay. For each outcome, a frequentist network meta-analysis was conducted to compare materials used. RESULTS The risk of infection was 1.62 times higher when MMA was used compared to autologous bone (RR 1.62, 95% CI 1.07 to 2.45). Length of stay following cranioplasty was on average 3.62 days shorter when titanium was used compared autologous bone (95% CI -6.26 to -0.98). The networks constructed for other outcomes demonstrated moderate to substantial between-study heterogeneity, wide confidence intervals, and no significant differences between materials. CONCLUSIONS The quality of existing literature on this topic is relatively poor, almost exclusively comprised of single-center retrospective studies. There is currently not strong enough evidence available to make comprehensive conclusions regarding the risk-profiles of various cranioplasty materials across multiple outcomes. Prospective randomized trials are necessary to confirm the significant results found in this analysis and to further elucidate the differential risks of various cranioplasty materials.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL.
| | | | | | - Aaron L Wiegmann
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL
| | | | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
| | - Amir H Dorafshar
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL
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Ansari D, Shah P, Mehta AI. Letter: Early Outcomes After Carotid Endarterectomy and Carotid Artery Stenting: A Propensity-Matched Cohort Analysis. Neurosurgery 2022; 91:e13-e15. [PMID: 35467574 DOI: 10.1227/neu.0000000000002005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/28/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Darius Ansari
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
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27
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Khalid SI, Thomson KB, Chilakapati S, Singh R, Eldridge C, Mehta AI, Adogwa O. The Impact of Smoking Cessation Therapy on Lumbar Fusion Outcomes. World Neurosurg 2022; 164:e119-e126. [PMID: 35439621 DOI: 10.1016/j.wneu.2022.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE While there are several reports on the impact of smoking tobacco on spinal fusion outcomes, there is minimal literature on the influence of modern smoking cessation therapies on such outcomes. Our study explores the outcomes of single-level lumbar fusion surgery in active smokers and in smokers undergoing recent cessation therapy. METHODS MARINER30, an all-payer claims database, was utilized to identify patients undergoing single-level lumbar fusions between 2010 and 2019. The primary outcomes were the rates of any complication, symptomatic pseudarthrosis, need for revision surgery, and all-cause readmission within 30 and 90 days. RESULTS The exact matched population analyzed in this study contained 31,935 patients undergoing single-level lumbar fusion with 10,645 (33%) in each of the following groups: (1) active smokers; (2) patients on smoking cessation therapy; and (3) those without any smoking history. Patients undergoing smoking cessation therapy have reduced odds of developing any complication following surgery (odds ratio 0.86, 95% confidence interval 0.80-0.93) when compared with actively smoking patients. Nonsmokers and patients on cessation therapy had a significantly lower rate of any complication compared with the smoking group (9.5% vs. 17% vs. 19%, respectively). CONCLUSIONS When compared with active smoking, preoperative smoking cessation therapy within 90 days of surgery decreases the likelihood of all-cause postoperative complications. However, there were no between-group differences in the likelihood of pseudarthrosis, revision surgery, or readmission within 90 days.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
| | - Kyle B Thomson
- Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois, USA
| | - Sai Chilakapati
- Department of Neurosurgery, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Ravi Singh
- Department of Neurosurgery, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Cody Eldridge
- Department of Neurosurgery, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
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Zhu A, Chiu RG, Nunna RS, Zhao JW, Hossa J, Behbahani M, Mehta AI. Gender Disparities in Outpatient Management of Postlaminectomy Syndrome. Int J Spine Surg 2022; 16:373-377. [PMID: 35444045 PMCID: PMC9930648 DOI: 10.14444/8225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Postlaminectomy syndrome (PLS), also known as failed back surgery syndrome, is the persistence of radicular pain in the face of surgical intervention. Despite its prevalence in 10 to 40% of spine surgery patients, outpatient pharmacologic and interventional management remains poorly characterized. METHODS The 2007 to 2016 National Ambulatory Medical Care Survey (NAMCS) was utilized to include all outpatients diagnosed with PLS. For each visit, documented pain medications (opioids, nonsteroidal anti-inflammatory drugs [NSAIDs], neuropathic agents, etc) as well as patient demographics and comorbidities (sex, age, race, insurance coverage, and medical history) were recorded. The association between medication class and rate of prescription relative to sex was assessed in the population-weighted cohort, using propensity score matching to control for potential confounders. RESULTS A total of 70,343 PLS patients were identified, including 36,313 (51.6%) women. After accounting for baseline demographics and comorbidity differences between male and female patients, men were 2 to 3 times more likely to be prescribed opioids (OR: 2.38; 95%CI: 2.30-2.46) and procedural interventions for PLS compared to the female cohort, while women utilized neuropathic agents (OR: 0.53; 95%CI: 0.51-0.55) and NSAIDs (OR: 0.68; 95%CI: 0.65-0.70) more frequently. CONCLUSION Pain management in outpatients presenting with PLS-related pain consisted of higher opioid utilization for men and higher neuropathic agents and NSAIDs utilization for the female patients. CLINICAL RELEVANCE This article is the first to shed light on disparities in pain management among patients with post-laminectomy syndrome. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Amy Zhu
