1
|
Desai A, Butke J, Herring EZ, Labak CM, Mauria R, Mahajan UV, Ronald A, Gerges C, Sajatovic M, Kasliwal MK. Indication as a predictor for outcomes in anterior cervical discectomy and fusion: The impact of myelopathy on disposition. Clin Neurol Neurosurg 2024; 236:108092. [PMID: 38134756 DOI: 10.1016/j.clineuro.2023.108092] [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: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND While the indication for Anterior Cervical Discectomy and Fusion (ACDF) may influence the expected postoperative course, there is limited data comparing how length of stay (LOS) and disposition for patients with myelopathy differ from those with radiculopathy. This study aimed to compare LOS and discharge disposition, in patients undergoing ACDF for cervical radiculopathy versus those for myelopathy. METHODS A retrospective review of all adult ACDF cases between 2013 and 2019 was conducted analyzing sex, age, race, comorbidities, level of surgery, myelopathy measures when applicable, complications, dysphagia, hospital LOS, and discharge disposition. RESULTS A total of 157 patients were included in the study with 73 patients undergoing an ACDF for radiculopathy and 84 for myelopathy. Univariate analysis determined older age (p < 0.01), male sex (p = 0.03), presence of CKD (p < 0.01) or COPD (p = 0.01), surgery at C3/4 level (p = 0.01), and indication (p < 0.01) as predictors for a discharge to either acute rehabilitation or a skilled nursing facility rather than to home. Multivariate logistic regression demonstrated age and indication as the only independent predictors of disposition, with home disposition being more likely with decreased age (OR 0.92, 95 % CI 0.86-0.98) and radiculopathy as the diagnosis (OR 6.72, 95 % CI 1.22- 37.02). CONCLUSIONS Myelopathic patients, as compared to those with radiculopathy at presentation, had significantly longer LOS, increased dysphagia, and were more often discharged to a facility. Understanding these two distinct populations as separate entities will streamline the pre and post-surgical care as the current DRG codes and ICD 10 PCS do not differentiate the expected post-operative course in patients undergoing ACDF for myelopathy versus radiculopathy.
Collapse
Affiliation(s)
- Ansh Desai
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Jeffrey Butke
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Eric Z Herring
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Collin M Labak
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Rohit Mauria
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Uma V Mahajan
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Andrew Ronald
- Department of Orthopedic Surgery, Boston University, Boston, MA, United States
| | - Christina Gerges
- Department of Neurological Surgery, Oregon Health and Science University, Portland, OR, United States
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Manish K Kasliwal
- Case Western Reserve University School of Medicine, Cleveland, OH, United States; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
| |
Collapse
|
2
|
Mazur-Hart DJ, Godil JA, Larson EW, Nugent JG, Gerges C, Pettersson DR, Ross DA. Evaluating Surgical Cervical Arthrodesis With a Novel MRI Grading Score. Clin Spine Surg 2023; 36:E493-E498. [PMID: 37448138 DOI: 10.1097/bsd.0000000000001487] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023]
Abstract
STUDY DESIGN This was a single-institution retrospective study. OBJECTIVE Evaluate a magnetic resonance imaging (MRI)-scoring system to differentiate arthrodesis from pseudoarthrosis following anterior cervical discectomy and fusion. SUMMARY OF BACKGROUND DATA Diagnostic workup following fusion surgery often includes MRI to evaluate neural structures and computed tomography (CT) and/or dynamic x-rays to evaluate instrumentation and arthrodesis. The use of MRI alone for these evaluations would protect patients from harmful CT and x-ray ionizing radiation. METHODS Neurosurgical attending evaluated CTs for arthrodesis or pseudoarthrosis. Blinded neuroradiology attending and neurosurgery senior resident evaluated independent T1 and T2 region of interest (ROI) signal intensity over instrumented disk space. Cerebral spinal fluid (CSF) at the cisterna magnum and distal adjacent uninstrumented vertebral body (VB) were also calculated. ROI interspace /ROI CSF and ROI interspace /ROI VB quotients were used to create T1- and T2-interspace interbody scores (IIS). RESULTS Study population (n=64 patients, 50% female) with a mean age of 51.72 years and 109 instrumented levels with 45 fused levels (41.3%) were included. T1-weighted MRI, median T1-IIS CSF for arthrodesis was 176.20 versus 130.92 for pseudoarthrosis ( P <0.0001), T1-IIS VB for arthrodesis was 68.52 and pseudoarthrosis was 52.71 ( P <0.0001). T2-weighted MRI, median T2-IIS CSF for arthrodesis was 27.72 and 14.21 for pseudoarthrosis ( P <0.0001), while T2-IIS VB for arthrodesis was 67.90 and 41.02 for pseudoarthrosis ( P <0.0001). The greatest univariable discriminative capability for arthrodesis via AUROC was T1-IIS VB (0.7743). CONCLUSION We describe a novel MRI scoring system that may help determine arthrodesis versus pseudoarthrosis following anterior cervical discectomy and fusion. Postoperative symptomatic patients may only require MRI, which would protect patients from ionizing radiation. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Donald A Ross
- Department of Neurological Surgery
- Operative Care Division, Portland Veterans Affairs Medical Center, Portland, OR
| |
Collapse
|
3
|
Gerges C, Raghavan A, Wright J, Shammassian B, Wright CH, Moore T. Cervical, thoracolumbar, and sacral spine trauma classifications: past, present, and future. Neurol Res 2023; 45:877-883. [PMID: 32758096 DOI: 10.1080/01616412.2020.1797373] [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: 05/29/2019] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Traumatic spine injuries are a relatively common occurrence and are associated with functional impairment, loss of neurologic function, and spinal deformity. A number of spinal trauma classification systems have been developed with varying degrees of acceptance. This review provides a chronological overview of spinal trauma classification systems, with special consideration towards the benefits and pitfalls related to each. Cervical, thoracolumbar, and sacral trauma classification systems are discussed. METHODS A review of the literature was performed. Published articles that reported on bony spinal trauma classification systems were examined. No year exemptions were identified. The reference lists of all selected articles were screened for additional studies. Article inclusion and exclusion criteria were defined a priori. RESULTS A total of 20 classification systems were identified from years 1938-2017. Of these 20 classification systems, 6 were cervical, 11 were thoracolumbar and 3 were sacral. The modernization of bony spinal trauma classification has been characterized by the development of weighted scales that include injury morphology, integrity of associated ligamentous structures and neurologic status. CONCLUSION For widespread acceptance and adoption in the clinical setting, future spinal trauma scoring classification will need to remain simple, highly reproducible, and impart information with regard to clinical decision-making and prognosis that may be effectively communicated across each medical specialty involved in the care of these patients.