- Department of Neurosurgery, University of Illinois, Chicago, IL, USA
| | - Ryan G. Chiu
- Department of Neurosurgery, University of Illinois, Chicago, IL, USA,Department of Neurosurgery, University of Texas Southwestern, Dallas, TX, USA
| | - Ravi S. Nunna
- Department of Neurosurgery, University of Illinois, Chicago, IL, USA
| | - Jeffrey W. Zhao
- Department of Neurosurgery, University of Illinois, Chicago, IL, USA,Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jessica Hossa
- Department of Neurosurgery, University of Illinois, Chicago, IL, USA
| | - Mandana Behbahani
- Department of Neurosurgery, University of Illinois, Chicago, IL, USA
| | - Ankit I. Mehta
- Department of Neurosurgery, University of Illinois, Chicago, IL, USA
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Ostrov PB, Reddy AK, Ryoo JS, Behbahani M, Mehta AI. Anterior Cervical Discectomy and Fusion Versus Cervical Disc Arthroplasty: A Comparison of National Trends and Outcomes. World Neurosurg 2022; 160:e96-e110. [PMID: 34973439 DOI: 10.1016/j.wneu.2021.12.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) has been considered the standard treatment for degenerative cervical disc disease; however, recent trials have shown comparable outcomes with cervical disc arthroplasty (CDA). This study aimed to observe disparities in treatment paradigms of single-level cervical disc diseases and compare inpatient outcomes between procedures. METHODS A retrospective cohort of patients treated for single-level cervical disc herniation or degeneration without myelopathy was queried from the Nationwide Inpatient Sample spanning 2012-2015. Multivariate logistic regression was performed to assess the effects of demographics, temporality of admission, and hospital characteristics on odds of receiving CDA versus ACDF. Propensity-score matching was performed to compare cost, length of stay (LOS), non-home discharge, and inpatient complications. RESULTS In total, 1028 CDAs and 44,374 ACDFs were performed for single-level cervical disc disease during 2012-2015. Matched comparison showed that while non-home discharges were not different between CDA and ACDF (P = 0.248), patients who received CDA had a 0.19-day shorter LOS (P < 0.001) and $4694 greater total cost (P < 0.001). There were no statistically significant differences in inpatient complication rates. Multivariate analysis showed that patients in the 26th-50th percentile, 51st-75th percentile, and 76th-100th percentile of median household income had greater odds of CDA compared with patients in the 0-25th percentile (odds ratio [OR] 1.35, P = 0.003; OR 1.31, P = 0.013; OR 1.34, P = 0.011, respectively). Patients with private insurance had greater odds of receiving CDA compared with patients on Medicare (OR 1.91, P < 0.001). CONCLUSIONS CDA was associated with shorter LOS but greater costs compared with ACDF. Patients with greater median income and private insurance were more likely to receive CDA.
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Affiliation(s)
- Philip B Ostrov
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Abhinav K Reddy
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - James S Ryoo
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mandana Behbahani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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Nunna RS, Ostrov PB, Ansari D, Dettori JR, Godolias P, Elias E, Tran A, Oskouian RJ, Hart R, Abdul-Jabbar A, Jackson KL, Devine JG, Mehta AI, Adogwa O, Chapman JR. The Risk of Nonunion in Smokers Revisited: A Systematic Review and Meta-Analysis. Global Spine J 2022; 12:526-539. [PMID: 34583570 PMCID: PMC9121161 DOI: 10.1177/21925682211046899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Systemic review and meta-analysis. OBJECTIVE To review and establish the effect of tobacco smoking on risk of nonunion following spinal fusion. METHODS A systematic search of Medline, Embase, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from inception to December 31, 2020, was conducted. Cohort studies directly comparing smokers with nonsmokers that provided the number of nonunions and fused segments were included. Following data extraction, the risk of bias was assessed using the Quality in Prognosis Studies Tool, and the strength of evidence for nonunion was evaluated using the GRADE working group criteria. All data analysis was performed in Review Manager 5, and a random effects model was used. RESULTS Twenty studies assessing 3009 participants, which included 1117 (37%) smokers, met inclusion criteria. Pooled analysis found that smoking was associated with increased risk of nonunion compared to not smoking ≥1 year following spine surgery (RR 1.91, 95% CI 1.56 to 2.35). Smoking was significantly associated with increased nonunion in those receiving either allograft (RR 1.39, 95% CI 1.12 to 1.73) or autograft (RR 2.04, 95% CI 1.54 to 2.72). Both multilevel and single level fusions carried increased risk of nonunion in smokers (RR 2.30, 95% CI 1.64 to 3.23; RR 1.79, 95% CI 1.12 to 2.86, respectively). CONCLUSION Smoking status carried a global risk of nonunion for spinal fusion procedures regardless of follow-up time, location, number of segments fused, or grafting material. Further comparative studies with robust methodology are necessary to establish treatment guidelines tailored to smokers.
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Affiliation(s)
- Ravi S. Nunna
- Swedish Neuroscience Institute, Seattle, WA, USA,Ravi S. Nunna, MD, Swedish Neuroscience Institute, 1600 E. Jefferson St, Seattle, WA 98122, USA.
| | - Philip B. Ostrov
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Darius Ansari
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | | | | | - Elias Elias
- Swedish Neuroscience Institute, Seattle, WA, USA
| | - Angela Tran
- Swedish Neuroscience Institute, Seattle, WA, USA
| | | | - Robert Hart
- Swedish Neuroscience Institute, Seattle, WA, USA
| | | | - Keith L. Jackson
- Dwight David Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | | | - Ankit I. Mehta
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Owoicho Adogwa
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Fuentes AM, Ansari D, Burch TG, Mehta AI. Use of intraoperative MRI for resection of intracranial tumors: A nationwide analysis of short-term outcomes. J Clin Neurosci 2022; 99:152-157. [PMID: 35279588 DOI: 10.1016/j.jocn.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 02/22/2022] [Accepted: 03/02/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Recent evidence supports the use of intraoperative MRI (iMRI) during resection of intracranial tumors due to its demonstrated efficacy and clinical benefit. Though many single-center investigations have been conducted, larger nationwide outcomes have yet to be characterized. METHODS We used the American College of Surgeons National Surgical Quality Improvement Program database to examine baseline characteristics and 30-day postoperative outcomes among patients undergoing craniotomy for tumor resection with and without iMRI. Comparisons between outcomes were accomplished after propensity matching using chi-square tests for categorical variables and Welch two-sample t-tests for continuous variables. RESULTS A total of 38,003 patients met inclusion criteria. Of this population, 54 (0.1%) received iMRI, while 37,949 (99.9%) did not receive iMRI. After propensity score matching, the resulting groups consisted of an iMRI group (n = 54) and a matched non-iMRI group (n = 54). Procedures involving iMRI were associated with significantly increased operation length compared to those without (p < 0.01). Length of hospital stay was higher in patients without iMRI, with this difference trending towards significance (p = 0.05) in the unmatched comparison. Patients undergoing craniotomy without iMRI had a higher rate of readmission (p = 0.04). There was no significant difference in occurrence of other adverse events between the two patient groups. CONCLUSION Despite increasing operative length, iMRI is not associated with higher infection rate and may have a clinical benefit associated with reducing readmissions and a trend towards reducing inpatient length of stay. Additional nationwide analyses including more iMRI patients would provide further insight into the strength of these findings.
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Affiliation(s)
- Angelica M Fuentes
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Darius Ansari
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Taylor G Burch
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To identify disparities in surgical decision making for lumbar disc pathologies based on patient demographics, hospital characteristics, and temporal characteristics of admission. METHODS A retrospective analysis of patients admitted for surgical intervention of disc herniation or degeneration was performed to observe the effect of demographic, hospital, and admission-related factors on the decision to perform an isolated decompression or decompression with single level fusion using the National Inpatient Sample. RESULTS Of 84 953 patients with lumbar disc pathologies, 69 975 patients were treated electively, and 14 978 patients were treated nonelectively. Hispanic and Asian/Pacific Islander patients were less likely to receive a fusion for elective cases compared with White patients (odds ratio [OR] 0.88, P = .004; OR 0.70, P < .001, respectively). In elective cases, privately insured and self-paying patients were less likely to receive a fusion compared with Medicare patients (OR 0.83, P < .001; OR 0.66, P < .001, respectively), while this effect was limited to self-pay patients in nonelective cases (OR 0.44, P < .001). Urban teaching and nonteaching hospitals were less likely to perform fusions compared with rural hospitals in nonelective cases (OR 0.47, P < .001; OR 0.58, P < .001, respectively). Private for-profit hospitals were associated with higher rates of fusion in both elective and nonelective cases (OR 1.16, P = .003; OR 1.94, P < .001). CONCLUSION This study illustrates disparities in the modality of surgical intervention for lumbar disc pathologies in terms of demographics, hospital characteristics, and temporal characteristics of admission. The development of more evidence-based guidelines is warranted to reduce variability seen in treatment regimens for these conditions.
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Affiliation(s)
- Soobin Kim
- University of Illinois at Chicago, Chicago, IL, USA
| | | | | | | | | | - Ankit I. Mehta
- University of Illinois at Chicago, Chicago, IL, USA,Ankit I. Mehta, Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood Street, 451-N, Chicago, IL 60612, USA.
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Selner A, Arslan D, McGuire LS, Mehta AI. 401 Risk Factors for Increased Mortality in Patients with ICH and COVID-19: Timing Matters. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Khalid SI, Maasarani S, Thomson KB, Pires GR, Becerra A, Adogwa O, Mehta AI, Noland SS, Torquati A. The Effects of Obesity and Bariatric Surgery on Rates of Upper Extremity Compression Neuropathies. Ann Surg Open 2022; 3:e146. [PMID: 37600109 PMCID: PMC10431332 DOI: 10.1097/as9.0000000000000146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives To estimate the effects of obesity on all types of upper extremity compression neuropathies (UECN) (carpal tunnel syndrome and other median nerve, radial nerve, and ulnar nerve compression neuropathies) and to assess whether bariatric surgery modifies these effects. Background UECN are increasingly prevalent and decrease the quality of life of affected individuals. Studies suggest obesity as a risk factor for carpal tunnel syndrome, the most common type of UECN. Methods A retrospective cohort study was conducted using the PearlDiver Mariner Database, an all-payor claims database containing claims for over 53 million patients from 2010 to 2019 in all 50 US states. Rates and odds of all types of UECN were compared between 1:1:1 exact matched cohorts of obese patients who were medically managed, obese patients who underwent bariatric surgery, and nonobese patients (111,967 patients in each cohort). Results Compared with nonobese patients, patients with obesity were significantly more likely to develop any UECN (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.09-1.18), carpal tunnel syndrome (OR, 1.15; 95% CI, 1.10-1.30), and 2 or more UECN (OR, 1.34; 95% CI, 1.20-1.48). Compared with obese patients who were managed medically, obese patients who underwent bariatric surgery were significantly less likely to develop any UECN (OR, 0.87; 95% CI, 0.84-0.91) and carpal tunnel syndrome (OR, 0.85; 95% CI, 0.81-0.89). Conclusions Obese patients have higher odds of both single and concomitant UECN, specifically carpal tunnel syndrome, compared with nonobese patients. Bariatric surgery decreases the odds of developing UECN compared with obese patients not undergoing surgical intervention.