Collapse
Affiliation(s)
- Christina Gerges
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - James Wright
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Berje Shammassian
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christina Huang Wright
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Timothy Moore
- Department of Orthopaedics, MetroHealth Medical Center, Cleveland, OH, USA
| |
Collapse
|
4
|
Mazur-Hart D, Larson EW, Gerges C, Nugent JG, Pettersson D, Ross DA. 485 Evaluating Surgical Arthrodesis With Novel MRI Grading Score. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_485] [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: 03/18/2023] Open
|
5
|
Johnson RA, Eaton A, Tignanelli CJ, Carrabre KJ, Gerges C, Yang GL, Hemmila MR, Ngwenya LB, Wright JM, Parr AM. Changes in patterns of traumatic brain injury in the Michigan Trauma Quality Improvement Program database early in the COVID-19 pandemic. J Neurosurg 2023; 138:465-475. [PMID: 35901671 DOI: 10.3171/2022.5.jns22244] [Citation(s) in RCA: 1] [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: 01/29/2022] [Accepted: 05/17/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The authors' objective was to investigate the impact of the global COVID-19 pandemic on hospital presentation and process of care for the treatment of traumatic brain injuries (TBIs). Improved understanding of these effects will inform sociopolitical and hospital policies in response to future pandemics. METHODS The Michigan Trauma Quality Improvement Program (MTQIP) database, which contains data from 36 level I and II trauma centers in Michigan and Minnesota, was queried to identify patients who sustained TBI on the basis of head/neck Abbreviated Injury Scale (AIS) codes during the periods of March 13 through July 2 of 2017-2019 (pre-COVID-19 period) and March 13, 2020, through July 2, 2020 (COVID-19 period). Analyses were performed to detect differences in incidence, patient characteristics, injury severity, and outcomes. RESULTS There was an 18% decrease in the rate of encounters with TBI in the first 8 weeks (March 13 through May 7), followed by a 16% increase during the last 8 weeks (May 8 through July 2), of our COVID-19 period compared with the pre-COVID-19 period. Cumulatively, there was no difference in the rates of encounters with TBI between the COVID-19 and pre-COVID-19 periods. Severity of TBI, as measured with maximum AIS score for the head/neck region and Glasgow Coma Scale score, was also similar between periods. During the COVID-19 period, a greater proportion of patients with TBI presented more than a day after sustaining their injuries (p = 0.046). COVID-19 was also associated with a doubling in the decubitus ulcer rate from 1.0% to 2.1% (p = 0.002) and change in the distribution of discharge status (p = 0.01). Multivariable analysis showed no differences in odds of death/hospice discharge, intensive care unit stay of at least a day, or need for a ventilator for at least a day between the COVID-19 and pre-COVID-19 periods. CONCLUSIONS During the early months of the COVID-19 pandemic, the number of patients who presented with TBI was initially lower than in the years 2017-2019 prior to the pandemic. However, there was a subsequent increase in the rate of encounters with TBI, resulting in overall similar rates of TBI between March 13 through July 2 during the COVID-19 period and during the pre-COVID-19 period. The COVID-19 cohort was also associated with negative impacts on time to presentation, rate of decubitus ulcers, and discharge with supervision. Policies in response to future pandemics must consider the resources necessary to care for patients with TBI.
Collapse
Affiliation(s)
- Reid A Johnson
- 1University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Anne Eaton
- 2Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
| | - Christopher J Tignanelli
- 3Department of Surgery, University of Minnesota, Minneapolis, Minnesota.,4Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota
| | - Kailey J Carrabre
- 1University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Christina Gerges
- 5Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon
| | - George L Yang
- 6Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio
| | - Mark R Hemmila
- 7Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan; and
| | - Laura B Ngwenya
- 6Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio
| | - James M Wright
- 5Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon
| | - Ann M Parr
- 8Department of Neurosurgery, Stem Cell Institute, University of Minnesota, Minneapolis, Minnesota
| | | |
Collapse
|
6
|
Gerges C, Pistritto AM, Gerges M, Friewald R, Hofbauer T, Hartig V, Dannenberg V, Skoro-Sajer N, Moser B, Taghavi S, Klepetko W, Lang IM. Chronic thromboembolic pulmonary hypertension and left ventricular filling pressures. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1911] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by chronic obstruction of major pulmonary arteries with organized thrombi and is classified as pre-capillary pulmonary hypertension (PH) by the current hemodynamic definition of the guidelines. However, clinical risk factors for PH due to left heart disease including features of the metabolic syndrome, left-sided valvular heart disease and stable ischemic heart disease can be frequently observed in patients with CTEPH. The aim of this study was to investigate the prevalence, mechanisms and prognostic implications of elevated left ventricular filling pressures (LVFP) in patients with CTEPH.
Methods
394 consecutive CTEPH patients undergoing a first diagnostic right and left heart catheterization were included in this study. mPAWP and LVEDP were utilized for assessment of LVFP. Two cutoffs were applied to identify patients with elevated LVFP: (1) mPAWP and/or LVEDP >15 mmHg as recommended by the current PH guidelines and (2) mPAWP and/or LVEDP >11 mmHg, which is the upper limit of normal in healthy subjects. Clinical and echocardiographic features as well as long-term mortality data were assessed.
Results
LVFP was >15 mmHg in 41 (10.4%) and >11 mmHg in 155 patients (39.3%). Univariable logistic regression analysis identified age, body mass index, systemic hypertension, diabetes, atrial fibrillation, mitral regurgitation and left atrial volume as significant clinical predictors of elevated LVFP. Systemic hypertension, atrial fibrillation, mitral regurgitation and left atrial volume remained independent determinants of LVFP in adjusted analysis. LVFP >11 mmHg was associated with worse long-term survival (p-logrank = 0.020).
Conclusions
Elevated LVFP is common in patients with CTEPH at the time of diagnosis. Elevated LVFP in CTEPH appears to be due to comorbid left heart disease. CTEPH patients with LVFP >11 mmHg have worse outcomes.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- C Gerges
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| | - A M Pistritto
- S.Elia Hospital of Caltanissetta, Department of Cardiology , Caltanissetta , Italy
| | - M Gerges
- Klinik Favoriten, Department of Internal Medicine V, Division of Cardiology , Vienna , Austria
| | - R Friewald
- Krems University Hospital, Department of Internal Medicine I, Division of Cardiology , Krems An Der Donau , Austria
| | - T Hofbauer
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| | - V Hartig
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| | - V Dannenberg
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| | - N Skoro-Sajer
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| | - B Moser
- Medical University of Vienna, Department of Thoracic Surgery , Vienna , Austria
| | - S Taghavi
- Medical University of Vienna, Department of Thoracic Surgery , Vienna , Austria
| | - W Klepetko
- Medical University of Vienna, Department of Thoracic Surgery , Vienna , Austria
| | - I M Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| |
Collapse
|
7
|
Uphus J, Hu JR, Huang S, Panzenboeck A, Sadushi-Kolici R, Shafran I, Skoro-Sajer N, Gerges C, Brittain E, Lang IM. The prognostic value of vasoresponse to nitric oxide in patients with chronic thromboembolic pulmonary hypertension. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1930] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by pulmonary artery obstructions due to organized chronic thrombotic material in major pulmonary arteries. In addition, about half of the patients suffer from a small vessel pulmonary arteriopathy that is a strong predictor of outcomes. Currently available treatment of CTEPH includes interventional strategies such as pulmonary endarterectomy (PEA) and balloon pulmonary angioplasty (BPA), and non-interventional strategies with PH-specific medications. A simple way of assessing small vessel disease is the degree of vasodilation (“vasoresponse”) in response to inhaled nitric oxide (iNO). In idiopathic pulmonary arterial hypertension vasoresponse serves as the best marker for good prognosis and treatment selection. In CTEPH, the prognostic value of vasoresponse remains unclear.