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Affiliation(s)
- Syed I Khalid
- From the Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
- Department of General Surgery, Rush University Medical Center, Chicago, IL
| | | | - Kyle B Thomson
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL
| | - Giovanna R Pires
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Adan Becerra
- Department of General Surgery, Rush University Medical Center, Chicago, IL
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Texas Southwestern Medical School, Dallas, TX
| | - Ankit I Mehta
- From the Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
| | - Shelley S Noland
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, AZ
| | - Alfonso Torquati
- Department of General Surgery, Rush University Medical Center, Chicago, IL
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Nunna RS, Khalid S, Chiu RG, Parola R, Fessler RG, Adogwa O, Mehta AI. Anterior vs Posterior Approach in Multilevel Cervical Spondylotic Myelopathy: A Nationwide Propensity-Matched Analysis of Complications, Outcomes, and Narcotic Use. Int J Spine Surg 2022; 16:88-94. [PMID: 35314510 PMCID: PMC9519084 DOI: 10.14444/8198] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND There is unclear evidence regarding the optimal surgical approach for multilevel cervical spondylotic myelopathy (CSM). The objective of this study was to compare complications, outcomes, and narcotic use in anterior discectomy and fusion (ACDF) vs posterior decompression and fusion (PCDF) in CSM patients. STUDY DESIGN Registry-based retrospective cohort analysis. METHODS Patients undergoing 3-level ACDF or PCDF for CSM between 2007 and 2017 were identified from the Humana Claims Database using relevant procedure codes. Propensity score-matched groups were compared in regards to complications, outcomes, and narcotic use. RESULTS Propensity score matching generated equal cohorts of 6124 patients. The posterior fusion group had a higher rate of urinary tract infection (OR 2.47, P < 0.0001), deep vein thrombosis (OR 1.90, P < 0.0001), and pulmonary embolism (OR 1.75, P < 0.0001). In regards to 30-day outcomes, the posterior approach demonstrated higher rates of stroke (OR 1.68, P < 0.0001), wound dehiscence (OR 5.59, P < 0.0001), Surgical site infection (SSI) (OR 4.76, P < 0.0001), wound revision surgery (OR 3.02, P < 0.0001), and all-cause readmission (OR 2.01, P < 0.0001). One-year outcomes revealed higher rates of pseudarthrosis (4.7% vs 2.0%, OR 2.43, P < 0.0001) and revision or extension surgery (OR 2.33, P < 0.0001) in the posterior fusion cohort. These patients also demonstrated significantly higher mean morphine milligram equivalent used at 30 days (OR 1.19, P < 0.0001), as well as 60 (OR 1.20, P < 0.0001), 90 (OR 1.21, P < 0.0001), and 120 (OR 1.21, P < 0.0001) days. CONCLUSIONS This nationwide propensity-matched analysis of multilevel CSM patients found the posterior approach to be associated with increased rates of inpatient complications, wound complications, 30-day readmission, 1-year pseudarthrosis, and 1-year revision or extension surgery. These patients also demonstrated higher levels of narcotic use up to 120 days after surgery. CLINICAL RELEVANCE The posterior approach for treatment of CSM may be associated with increased rates of short- and long-term complications in addition to increased narcotic consumption in comparison to the anterior approach.
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Affiliation(s)
- Ravi S Nunna
- Department of Neurosurgery, Swedish Medical Center, Seattle, WA, USA
| | - Syed Khalid
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Ryan G Chiu
- Department of Neurosurgery, University of Illinois-Chicago Medical Center, Chicago, IL, USA
| | - Rown Parola
- Department of Neurosurgery, University of Illinois-Chicago Medical Center, Chicago, IL, USA
| | - Richard G Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois-Chicago Medical Center, Chicago, IL, USA
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Ansari D, Guntin JA, Shah P, Patil SN, Patel S, Kumar M, Heron D, Mehta AI. Thrombocytopenia as an Independent Prognostic Indicator Following Extradural Spinal Tumor Resection. World Neurosurg 2022; 160:e199-e208. [PMID: 34990841 DOI: 10.1016/j.wneu.2021.12.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Few studies have examined the prognosis for patients with baseline thrombocytopenia undergoing extradural spine tumor resection. OBJECTIVE To evaluate mortality, readmission, and other 30-day outcomes in patients with varying degrees of preoperative thrombocytopenia undergoing osseous extradural tumor excision. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried from 2011-2019. Patients were categorized according to baseline preoperative platelet count, in 25,000/μL increments: 125,000-149,000/μL, 100,000-125,000/μL, 75,000-100,000/μL, and < 75,000/μL. These were compared to a control group with platelet count >150,000/μL. Outcomes in each cohort were analyzed using multivariate logistic regression analysis. RESULTS The database search revealed 3,574 patients undergoing extradural tumor resection; 2,171 (4.8%) of patients with platelets 125,000-149,000/μL, 114 (3.2%) with 100,000-125,000/μL, 75,000-100,000/μL in 43 (1.2%), and < 75,000/μL in 42 (1.2%). Platelet counts <100,000/μL was associated with perioperative blood transfusion, cardiac complications, and non-home discharge, and 30-day mortality. On subgroup analysis for mortality, an interaction was present between individuals with moderate/severe thrombocytopenia and cervical tumors. CONCLUSION In patients undergoing surgery for extradural spine tumor, degree of baseline thrombocytopenia-rather than presence alone-is an independent predictor of several adverse events. Wherever possible, optimization of preoperative platelet count to at least 100,000/μL may improve outcomes.
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Affiliation(s)
- Darius Ansari
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jordan A Guntin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Pal Shah
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Shashank N Patil
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Megh Kumar
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - David Heron
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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Khalid SI, Eldridge C, Singh R, Chilakapati S, Thomson KB, Shanker RM, Mehta AI, Adogwa O. The influence of social determinants of health on single-level anterior cervical discectomy and fusion outcomes. J Neurosurg Spine 2021:1-6. [PMID: 34920426 DOI: 10.3171/2021.9.spine211059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/28/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Methods of reducing complications in individuals electing to undergo anterior cervical discectomy and fusion (ACDF) rely upon understanding at-risk patient populations, among other factors. This study aims to investigate the interplay between social determinants of health (SDOH) and postoperative complication rates, length of stay, revision surgery, and rates of postoperative readmission at 30 and 90 days in individuals electing to have single-level ACDF. METHODS Using MARINER30, a database that contains claims information from all payers, patients were identified who underwent single-level ACDF between 2010 and 2019. Identification of patients experiencing disparities in 1 of 6 categories of SDOH was completed using ICD-9 and ICD-10 (International Classifications of Diseases, Ninth and Tenth Revisions) codes. The population was propensity matched into 2 cohorts based on comorbidity status: those with SDOH versus those without. RESULTS A total of 10,030 patients were analyzed; there were 5015 (50.0%) in each cohort. The rates of any postoperative complication (12.0% vs 4.6%, p < 0.001); pseudarthrosis (3.4% vs 2.6%, p = 0.017); instrumentation removal (1.8% vs 1.2%, p = 0.033); length of stay (2.54 ± 5.9 days vs 2.08 ± 5.07 days, p < 0.001 [mean ± SD]); and revision surgery (9.7% vs 4.2%, p < 0.001) were higher in the SDOH group compared to patients without SDOH, respectively. Patients with any SDOH had higher odds of perioperative complications (OR 2.8, 95% CI 2.43-3.33), pseudarthrosis (OR 1.3, 95% CI 1.06-1.68), revision surgery (OR 2.4, 95% CI 2.04-2.85), and instrumentation removal (OR 1.4, 95% CI 1.04-2.00). CONCLUSIONS In patients who underwent single-level ACDF, there is an association between SDOH and higher complication rates, longer stay, increased need for instrumentation removal, and likelihood of revision surgery.
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Affiliation(s)
- Syed I Khalid
- 1Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Cody Eldridge
- 2Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Ravinderjit Singh
- 2Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Sai Chilakapati
- 2Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Kyle B Thomson
- 1Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Rachyl M Shanker
- 3Department of Surgery, Loyola University Chicago's Stritch School of Medicine, Maywood, Illinois
| | - Ankit I Mehta
- 1Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Owoicho Adogwa
- 2Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; and
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Khalid SI, Nunna RS, Maasarani S, Shanker RM, Behbahani M, Edmondson CP, Mehta AI, Gupta SK, Chan EY, Torquati A, Byrne RW, Adogwa O. Laparoscopic-Assisted Versus Mini-Open Laparotomy for Ventriculoperitoneal Shunt Placement in the Medicare Population. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa541_s115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chiu RG, Fuentes AM, Patil SN, Chiu R, McGuire LS, Mehta AI. Cannabis Abuse and Perioperative Complications After Treatment of Intracranial Aneurysms: A Nationwide Analysis. World Neurosurg 2021; 158:e184-e195. [PMID: 34757211 DOI: 10.1016/j.wneu.2021.10.156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In the present retrospective cohort analysis, we examined the differences in baseline characteristics and peri- and postoperative outcomes stratified by 3 groups: cannabis abuse or dependence versus none, surgical versus endovascular treatment, and unruptured and ruptured intracranial aneurysms. METHODS A study population of 26,868 patients was defined using the 2009-2016 National Inpatient Sample database. The baseline characteristics were compared between the cannabis and no-cannabis groups, and the traits that differed significantly were factored into the multivariate analysis using 1:1 propensity score matching. The matched groups were analyzed to compare the cannabis and no-cannabis cohorts for the following endpoints: mortality, length of stay, discharge disposition, total hospital charges, and several peri- and postoperative outcomes. RESULTS In the surgically and endovascularly treated groups for unruptured intracranial aneurysms, those in the cannabis group were more likely to be male and younger and to smoke tobacco than were those in the no-cannabis group. After matching, no significant endpoint differences were noted. Similarly, in the surgically and endovascularly treated ruptured aneurysm groups, those in the cannabis group were more likely to be male and younger and to smoke tobacco. After matching, the cannabis group within the endovascular treatment group had had a longer length of stay and were more likely to have developed any hydrocephalus, obstructive hydrocephalus, sepsis, and acute kidney injury. Those in the cannabis group who had undergone surgery were more likely to have developed any hydrocephalus, specifically, communicating hydrocephalus. CONCLUSIONS The cannabis group with ruptured intracranial aneurysms was more likely to experience certain adverse outcomes after surgical or endovascular treatment compared with the no-cannabis group. However, such was not the case for cannabis abusers treated for unruptured aneurysms.