Purpose
We investigated the prognostic value of three definitions of vasoresponse to nitric oxide in patients with CTEPH.
Methods
We studied 325 CTEPH patients who underwent baseline diagnostic right heart catheterization (RHC) with 40ppm iNO testing at a general hospital (AKH) between 1995 and 2019. Cox regression models, adjusting for covariates including age, sex, comorbidities, and markers for disease severity at baseline, such as proBNP, GFR, NYHA functional class, were used to determine the risk of death or lung transplantation with respect to vasoresponse. We analysed three currently used definitions of vasoresponse to nitric oxide – the classical definition (CD) as a 10mmHg reduction in mPAP to a level below 40mmHg; an absolute definition (AD) as a 10mmHg reduction in mPAP regardless of resulting mPAP; and the percent definition (PD) as a 10% reduction in mPAP regardless of resulting mPAP.
Results
Patients had a median age of 62 (interquartile range [IQR]: 50, 71) at time of baseline right heart catheterization and 50% were female. During a median observation time of 5 years (IQR: 2.2, 9.0), the combined endpoint of death or lung transplantation occurred in 88 cases (27%). In the cox regression model PD vasoresponders, showed improved survival when undergoing PEA (p=0.0019). In PD vasoresponsive patients who were not given PEA surgery (n=66), PH medication therapy was associated with improved survival (p=0.0053), whereas BPA had no association with survival (p=0.58). In PD non-vasoresponsive patients who were not given PEA surgery (n=107) BPA improved survival (p<0.0001), whereas PH medication therapy did not improve survival (p=0.08).
Conclusion
The PD vasoresponse to iNO carries valuable prognostic information about freedom from death or lung transplantation in patients with CTEPH. In patients who are not eligible for PEA, PD vasoresponse can improve optimal therapy selection.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- J Uphus
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| | - J R Hu
- Yale University, Department of Internal Medicine, Section of Cardiovascular Medicine , New Haven , United States of America
| | - S Huang
- Vanderbilt University Medical Center, Department of Medicine, Division of Cardiovascular Medicine , Nashville , United States of America
| | - A Panzenboeck
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| | - R Sadushi-Kolici
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| | - I Shafran
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| | - N Skoro-Sajer
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| | - C Gerges
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| | - E Brittain
- Vanderbilt University Medical Center, Department of Medicine, Division of Cardiovascular Medicine , Nashville , United States of America
| | - I M Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology , Vienna , Austria
| |
Collapse
|
8
|
Gerges C, Malloy P, Rabah N, Defta D, Duan Y, Wright CH, van Keulen M, Wright J, Mowry S, Megerian CA, Bambakidis N. Functional Outcomes and Postoperative Cerebral Venous Sinus Thrombosis after Translabyrinthine Approach for Vestibular Schwannoma Resection: A Radiographic Demonstration of Anatomic Predictors. Skull Base Surg 2022; 83:e89-e95. [DOI: 10.1055/s-0040-1722716] [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: 08/01/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
Abstract
Introduction While regarded as an effective surgical approach to vestibular schwannoma (VS) resection, the translabyrinthine (TL) approach is not without complications. It has been postulated that postoperative cerebral venous sinus thrombosis (pCVST) may occur as a result of injury and manipulation during surgery. Our objective was to identify radiologic, surgical, and patient-specific risk factors that may be associated with pCVST.
Methods The Institutional Review Board (IRB) approval was obtained and the medical records of adult patients with VS who underwent TL craniectomy at University Hospitals Cleveland Medical Center between 2009 and 2019 were reviewed. Demographic data, radiographic measurements, and tumor characteristics were collected. Outcomes assessed included pCVST and the modified Rankin score (mRS).
Results Sixty-one patients ultimately met inclusion criteria for the study. Ten patients demonstrated radiographic evidence of thrombus. Patients who developed pCVST demonstrated shorter internal auditory canal (IAC) to sinus distance (mean: 22.5 vs. 25.0 mm, p = 0.044) and significantly smaller petrous angles (mean: 26.3 vs. 32.7 degrees, p = 0.0045). Patients with good mRS scores (<3) appeared also to have higher mean petrous angles (32.5 vs. 26.8, p = 0.016). Koos' grading and tumor size, in our study, were not associated with thrombosis.
Conclusion More acute petrous angle and shorter IAC to sinus distance are objective anatomic variables associated with pCVST in TL surgical approaches.
Collapse
Affiliation(s)
- Christina Gerges
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Patrick Malloy
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Nicholas Rabah
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Dana Defta
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | - Yifei Duan
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | - Christina H. Wright
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | - Marte van Keulen
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | - James Wright
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | - Sarah Mowry
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
- Department of Otolaryngology, Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | - Cliff A. Megerian
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
- Department of Otolaryngology, Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| | - Nicholas Bambakidis
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
| |
Collapse
|
9
|
Yang GL, Johnson MD, Solomon D, Ferguson AM, Johnson RA, Gerges C, Wright JM, Parr AM, Ngwenya LB. The Effects of the COVID-19 Pandemic on Penetrating Neurotrauma at a Level 1 Trauma Center. World Neurosurg 2022; 164:e530-e539. [PMID: 35552030 PMCID: PMC9085351 DOI: 10.1016/j.wneu.2022.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/03/2022] [Indexed: 11/19/2022]
Abstract
Background/Objective The COVID-19 pandemic has had a profound impact on the global delivery of health care. Recent data suggest a possible impact of the pandemic on patterns of neurotrauma. The aim was to assess the impact of the pandemic on the incidence of neurotrauma, with a focus on cranial gunshot wounds (cGSWs) at a large Midwestern level 1 trauma center. Methods We conducted a retrospective review of our trauma registry from March through September 2020 and compared it to the same months in 2019. Odds ratios were utilized to assess for differences in patient demographics, injury characteristics, rates of neurotrauma, and rates of cGSWs. Results A total of 1188 patients presented with neurotrauma, 558 in 2019 and 630 in 2020. The majority of patients were male (71.33% in 2019; 68.57% in 2020) and Caucasian (78.67% in 2019; 75.4% in 2020). Patients presented with cGSWs more frequently in 2020 (n = 49, 7.78%) than in 2019 (n = 25, 4.48%). The odds of suffering a cGSW in 2020 was 73.6% higher than those in 2019 (95% confidence interval = [1.0871, 2.7722]; P = 0.0209). The etiology of such injury was most commonly assault (n = 16, 21.62% in 2019; n = 34, 45.95% in 2020), followed by self-inflicted injury (n = 4, 5.41% in 2019; 12, 16.22% in 2020). Conclusions Despite the government-mandated shutdown, we observed an increase in the number of neurotrauma cases in 2020. There was a significant increase in the incidence cGSWs in 2020, with an increase in assaults and self-inflicted injuries. Further investigation into socioeconomic factors for the observed increase in cGSWs is warranted.