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Affiliation(s)
- Ryan G Chiu
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Angelica M Fuentes
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Shashank N Patil
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Richard Chiu
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Laura S McGuire
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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Chiu RG, Mehta AI. In Reply to the Letter to the Editor Regarding "Racial and Ethnic Disparities in the Inpatient Management of Primary Spinal Cord Tumors". World Neurosurg 2021; 147:240. [PMID: 33685014 DOI: 10.1016/j.wneu.2020.12.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Ryan G Chiu
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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Siddiqui N, Chiu RG, Nunna RS, Glastris G, Mehta AI. Effect of the FDA Safety and Innovation Act on racial and gender diversity in neurosurgical device trials. J Neurosurg 2021; 136:274-281. [PMID: 34171831 DOI: 10.3171/2020.10.jns202155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The US FDA uses evidence from clinical trials in its determination of safety and utility. However, these trials have often suffered from limited external validity and generalizability due to unrepresentative study populations with respect to clinical patient demographics. Section 907 of the FDA Safety and Innovation Act (FDASIA) of 2012 attempted to address this issue by mandating the reporting of certain study demographics in new device applications. However, no study has been performed on its effectiveness in the participant diversity of neurosurgical device trials. METHODS The FDA premarket approval (PMA) online database was queried for all original neurosurgical device submissions from January 1, 2006, to December 31, 2019. Endpoints of the study included racial and gender demographics of reported effectiveness trials, which were summated for each submission. Chi-square tests were performed on both endpoints for before and after years of FDASIA passage and implementation. RESULTS A total of 33 device approvals were analyzed, with 14 occurring before SIA implementation and 19 after. Most trials (96.97%) reported gender to the FDA, while 66.67% reported race and 63.64% reported ethnicity. Gender breakdown did not change significantly post-SIA (53.30% female, p = 0.884). Racial breakdown was significantly different from the 2010 US Census for all races (p < 0.001) both pre- and post-SIA. Only Native American race was significantly different in terms of representation post-SIA, increasing from 0% to 0.63% (p = 0.0187). There was no significant change in ethnicity. CONCLUSIONS The FDASIA, as currently written, does not appear to have had a significant impact on the racial or gender diversity of neurosurgical device clinical trial populations. This may be due to the noncompulsory nature of its guidance, or a lack of more stringent regulation on the composition of clinical trials themselves.
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Affiliation(s)
- Neha Siddiqui
- 1Carle Illinois College of Medicine, University of Illinois, Champaign; and.,2Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Ryan G Chiu
- 2Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Ravi S Nunna
- 2Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Georgia Glastris
- 2Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Ankit I Mehta
- 2Department of Neurosurgery, University of Illinois at Chicago, Illinois
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Ostrov PB, Mehta AI. Commentary: Complications of Cranioplasty in Relation to Material: Systematic Review, Network Meta-Analysis and Meta-Regression. Neurosurgery 2021; 89:E144. [PMID: 34161587 DOI: 10.1093/neuros/nyab216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Philip B Ostrov
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
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Fuentes AM, Chiu RG, Nie J, Mehta AI. Inpatient outcomes of posterior fossa decompression with or without duraplasty for Chiari malformation type I. Clin Neurol Neurosurg 2021; 207:106757. [PMID: 34230005 DOI: 10.1016/j.clineuro.2021.106757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/05/2021] [Accepted: 06/06/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVE Chiari malformation type 1 (CM-1) is a congenital neurologic condition in which the cerebellar tonsils herniate below the foramen magnum, resulting in symptoms such as headache and neck pain. Two common surgical treatment approaches are posterior fossa decompression with (PFDD) and without duraplasty (PFD). Previous single-center studies have demonstrated increased neurologic complications after PFDD compared to PFD. The goal of this study is to determine differences in inpatient complications and hospitalization data among patients treated with these surgical techniques using a nationwide sample. METHODS The National Inpatient Sample (NIS) was queried for years 2012-2015 for all patients with a primary diagnosis of CM-1 who underwent PFD or PFDD. Differences in baseline demographics and comorbidities were accounted for in subsequent analysis using propensity score matching. Hospitalization measures and inpatient complications of the two cohorts were compared using Chi-squared tests and t-tests when appropriate. RESULTS A total of 2395 patients with CM-1 were included in this study, with 750 (31.3%) undergoing PFD and 1645 (68.7%) undergoing PFDD. PFDD was associated with higher total hospital costs than PFD. There were no significant differences in other hospitalization or discharge data, non-neurologic complications, or CNS complications (CSF leak, pseudomeningocele, abscess, meningitis, stroke) between the two surgical groups. CONCLUSIONS This study represents the largest national analysis to date of adult CM-1 patients undergoing PFD or PFDD. Our findings suggest that whether the decision is made to perform the less invasive PFD or more invasive PFDD, inpatient complications and hospitalization data will not significantly differ.
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Affiliation(s)
- Angelica M Fuentes
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Ryan G Chiu
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - James Nie
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Abstract
MINI Due to its complicated legal status, the effects of cannabis on elective spine surgery patients have not been well studied. In this nationwide analysis, we find that cannabis abuse is associated with higher perioperative thromboembolism and neurologic complications, respiratory complications, sepsis, length of stay, hospital charges, and rates of unfavorable discharge disposition.