Collapse
Affiliation(s)
- George L Yang
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA; Collaborative for Research on Acute Neurological Injury (CRANI), University of Cincinnati, Cincinnati, Ohio, USA; University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
| | - Mark D Johnson
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA; Collaborative for Research on Acute Neurological Injury (CRANI), University of Cincinnati, Cincinnati, Ohio, USA; University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daniel Solomon
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew M Ferguson
- Department of Psychiatry, University of Cincinnati, Cincinnati, Ohio, USA; University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Reid A Johnson
- University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christina Gerges
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - James M Wright
- Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Ann M Parr
- Department of Neurosurgery, Stem Cell Institute, University of Minnesota, Minneapolis, Minnesota, USA
| | - Laura B Ngwenya
- Department of Neurosurgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA; Collaborative for Research on Acute Neurological Injury (CRANI), University of Cincinnati, Cincinnati, Ohio, USA; Department of Neurology & Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA; University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
10
|
Yang GL, Johnson MD, Solomon D, Ferguson A, Wright JM, Johnson RA, Gerges C, Parr AM, Ngwenya LB. 320 The Effects of the COVID-19 Pandemic on Penetrating Neurotrauma at a Level 1 Trauma Center. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_320] [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
|
11
|
Mulligan KM, Pan X, Gerges C, Rabah NM, Selden NR, Wolfe SQ, Wright CH, Wright JM. The 2021 Neurosurgery Match: An analysis of the impact of virtual interviewing and other COVID-19 related changes. World Neurosurg 2021; 162:e8-e13. [PMID: 34864190 PMCID: PMC8989630 DOI: 10.1016/j.wneu.2021.11.109] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/18/2022]
Abstract
Given safety concerns during the COVID-19 pandemic, residency programs suspended away rotations in 2021 and the interview process transitioned to a virtual video format. In this study, we assessed the extent to which these changes affected match outcomes and if medical school ranking, international graduate status, or affiliation with a home neurosurgery program affected these outcomes. A cross-sectional analysis of neurosurgery match data from 2016-2021 was performed, and match outcomes were assessed based on matched program geography and program research ranking. Chi square tests were performed to identify significant differences between 2021 and 2016-2020 match results. A total of 1324 confirmed matched neurosurgery residents were identified from 2016-2021 (2016-2020: n=1113, 2021: n=211). There was no statistically significant difference in the rates of matching at a home program, within state, or within region between 2021 and 2016-2020 in the overall cohort. Proportions of international graduates and students without home programs among matched applicants were unchanged in 2021. In 2021, students from top 25 medical schools were less likely to match within their state or region (p<.05). Our findings may reflect an enhanced weighting given by programs to applicants from top medical schools in the absence of data from in-person rotations and interviews. These findings, coupled with the potential benefits of an increasingly virtual application process in improving equity and diversity among candidates from underrepresented communities, should be considered when determining permanent modifications to future residency application cycles.
Collapse
Affiliation(s)
| | - Xuankang Pan
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Christina Gerges
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Nicholas M Rabah
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nathan R Selden
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Stacey Q Wolfe
- Department of Neurological Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Christina Huang Wright
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - James M Wright
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
| |
Collapse
|
12
|
Hofer F, Pailer U, Sulzgruber P, Gerges C, Winter MP, Giugliano RP, Gottsauner-Wolf M, Huelsmann M, Kazem N, Koller L, Schoenbauer R, Niessner A, Hengstenberg C, Zelniker TA. Influence of diabetes, heart failure, and NT-proBNP on cardiovascular outcomes in patients with atrial fibrillation – insights from a cohort study of 7,412 patients with extended follow-up. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diabetes and heart failure (HF) promote atrial fibrillation (AF) and are associated with an increased risk of adverse cardiovascular (CV) events in patients with AF. Because of effective anticoagulation options, AF patients are now more likely to develop HF than a stroke or a systemic embolic event. Appropriate risk stratification of patients with AF should therefore not only consider the risk for stroke but also for HF events.
Methods
Patients with AF admitted to a tertiary academic center between 01/2005 and 07/2019 were identified through a search of electronic health records. The primary outcome of interest was CV death or hospitalization for HF (HHF). We used Cox regression models adjusted for age, sex, estimated glomerular filtration rate, diabetes, HF, body mass index, prior myocardial infarction, hypertension, smoking, C-reactive protein, and LDL-C. To select the most informative variables and overcome the limitations of stepwise regression procedures, we performed a least absolute shrinkage and selection operator logistic regression in a model that incorporated diabetes, HF, NT-proBNP, and the covariates for adjustment in combination with 10-fold cross-validation.
Results
In total, 7,412 patients (median age 70 years, 39.7% female) were included in the present analysis and followed over a median of 4.6 years. Both diabetes (Adjusted (Adj.) hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.55 to 2.25) and HF (Adj. HR 2.57, 95% CI 2.22 to 2.98) were significantly associated with CV death/HHF after multivariable adjustment. Compared to patients with diabetes, HF patients had a higher risk of HHF but a similar risk of CV and all-cause death. There was a robust relationship between CV death/HHF and NT-proBNP (Adj. HR for 1-unit increase in standardized log-transformed biomarker 1.86, 95% CI 1.67 to 2.07). NT-proBNP showed good discriminatory performance (AUC 0.78, 95% CI 0.77–0.80), and the addition of NT-proBNP to the covariates used for adjustment resulted in a significant AUC improvement (Δ=0.04, P<0.001). With least absolute shrinkage and selection operator logistic regression, the strongest associations for CV death/HHF were obtained for NT-proBNP (OR 2.69 per 1-SD in log-transformed biomarker), HF (OR 1.73), and diabetes (OR 1.65).
Conclusion
These findings suggest that the influence of diabetes and HF expand beyond the risk of stroke and systemic embolic events to CV death/HHF in an unselected AF patient population. NT-proBNP may provide improved risk assessment in AF patients.
Funding Acknowledgement
Type of funding sources: None. Figure 1. Forest Plot
Collapse
Affiliation(s)
- F Hofer
- Medical University of Vienna, Vienna, Austria
| | - U Pailer
- Vienna Healthcare Group, Vienna, Austria
| | | | - C Gerges
- Medical University of Vienna, Vienna, Austria
| | - M P Winter
- Medical University of Vienna, Vienna, Austria
| | - R P Giugliano
- Brigham and Women's Hospital, Boston, United States of America
| | | | - M Huelsmann
- Medical University of Vienna, Vienna, Austria
| | - N Kazem
- Medical University of Vienna, Vienna, Austria
| | - L Koller
- Medical University of Vienna, Vienna, Austria
| | | | - A Niessner
- Medical University of Vienna, Vienna, Austria
| | | | | |
Collapse
|
13
|
Gerges C, Friewald R, Gerges M, Shafran I, Sadushi-Kolici R, Skoro-Sajer N, Moser B, Taghavi S, Klepetko W, Lang IM. Efficacy and safety of percutaneous pulmonary artery subtotal occlusion and CTO intervention in chronic thromboembolic pulmonary hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1955] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Balloon pulmonary angioplasty (BPA) is an emerging percutaneous therapy for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH), and patients with mean pulmonary artery pressure (mPAP) ≤30mmHg have an excellent survival. Common vascular lesion types are ring-like stenoses (type A), web lesions (type B), subtotal occlusions (type C), chronic total occlusions (CTO, type D) and tortuous lesions (type E). Occlusive lesions (i.e. subtotal occlusions and CTOs) are most challenging. While the CTO intervention the coronary arteries remains controversial, risk and benefit of pulmonary artery occlusive lesion intervention in CTEPH has not been studied yet. We evaluated the impact of percutaneous pulmonary artery subtotal occlusion and CTO intervention on BPA treatment response.