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Affiliation(s)
- Ryan G Chiu
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
| | - Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
| | - Neha Siddiqui
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
- Carle Illinois College of Medicine, University of Illinois, Champaign, IL
| | - Ravi S Nunna
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
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Khalid SI, Nunna RS, Maasarani S, Shanker RM, Behbahani M, Edmondson CP, Mehta AI, Gupta SK, Chan EY, Torquati A, Byrne RW, Adogwa O. Laparoscopic-Assisted Versus Mini-Open Laparotomy for Ventriculoperitoneal Shunt Placement in the Medicare Population. Neurosurgery 2021; 88:812-818. [PMID: 33475722 DOI: 10.1093/neuros/nyaa541] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/10/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Placement of the distal shunt catheter into the peritoneum during ventriculoperitoneal shunt (VPS) surgery can be done with either laparoscopic assistance or laparotomy. OBJECTIVE To compare outcomes in laparoscopic-assisted vs laparotomy for placement of VPS in the Medicare population. METHODS Patients undergoing VPS placement, between 2004 and 2014, were identified by International Classification of Disease, Ninth Revision and Current Procedural Terminology codes in the Medicare database. Demographic data including age, sex, comorbidities, and indications were collected. Six- and twelve-month complication rates were analyzed. RESULTS A total of 1966 (3.2%) patients underwent laparoscopic-assisted VPS and 60 030 (96.8%) patients underwent nonlaparoscopic-assisted VPS placement. Compared with traditional open VPS placement, the laparoscopic approach was associated with decreased odds of distal revision at 6- and 12-mo postoperatively (6 mo: odds ratio [OR] = 0.41, 95% confidence interval [CI]: 0.21-0.74; 12 mo: OR = 0.60, 95% CI: 0.39-0.94). At 6- and 12-mo postoperatively, multivariable regression analysis demonstrated increased odds of distal revision in patients with a body mass index (BMI) > 30 Kg/M2, history of open abdominal surgery, and history of laparoscopic abdominal surgery. Additionally, history of prior abdominal surgery and BMI > 30 Kg/M2 were significantly associated with increase odds of shunt infection at 6 and 12-mo, respectively. CONCLUSION In the largest retrospective analysis to date, patients with a history of abdominal surgery and obesity were found to be at increased risk of infection and distal revision after VPS placement. However, the laparoscopic approach for abdominal placement of the distal catheter was associated with reduced rates of distal revision in this population, suggesting an avenue for reducing complications in well-selected patients.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL
| | - Ravi S Nunna
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Samantha Maasarani
- Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois
| | - Rachyl M Shanker
- Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois
| | - Mandana Behbahani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Corbin P Edmondson
- Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Samir K Gupta
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL
| | - Edie Y Chan
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL
| | - Alfonso Torquati
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL
| | - Richard W Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Texas Southwestern Medical School, Dallas, Texas
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Mudreac A, Behbahani M, Chiu RG, Patil SN, Reddy AK, Khalid SI, Mehta AI. Pediatric cerebral cysts: comparison of early complications following fenestration versus shunting procedures. Neurol Res 2021; 43:736-743. [PMID: 33966614 DOI: 10.1080/01616412.2021.1922183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: Characterize practice patterns and acute (30-day) surgical complications following fenestration and shunt procedures for the treatment of cerebral cysts in pediatric patients.Methods: This study utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database. Patients were identified by International Classification of Disease codes for cerebral cysts and Current Procedural Terminology codes for shunting or fenestration. Demographic data, preoperative comorbidities, and postoperative complications were compared between the two procedures.Results: 741 patients were included in the data analysis, with a majority aged 4 years or younger (55.9%) and a male predominance (62.6%). Fenestration was performed in 590 (79.6%) patients. Primary shunting was performed in 151 (20.4%) patients. Patients who received shunts were more commonly aged 0-4 years and had proportionately worse preoperative health status. No statistically significant differences in postoperative complications were detected. Reoperation rate was 7.9% and 8.6% in the shunt and fenestration groups, respectively. Common reasons for reoperation were shunt revision or replacement and shunt placement after fenestration. Patients requiring shunting after a failed fenestration tended to be younger with higher American Society of Anesthesiologists (ASA) classification.Discussion: Fenestrations are performed more often than shunting. Generally, children who receive shunts are younger than those who undergo fenestration. Acute surgical risk appears to be similar for both operations.
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Affiliation(s)
- Andrew Mudreac
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Mandana Behbahani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Ryan G Chiu
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Shashank N Patil
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Abhinav K Reddy
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Syed I Khalid
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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Behbahani M, Rosinski CL, Chaudhry NS, Chaker AN, Chiu RG, Du X, Mehta AI, Arnone GD, Amin-Hanjani S. Optimal timing and sequence of ventriculoperitoneal shunt and gastrostomy placement. Neurol Res 2021; 43:708-714. [PMID: 33944706 DOI: 10.1080/01616412.2021.1922174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: The optimal timing of ventriculoperitoneal shunt (VPS) and gastrostomy placement, relative to the safety of simultaneous versus staged surgery, has not been clearly delineated in the literature.Objective: To study the optimal inter-procedural timing relative to distal VPS infection and pertinent reoperation.Methods: A fifteen-year, retrospective, single-center study was conducted on adults undergoing VPS and gastrostomy within 30-days. Patients were grouped according to inter-procedural interval: 0-24 hr (immediate), 24 hr-7 days (early), and 7-30 days (delayed). The primary endpoint of the study was VPS infection and distal shunt complications requiring reoperation. Potential predictors of the primary end point (baseline cohort characteristics, procedural factors) were examined with standard statistical methods.Results: A total of 188 patients met inclusion criteria. The average interval between procedures was 7 ± 6 days, with 43.1% undergoing VPS prior to gastrostomy. Primary endpoint was encountered in 5 patients (2.7%): 1 (5.9%) of 17 patients undergoing immediate placement, 3 (2.8%) of 107 with early placement, and 1 (1.6%) of 64 with delayed placement. Although not statistically significant, 3.7% of patients undergoing VPS first had the primary endpoint, compared to 1.9% of those with gastrostomy. There were no statistically significant associations between the primary outcome and peri-operative CSF counts, gastrostomy modality, hydrocephalus etiology, chronic steroid use, or extended antibiotic administration.Conclusion: Although the low overall event rate in this cohort precludes definitive determination regarding differential safety, the data generally support a practice of performing the procedures >24-hours apart, with placement of gastrostomy prior to VPS.
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Affiliation(s)
- Mandana Behbahani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Il, USA
| | - Clayton L Rosinski
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Il, USA
| | - Nauman S Chaudhry
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Il, USA
| | - Anisse N Chaker
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Il, USA
| | - Ryan G Chiu
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Il, USA.,Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
| | - Xinjian Du
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Il, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Il, USA
| | - Gregory D Arnone
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Il, USA.,Department of Neurosurgery, Penn State College of Medicine, Hershey, PA, USA
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Patel S, Parola R, Rosinski CL, Nunna RS, Mehta AI. Fenestrated Pedicle Screws in Spinal Oncology: Technique and Comparative Retrospective Analysis. Int J Spine Surg 2021; 15:113-118. [PMID: 33900964 DOI: 10.14444/8015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The use of spinal stabilization with decompression has been shown to improve survival, spinal stability, and ambulatory status in patients with metastatic spinal tumors. However, the poor bone quality typically seen in these patients can prevent adequate stabilization. Fenestrated pedicle screws permit augmented fixation via injection of bone cement into the vertebral body upon screw placement, potentially mitigating the difficulties in achieving adequate stabilization in these patients. OBJECTIVE To compare surgical outcomes of posterior spinal fusion in patients with cancerous spinal lesions between polymethyl methacrylate cement-augmented fenestrated screws and standard pedicle screws. METHODS A total of 19 consecutive patients with cancerous spinal lesions receiving posterior spinal fusion (PSF) with pedicle screws from a single surgeon were retrospectively reviewed for demographic information, comorbidities, surgical parameters, and outcomes. RESULTS Ten patients underwent PSF with cement augmentation, whereas 9 underwent standard PSF. There was no significant difference in demographics, comorbidities, or surgical characteristics. Operative time was significantly greater in the cement-augmented group (302 ± 100 minutes vs 203 ± 55 minutes; P = .015). There was no significant difference in rates of operation or readmission between the cohorts nor was there any significant difference in discharge disposition. There was 1 case of surgical site infection (in a patient with a fenestrated screw) and no cases of cement extravasation. No instances of mechanical hardware failure were recorded. CONCLUSIONS Fenestrated screws confer similar risk profiles as nonfenestrated screws for posterior spinal fusion in patients with spinal cancer. However, fenestrated screws may affect operative time, radiation exposure, and impose risk of cement extravasation. Cement-augmented fenestrated pedicle screws may be a viable option for patients with poor bone quality associated with metastatic disease without significantly increased rates of surgical complications. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Rown Parola
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Clayton L Rosinski
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Ravi S Nunna
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
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Fuentes AM, Chiu RG, Mehta AI. Disparities in the symptomatic presentation of Moyamoya disease in the United States: A nationwide all-payer analysis. J Clin Neurosci 2021; 87:92-96. [PMID: 33863543 DOI: 10.1016/j.jocn.2021.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/19/2020] [Accepted: 02/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Moyamoya disease is a chronic occlusive cerebrovascular disease that can present with either hemorrhagic or ischemic symptoms. The objective of this study was to evaluate whether the symptomatology of Moyamoya disease differs according to patient demographic groups. METHODS In this study, we used the Nationwide Inpatient Sample (NIS) to investigate differences in the presentation of Moyamoya disease by age group, gender, and ethnicity from 2012 to 2016. After propensity score matching was utilized to control for overall comorbidity, the matched cohorts for each symptomatology were compared using a Chi-square test with respect to the potential risk factors of interest (i.e. age, sex, ethnicity) in order to generate multivariate reported P-values. RESULTS A total of 4,474 patients met inclusion criteria. Patients presenting with ischemic stroke were more likely to be 65 years and older (p < 0.001); patients presenting with intracranial hemorrhage (ICH) were more likely to be 65 years and older (p < 0.001), male (p = 0.027), and Asian (p = 0.007); those presenting with seizure were more likely to be less than 10 years old (p = 0.002) and African American (p < 0.001); and those presenting with headache were more likely to be between 10 and 19 years old (p = 0.008). CONCLUSIONS Our findings demonstrate that the distinct presentations of Moyamoya are associated with patient age, gender, and race. This is the largest study of its kind and adds to the collective understanding of this rare but life-threatening condition.
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Affiliation(s)
- Angelica M Fuentes
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Ryan G Chiu
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Patel S, Nunna RS, Ryoo JS, Ansari D, Chaudhry NS, Mehta AI. Outcomes and Patterns of Care in Adult Skull Base Chondrosarcoma Patients in the United States. World Neurosurg 2021; 150:71-83. [PMID: 33785427 DOI: 10.1016/j.wneu.2021.03.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Chondrosarcomas of the skull base are rare intracranial tumors of chondroid origin. The rarity of these lesions has made it difficult to form a consensus on optimal treatment regimens. The aim of this study was to provide a comprehensive analysis of prognostic factors, treatment modalities, and survival outcomes in patients with chondrosarcoma of the skull base. METHODS Patients with diagnosis codes for chondrosarcoma of the skull base were queried from the National Cancer Database for the years 2004-2016. Outcomes were investigated using Cox univariate and multivariate regression analyses, and survival curves were generated for comparative visualization. RESULTS A total of 718 patients with chondrosarcoma of the skull base were identified. Mean overall survival (OS) in these patients was 10.7 years. Older age and presence of metastases were associated with worsened OS. Of patients, 83.3% received surgical intervention, and both partial resection and radical resection were associated with significantly improved OS (P < 0.001). Neither radiotherapy nor chemotherapy improved OS; however, patients who received proton-based radiation and patients who received high-dose radiation (≥6000 cGy) had significantly improved OS compared with patients who received traditional radiation. CONCLUSIONS In the largest study to our knowledge of skull base chondrosarcoma to date, both partial resection and radical resection significantly improved OS, thus supporting the goal of maximal safe resection to preserve vital neurovascular structures without sacrificing outcome. In patients who received radiotherapy, proton-based modalities and high-dose radiation were associated with increased OS.
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Affiliation(s)
- Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ravi S Nunna
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - James S Ryoo
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Darius Ansari
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Nauman S Chaudhry
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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