Methods
120 patients underwent 712 BPA procedures between April 2014 and October 2019. Clinical features and hemodynamics were assessed at baseline and 6–12 months after the last BPA session.
Results
A total of 2542 lesions were targeted; 720 occlusions (28.3%; 352 CTOs and 368 subtotal occlusions) and 1822 non-occlusion lesions (71.7%). Complications occurred in 6.0% of all procedures (severe complications in 0.4% of all procedures). 45 patients completed BPA treatment after a median of 6 (4; 10) procedures per patient. In these patients, mPAP dropped from 40.1±10.8 to 25.6±5.1mmHg (p<0.001), without significant change in cardiac output (5.2±1.4 to 5.5±3.1L/min, p=0.409). In the overall cohort, success rate for recanalization of occlusions was 81% (subtotal occlusions (type C lesions): 98%; CTOs (type D lesions) 50%). Number of successfully treated lesions of any type (β −0.86 [−1.19; −0.53]; p<0.001), number of successfully treated occlusions (β −2.17 [−3.38; −0.97]; p=0.001) and number of successfully treated non-occlusion lesions (β −0.81 [−1.25; −0.37]; p<0.001) emerged as predictors of relative change in mPAP. The impact on relative change in mPAP was higher for CTOs (β −5.88 [−10.49; −1.26]; p=0.014) than for subtotal occlusions (β −2.51 [−4.18; −0.83]; p=0.004).
Conclusions
The number of successfully treated vascular lesions predicts treatment response to BPA. The number of successfully recanalized occlusions (particularly CTOs) appears to have the strongest impact on change in mPAP, highlighting the importance of advanced BPA technique.
Funding Acknowledgement
Type of funding sources: None. Visual overview
Collapse
Affiliation(s)
- C Gerges
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - R Friewald
- Krems University Hospital, Department of Internal Medicine I, Division of Cardiology, Krems An Der Donau, Austria
| | - M Gerges
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - I Shafran
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - R Sadushi-Kolici
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - N Skoro-Sajer
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - B Moser
- Medical University of Vienna, Department of Thoracic Surgery, Vienna, Austria
| | - S Taghavi
- Medical University of Vienna, Department of Thoracic Surgery, Vienna, Austria
| | - W Klepetko
- Medical University of Vienna, Department of Thoracic Surgery, Vienna, Austria
| | - I M Lang
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| |
Collapse
|
14
|
Ronald AA, Herring EZ, Gerges C, Shost M, Jella T, Sajatovic M, Labak CM, Smith G. Immediate Postoperative Imaging Following Elective Lumbar Fusion Provides Little Clinical Utility. Spine (Phila Pa 1976) 2021; 46:958-964. [PMID: 33492086 DOI: 10.1097/brs.0000000000003953] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review at a single institution of all adult patients who underwent elective lumbar fusion surgery for degenerative spinal disease from 2013 to 2018. Reoperation rates and change in clinical management due to routine imaging findings were the primary outcomes. OBJECTIVE To investigate what effects immediate routine postoperative imaging has on the clinical management of patients following lumbar fusion surgery. SUMMARY OF BACKGROUND DATA The clinical utility of routine postoperative imaging following lumbar fusion surgery remains uncertain. Existing studies on the clinical utility of postoperative imaging in lumbar fusion patients have largely focused on imaging obtained post-discharge. We present a retrospective analysis that to our knowledge is the first study reporting on the clinical utility of routine imaging in lumbar fusion patients during the immediate postoperative period. METHODS The medical records of patients who had undergone elective lumbar instrumented fusion for degenerative disease from 2013 to 2018 by neurosurgeons across one regional healthcare system were retrospectively analyzed. Inpatient records and imaging orders for patients were reviewed. Routine immediate postoperative imaging was defined by any lumbar spine imaging prior to discharge in the absence of specific indications. RESULTS Analysis identified 115 patients who underwent elective lumbar instrumented fusion for degenerative disease. One-hundred-twelve patients received routine postoperative imaging. Routine imaging was abnormal in four patients (4%). There was one instance (<1%) where routine immediate postoperative imaging led to change in clinical management. Abnormal routine imaging was not associated with either reoperation or development of neurological symptoms postoperatively (P = 0.10), however, new or worsening neurologic deficits did predict reoperation (P < 0.01). CONCLUSION New neurologic deficit was the only significant predictor of reoperation. Routine imaging, whether normal or abnormal, was not found to be associated with reoperation. The practice of routine imaging prior to discharge following elective lumbar fusion surgery appears to provide little utility to clinical management.Level of Evidence: 3.
Collapse
Affiliation(s)
- Andrew A Ronald
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Eric Z Herring
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Christina Gerges
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Michael Shost
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Tarun Jella
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Martha Sajatovic
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Collin M Labak
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Gabriel Smith
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH
| |
Collapse
|
15
|
Gerges C, Wijesekera O, Herring E, Adesina A, Wright CH, Woodard J, Stout A, Rothstein B, Selden N, Wright J. Evaluation of Risk of Gastrostomy and Ventriculoperitoneal Shunt Placement in Pediatric Patients: A Systematic Review of the Literature. World Neurosurg 2021; 152:180-188.e1. [PMID: 34033958 DOI: 10.1016/j.wneu.2021.05.044] [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: 04/02/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022]
Abstract
A subset of patients with neurologic deficits require ventriculoperitoneal shunt (VPS) placement in addition to gastrostomy tubes (GTs). At present, the literature is inconsistent with respect to the sequence and time period between procedures that yields the lowest risk profile for GT and VPS placement. The purpose of this systematic literature review was to determine if time elapsed between VPS and GT placement was associated with infection (peritoneal and/or CSF). A systematic literature review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guidelines. PubMEd/MEDLINE, Scopus, Ovid, Cochrane, and EMBASE databases were queried. Precise search terminology is available in the body of the manuscript. The initial database query yielded 88 unique articles. After abstract screening, 28 articles were identified and 6 met criteria for inclusion in the final analysis. The included studies were all retrospective analyses and reported data for 217 patients between the years of 1988 and 2016. Across all included studies, the infection rate after VPS and GT placement during the studies' surveillance period was 15.2% (n = 33/217). The cumulative rate of all reported complications in patients with both VPS and GT was 24.0% (n = 52/217). These studies suggest that placement of GT in patients with preexisting VPS does not significantly contribute to increased shunt or intraperitoneal infection. Future studies should determine the optimal time interval between VPS and GT placement and to identify the most appropriate prophylactic antibiotic regimen.
Collapse
Affiliation(s)
- Christina Gerges
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Olindi Wijesekera
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Eric Herring
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Adeleso Adesina
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Christina Huang Wright
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA; Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jos'lyn Woodard
- Division of Pediatric Neurosurgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Amber Stout
- Core Library, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Brian Rothstein
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA; Department of Neurosurgery, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Nathan Selden
- Division of Pediatric Neurosurgery, Oregon Health & Science University, Portland, Oregon, USA
| | - James Wright
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA; Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| |
Collapse
|
16
|
Wright J, Elder T, Gerges C, Reisen B, Wright C, Jella T, Shah S, Yang G, Ngwenya LB, Wang V, Parr AM. A systematic review of telehealth for the delivery of emergent neurosurgical care. J Telemed Telecare 2021; 27:261-268. [PMID: 34006136 DOI: 10.1177/1357633x211015548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/17/2022]
Abstract
INTRODUCTION In 2017, the American Association of Neurological Surgeons and Congress of Neurological Surgeons published a statement in support of adopting telemedicine technologies in neurosurgery. The position statement detailed the principles for use and summarised the active efforts at the time to address barriers that limited expansion of use, such as reimbursement, liability, credentialing and patient confidentiality. The primary aim of this systematic literature review was to identify the available published literature on the application of telemedicine to neurosurgical patient care, with a specific focus on neurotrauma and emergent neurological conditions. METHODS This Level II systematic review of the literature was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guidelines. Following removal of duplicates, 359 studies were yielded from database query. Following application of inclusion and exclusion criteria, 78 articles were identified for full-text review. RESULTS Full-text screening yielded a total of 11 studies for the final analysis. The study interventions took place in seven unique countries and included both developed and developing nations. Data captured spanned the years 1997 to 2019. The total cumulative number of patients who received neurosurgical telemedicine consultations captured by this review was 37,224. DISCUSSION This review of the literature suggests that telemedicine in emergent settings offers safe, feasible, and cost-reducing methods of increasing access to high acuity neurosurgical care and may serve to limit unnecessary inter-facility transfers. As infrastructure and regulatory guidelines continue to evolve, neurosurgical patients, both domestic and abroad, will benefit from improved access to expertise afforded by telemedicine technologies.
Collapse
Affiliation(s)
- James Wright
- Center for Spine Health, Cleveland Clinic Foundation, USA.,School of Medicine, Case Western Reserve University, USA
| | - Theresa Elder
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, USA
| | | | | | - Christina Wright
- Center for Spine Health, Cleveland Clinic Foundation, USA.,School of Medicine, Case Western Reserve University, USA
| | - Tarun Jella
- School of Medicine, Case Western Reserve University, USA
| | - Sanjit Shah
- Department of Neurosurgery, University of Cincinnati, USA
| | - George Yang
- Department of Neurosurgery, University of Cincinnati, USA
| | | | - Vincent Wang
- Department of Neurosurgery, Ascension Seton Brain and Spine Institute, USA
| | - Ann M Parr
- Department of Neurosurgery, University of Minnesota, USA
| | | |
Collapse
|
17
|
Wright J, Gerges C, Shammassian B, Zhou X, Huang Wright C, Duan Y, Cabrera CI, Rosenfeld K, D'Anza B, Pronovost P, Sajatovic M, Bambakidis N. Use of Telemedicine to Improve Interfacility Communication and Aid in Triage of Patients with Intracerebral Hemorrhage: A Pilot Study. World Neurosurg 2020; 147:e189-e199. [PMID: 33309640 DOI: 10.1016/j.wneu.2020.12.010] [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: 10/04/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Over the past several years there has been a dramatic increase in the implementation of telemedicine technology to aid in the delivery of care across community, inpatient, and emergency settings. This technology has proved valuable for acute life-threatening clinical scenarios. We aimed to pilot a novel neurosurgical telemedicine program within an academic tertiary care center to assist in consultation of patients with high-grade intracranial hemorrhage (ICH) (ICH score 4, 5). METHODS A quality improvement conceptual framework was developed. Subsequently, a process map and improvement interventions were created. Patients in community hospitals with high-grade ICH or pre-existing Do Not Resuscitate/Do Not Intubate orders with an admitting diagnosis of ICH triggered a TeleNeurosurgery consultation. Patients who met the inclusion criteria, with consent of their decision makers, were enrolled in the study. Post-encounter physician surveys were used to evaluate overall satisfaction with the implementation. RESULTS This 18-month pilot study proved feasible, with an enrollment of 63.6% (n = 14 of 22) of patients who met criteria. All patients who were enrolled in the study and participated in TeleNeurosurgery consultation remained at the presenting facility for end-of-life care and palliative medicine consultation. Both community emergency physicians and subspecialists who performed the consultations reported satisfaction with the TeleNeurosurgery consultation process and a perceived benefit both to patients, families, and emergency medicine physicians. CONCLUSIONS The program proved feasible and several areas in need of improvement within the health system were identified. Emergency physicians reported comfort with the process, program effectiveness, and improved access to care by implementation of this program.
Collapse
Affiliation(s)
- James Wright
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Christina Gerges
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Berje Shammassian
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Xiaofei Zhou
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Christina Huang Wright
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yifei Duan
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Claudia I Cabrera
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kenneth Rosenfeld
- Department of Medicine, Division of Geriatrics and Palliative Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Brian D'Anza
- Medical Director, Telehealth, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Peter Pronovost
- Chief Clinical Transformation Officer, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Nicholas Bambakidis
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
18
|
Gerges C, Defta D, Duan Y, Malloy P, van Keulen M, Wright J, Wright C, Bambakidis NC. Sinus Thrombosis After Translabyrinthine Approach for Acoustic Neuroma Resection. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_890] [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
|
19
|
Wright J, Gerges C, Shammassian BH, Zhou X, Wright C, Duan Y, Rosenfeld K, D’Anza B, Pronovost P, Sajatovic M, Bambakidis NC. TeleNeurosurgery. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_476] [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
|
20
|
Shah S, Yang GL, Le DT, Gerges C, Wright JM, Parr AM, Cheng JS, Ngwenya LB. Examining the Emergency Medical Treatment and Active Labor Act: impact on telemedicine for neurotrauma. Neurosurg Focus 2020; 49:E8. [PMID: 33130613 DOI: 10.3171/2020.8.focus20587] [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: 06/30/2020] [Accepted: 08/18/2020] [Indexed: 11/06/2022]
Abstract
The Emergency Medical Treatment and Active Labor Act (EMTALA) protects patient access to emergency medical treatment regardless of insurance or socioeconomic status. A significant result of the COVID-19 pandemic has been the rapid acceleration in the adoption of telemedicine services across many facets of healthcare. However, very little literature exists regarding the use of telemedicine in the context of EMTALA. This work aimed to evaluate the potential to expand the usage of telemedicine services for neurotrauma to reduce transfer rates, minimize movement of patients across borders, and alleviate the burden on tertiary care hospitals involved in the care of patients with COVID-19 during a global pandemic. In this paper, the authors outline EMTALA provisions, provide examples of EMTALA violations involving neurosurgical care, and propose guidelines for the creation of telemedicine protocols between referring and consulting institutions.
Collapse
Affiliation(s)
- Sanjit Shah
- 1Department of Neurological Surgery, University of Cincinnati College of Medicine
| | - George L Yang
- 1Department of Neurological Surgery, University of Cincinnati College of Medicine
| | - Diana T Le
- 2University of Cincinnati College of Medicine, Cincinnati
| | | | - James M Wright
- 3Case Western Reserve University School of Medicine, Cleveland.,4Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio; and
| | - Ann M Parr
- 5Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
| | - Joseph S Cheng
- 1Department of Neurological Surgery, University of Cincinnati College of Medicine.,2University of Cincinnati College of Medicine, Cincinnati
| | - Laura B Ngwenya
- 1Department of Neurological Surgery, University of Cincinnati College of Medicine.,2University of Cincinnati College of Medicine, Cincinnati
| |
Collapse
|
21
|
Chugh AJ, Patel M, Gerges C, Sunshine K, Wilson B, Kasliwal MK. Use of C7 Slope as a Surrogate Marker for T1 Slope: A Radiographic Study in Patients with and without Cervical Deformity. World Neurosurg 2020; 143:e516-e522. [DOI: 10.1016/j.wneu.2020.07.219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 11/15/2022]
|
22
|
Shafran I, Probst V, Campean J, Sadushi-Kolici R, Gerges C, Lang I, Skoro-Sajer N. The role of asymmetric dimethylarginine (ADMA) in the follow-up of patients with precapillary pulmonary hypertension (PH). Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2303] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Asymmetric dimethylarginine (ADMA) interferes with L-arginine in the production of nitric oxide, a key mediator of endothelial cell function. ADMA is elevated in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) and is associated with unfavorable outcomes.
Aim
To assess the role of ADMA to monitor disease progression of PH patients treated with PAH-specific therapy.
Methods
ADMA was measured by competitive ELISA at baseline (BL) and follow-up (FU). Risk assessment including a clinical assessment, echocardiography, 6-minute walking test, NT-pro-BNP and hemodynamic assessment by right heart catheterization was performed accordingly. Risk was calculated according to the ESC/ERS 2015 guidelines by the SPHAR method.
Results
ADMA samples were collected from 113 patients treated at our institution between 2012 and 2019. 89 (79%) patients had PAH, 15 (13%) were diagnosed with CTEPH and 9 (8%) with group 3 – PH associated with lung disease. 69% were females. 15 (13.3%) patients had a low risk at baseline, 96 (85%) intermediate risk and 2 (1.8%) were high risk patients. 75% received oral medications, 31% received subcutaneous treprostinil. Median baseline ADMA was 0.738umol/l. At BL no significant difference of ADMA plasma levels was found among the different PH types (p=0.063), or between different risk categories (p=0.531).
Change in ADMA plasma levels correlated with change in risk (p=0.002, rs 0.291) and with change in mixed venous saturation (p=0.034, rs −0.205). Change in ADMA plasma levels also correlated with risk at FU (p=0.011, rs 0.240).
Patients categorized as low risk at FU had a median ADMA plasma level decrease of 22%, compared with −3 to 0% ADMA plasma level change in patients with moderate to high risk at FU (p=0.04). Patients who improved their risk category had a median decrease of ADMA plasma level of 23% vs. 2.3% in patients who did not improve (p=0.011). Decrease of ADMA plasma levels was a weak but significant discriminator for improvement of risk in ROC analysis (p=0.032, AUC 0.374).
Conclusion
ADMA plasma levels paralleled the hemodynamic and clinical benefit of PAH-specific treatments in patients with precapillary PH. ADMA could be used as a biomarker for monitoring treatment effects in precapillary PH.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- I Shafran
- Medical University of Vienna, Vienna, Austria
| | - V Probst
- Medical University of Vienna, Vienna, Austria
| | - J Campean
- Medical University of Vienna, Vienna, Austria
| | | | - C Gerges
- Medical University of Vienna, Vienna, Austria
| | - I Lang
- Medical University of Vienna, Vienna, Austria
| | | |
Collapse
|
23
|
Berardo L, Gerges C, Wright J, Stout A, Shah H, Papanastassiou A, Kimmell K. Assessment of burnout prevention and wellness programs for US-based neurosurgical faculty and residents: a systematic review of the literature. J Neurosurg 2020:1-9. [PMID: 33126213 DOI: 10.3171/2020.6.jns201531] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neurosurgeon burnout is a serious and prevalent issue that has been shown to impact professionalism, physician health, and patient outcomes. Interventions targeting physician burnout primarily focus on improving physician wellness. Many academic neurosurgery programs have established wellness curricula to combat burnout and improve wellness. No official recommendations exist for establishing a wellness program that effectively targets sources of burnout. The aim of this review was to examine measures of burnout and report objective results of wellness interventions for neurosurgical faculty and residents. METHODS Two systematic literature reviews were performed in parallel, in accordance with PRISMA 2009 guidelines. Following removal of duplicates, a query of PubMed/MEDLINE, Scopus, Ovid, Cochrane, and EMBASE databases yielded 134 resident-related articles and 208 faculty-related articles for abstract screening. After abstract screening, 17 articles with a primary focus of resident wellness and 10 with a focus on faculty wellness met criteria for full-text screening. Of the total 27 screened articles, 9 (6 resident, 2 faculty, 1 both resident and faculty) met criteria and were included in the final analysis. Article quality was assessed using the Joanna Briggs Institute critical appraisal tools for cohort studies. RESULTS Included studies reported burnout rates for neurosurgery residents of 30%-67%. Work-life imbalance, imbalance of duties, inadequate operative exposure, and hostile faculty were contributors to burnout. The 2 included studies reported burnout rates for neurosurgery faculty members of 27% and 56.7%. Psychosocial stressors, relational stressors, and financial uncertainty were generally associated with increased feelings of burnout. Of the 4 studies reporting on outcomes of wellness initiatives included in this review, 3 reported a positive impact of the wellness interventions and 1 study reported no significant improvement after implementing a wellness initiative. CONCLUSIONS Burnout among neurosurgical faculty and residents is prevalent and permeates the daily lives of neurosurgeons, negatively affecting patient outcomes, career satisfaction, and quality of life. Many neurosurgery programs have instituted wellness programs to combat burnout, but few have published evidence of improvement after implementation. While studies have shown that residents and faculty recognize the importance of wellness and look favorably on such initiatives, very few studies have reported objective outcomes.
Collapse
Affiliation(s)
- Laura Berardo
- 1School of Medicine, University of Texas at San Antonio, Texas
| | - Christina Gerges
- 2School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - James Wright
- 2School of Medicine, Case Western Reserve University, Cleveland, Ohio
- 3Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Amber Stout
- 3Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Hamid Shah
- 4Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Kristopher Kimmell
- 6Department of Neurosurgery, Rochester Regional Health and University of Rochester Medical Center, Rochester, New York
| |
Collapse
|
24
|
Gerges C, Elder T, Penuela M, Rossetti N, Maynard M, Jeong S, Wright CH, Wright J, Zhou X, Burant C, Sajatovic M, Hodges T. Comparative epidemiology of gliosarcoma and glioblastoma and the impact of Race on overall survival: A systematic literature review. Clin Neurol Neurosurg 2020; 195:106054. [PMID: 32650210 DOI: 10.1016/j.clineuro.2020.106054] [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: 04/20/2020] [Revised: 06/09/2020] [Accepted: 06/27/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Gliosarcoma (GSM) is a rare subtype of glioblastoma (GBM) that accounts for approximately four percent of high-grade gliomas. There is scarce epidemiological data on patients with GSM as a distinct subgroup of GBM. METHODS A systematic literature review was performed of peer-reviewed databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to evaluate the impact of race and ethnicity on survival in patients with GSM compared to patients with GBM. RESULTS Following initial abstract screening, a total of 138 articles pertaining to GSM and 275 pertaining to GBM met criteria for full-text review, with 5 and 27 articles included in the final analysis for GSM and GBM, respectively. The majority of patients in both cohorts were non-Hispanic Whites, representing 85.6 % of total GSM patients and 87.7 % of GBM patients analyzed. Two GSM studies stratified survival by race, with one reporting the longest median survival for the Hispanic population of 10.6 months and the shortest median survival for the Asian population of 9 months. Among the GBM studies analyzed, the majority of studies reported shorter survival and higher risk of mortality among White Non-Hispanics compared to non-White patients; and of the 15 studies which reported data for the Asian population, 12 studies reported this race category to have the longest survival compared to all other races studied. Younger age, female sex, MGMT promoter methylation status, and adjuvant chemoradiation therapy were associated with improved survival in both GSM and GBM cohorts, although these were not further stratified by race. CONCLUSION GSM portends a similarly poor prognosis to other GBM subtypes; however, few studies exist which have examined factors associated with differences in survival between these histologic variants. This review of the literature suggests there is a possible association between race and survival for patients with GBM, however data supporting this conclusion for patients with GSM is lacking. These findings suggest that GSM is a distinct disease from other GBM subtypes, with epidemiologic differences that should be further explored.
Collapse
Affiliation(s)
- Christina Gerges
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA
| | - Theresa Elder
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, USA.
| | - Maria Penuela
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA
| | - Nikki Rossetti
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA
| | - Marquis Maynard
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA
| | - Stacy Jeong
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA
| | - Christina Huang Wright
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, USA
| | - James Wright
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, USA
| | - Xiaofei Zhou
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, USA
| | - Christopher Burant
- Mandel School of Applied Social Sciences Case Western Reserve University, Cleveland, OH, USA; Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Research Center, University Hospitals Cleveland Medical Center, Cleveland, OH USA; Departments of Neurology and Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Tiffany Hodges
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, USA
| |
Collapse
|
25
|
Schneider M, Ran H, Pistritto AM, Gerges C, Heidari H, Hengstenberg C, Bergler-Klein J, Lang I, Binder T, Goliasch G. P1739 Diameter of the pulmonary artery in relation to the ascending aorta: a promising parameter for the diagnosis of pulmonary hypertension. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1099] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary hypertension (PH) is a disease with significant morbidity and mortality. The first imaging modality in the diagnostic algorithm is transthoracic echocardiography (TTE). Despite significant technological advances in recent years, there are still patients with PH who are missed by TTE. The pulmonary artery to ascending aorta ratio (PA/Ao-R) has been evaluated in cardiac magnetic resonance (CMR) and computed tomography (CT) studies. The ratio was able to detect patients with PH, it correlated with hemodynamics, and it was predictive for mortality. We sought to evaluate the diagnostic accuracy of PA/Ao-R measured by TTE in the detection of PH.
Methods
We evaluated consecutive patients who received quasi-simultaneous transthoracic echocardiography and right heart catheterization (RHC) for evaluation of pulmonary hypertension between July 2015 and July 2016.
Results
A total of 84 patients fulfilled the inclusion criteria, 47 were female, mean age was 65 years. Median PA/Ao-R was 0.8 (Q1;Q3 0.69;0.94). Seventy patients had PH (median mean pulmonary artery pressure (mPAP) was 35.5 mmHg, Q1;Q3 27;47). The area under the curve for the diagnosis of PH via PA/Ao-R was 0.853. A cut-off of 1 was chosen for further analysis. Sensitivity for the diagnosis of PH was 100%, specificity was 23%. PA/Ao-R correlated with mPAP (r = 0.65, p < 0.001), and pulmonary vascular resistance (r = 0.68, p < 0.001). In the subgroup of patients with PH, those patients with a PA/Ao-R of ≥1 had significantly (p < 0.001) higher pulmonary pressures than those below, with a mean mPAP of 53 mmHg as compared to 38.5 mmHg.
Conclusion
PA/Ao-R correlates with mPAP. A ratio of ≥1 should prompt suspicion for the presence of PH. PA/Ao-R should be reported in every patient who is evaluated for PH.
Collapse
Affiliation(s)
- M Schneider
- Medical University of Vienna, Vienna, Austria
| | - H Ran
- Nanjing 1st Hospital, Department of Echocardiography, Nanjing, China
| | - A M Pistritto
- San Paolo Hospital, Emergency Department, Division of Cardiology, Savona, Italy
| | - C Gerges
- Medical University of Vienna, Vienna, Austria
| | - H Heidari
- Medical University of Vienna, Vienna, Austria
| | | | | | - I Lang
- Medical University of Vienna, Vienna, Austria
| | - T Binder
- Medical University of Vienna, Vienna, Austria
| | - G Goliasch
- Medical University of Vienna, Vienna, Austria
| |
Collapse
|
26
|
Gerges M, Gerges C, Publig M, Skoro-Sajer N, Bonderman D, Frey M, Schwarzinger I, Lechner K, Seidl V, Alimohammadi A, Winter M, Humenberger M, Eichelberger B, Panzer S, Lang I. P5367Chronic inflammation after splenectomy is a risk factor for increased thrombotic cardiovascular events. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5367] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
27
|
Rosenkranz S, Lang IM, Blindt R, Bonderman D, Bruch L, Diller GP, Felgendreher R, Gerges C, Hohenforst-Schmidt W, Holt S, Jung C, Kindermann I, Kramer T, Kübler WM, Mitrovic V, Riedel A, Rieth A, Schmeisser A, Wachter R, Weil J, Opitz C. [Pulmonary hypertension associated with left heart disease: recommendations of the Cologne Consensus Conference 2016]. Dtsch Med Wochenschr 2016; 141:S48-S56. [PMID: 27760450 DOI: 10.1055/s-0042-114522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The 2015 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension are also valid for Germany. While the guidelines contain detailed recommendations regarding pulmonary arterial hypertension (PAH), they contain only a relatively short paragraph on other, much more common forms of PH such as PH due to left heart disease. Despite the lack of data, targeted PAH treatments are increasingly being used for PH associated with left heart disease. This development is of concern because of limited ressources and the need to base treatments on scientific evidence. On the other hand, PH is a frequent problem that is highly relevant for morbidity and mortality in patients with left heart disease, representing an unmet need of targeted PH therapies. It that sense, the practical implementation of the European Guidelines in Germany requires the consideration of several specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, several working groups were initiated, one of which was specifically dedicated to PH associated with left heart disease. This article summarizes the results and recommendations of this working group.
Collapse
|
28
|
Gerges C, Gerges M, Lang MB, Mascherbauer J, Lang IM. Pulmonary vascular reactivity in pulmonary hypertension due to left heart disease. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p295] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
29
|
Gerges C, Gerges M, Zhou Y, Lam D, Lang MB, Lang IM. Hemodynamic correlates of RV afterload and pulmonary artery pulsatility under treatment with prostacyclin: retrospective analysis of changes from baseline in pulmonary arterial hypertension patients. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.1064] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
30
|
Gerges C, Gerges M, Zhou Y, Zhang L, Lang MB, Lang IM. Baseline hemodynamic predictors of treatment response in pulmonary arterial hypertension. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p229] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
31
|
Gerges M, Gerges C, Lang MB, Lang IM. Hemodynamic assessment of patients with pulmonary hypertension due to lung disease and/or hypoxia. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p308] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
32
|
Gerges M, Gerges C, Lang M, Lang I. 181 Hemodynamic Assessment of Pulmonary Hypertension in Grown-Up Congenital Heart Disease. J Heart Lung Transplant 2012. [DOI: 10.1016/j.healun.2012.01.186] [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: 11/29/2022] Open
|