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Rahman F, Bhat V, Ozair A, Detchou DKE, Ahluwalia MS. Financial barriers and inequity in medical education in India: challenges to training a diverse and representative healthcare workforce. Med Educ Online 2024; 29:2302232. [PMID: 38194431 PMCID: PMC10778416 DOI: 10.1080/10872981.2024.2302232] [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] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
India has been historically challenged by an insufficient and heterogeneously clustered distribution of healthcare infrastructure. While resource-limited healthcare settings, such as major parts of India, require multidisciplinary approaches for improvement, one key approach is the recruitment and training of a healthcare workforce representative of its population. This requires overcoming barriers to equity and representation in Indian medical education that are multi-faceted, historical, and rooted in inequality. However, literature is lacking regarding the financial or economic barriers, and their implications on equity and representation in the Indian allopathic physician workforce, which this review sought to describe. Keyword-based searches were carried out in PubMed, Google Scholar, and Scopus in order to identify relevant literature published till November 2023. This state-of-the-art narrative review describes the existing multi-pronged economic barriers, recent and forthcoming changes deepening these barriers, and how these may limit opportunities for having a diverse workforce. Three sets of major economic barriers exist to becoming a specialized medical practitioner in India - resources required to get selected into an Indian medical school, resources required to pursue medical school, and resources required to get a residency position. The resources in this endeavor have historically included substantial efforts, finances, and privilege, but rising barriers in the medical education system have worsened the state of inequity. Preparation costs for medical school and residency entrance tests have risen steadily, which may be further exacerbated by recent major policy changes regarding licensing and residency selection. Additionally, considerable increases in direct and indirect costs of medical education have recently occurred. Urgent action in these areas may help the Indian population get access to a diverse and representative healthcare workforce and also help alleviate the shortage of primary care physicians in the country. Discussed are the reasons for rural healthcare disparities in India and potential solutions related to medical education.
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Affiliation(s)
- Faique Rahman
- Faculty of Medicine, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University (AMU), Aligarh, UP, India
| | - Vivek Bhat
- St. John’s Medical College, Bangalore, KA, India
| | - Ahmad Ozair
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Faculty of Medicine, King George’s Medical University, Lucknow, UP, India
| | - Donald K. E. Detchou
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Manmeet S. Ahluwalia
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
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Borja AJ, Farooqi AS, Gallagher RS, Detchou DKE, Glauser G, Shultz K, McClintock SD, Malhotra NR. Varying Degree of Overlap Following the Critical Steps of Lumbar Fusion and Short-term Outcomes. Clin Spine Surg 2023; 36:E423-E429. [PMID: 37559210 DOI: 10.1097/bsd.0000000000001504] [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: 11/08/2021] [Accepted: 06/21/2023] [Indexed: 08/11/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE The present study analyzes the impact of end-overlap on short-term outcomes after single-level, posterior lumbar fusions. SUMMARY OF BACKGROUND DATA Few studies have evaluated how "end-overlap" (i.e., surgical overlap after the critical elements of spinal procedures, such as during wound closure) influences surgical outcomes. METHODS Retrospective analysis was performed on 3563 consecutive adult patients undergoing single-level, posterior-only lumbar fusion over a 6-year period at a multi-hospital university health system. Exclusion criteria included revision surgery, missing key health information, significantly elevated body mass index (>70), non-elective operations, non-general anesthesia, and unclean wounds. Outcomes included 30-day emergency department visit, readmission, reoperation, morbidity, and mortality. Univariate analysis was carried out on the sample population, then limited to patients with end-overlap. Subsequently, patients with the least end-overlap were exact-matched to patients with the most. Matching was performed based on key demographic variables-including sex and comorbid status-and attending surgeon, and then outcomes were compared between exact-matched cohorts. RESULTS Among the entire sample population, no significant associations were found between the degree of end-overlap and short-term adverse events. Limited to cases with any end-overlap, increasing overlap was associated with increased 30-day emergency department visits ( P =0.049) but no other adverse outcomes. After controlling for confounding variables in the demographic-matched and demographic/surgeon-matched analyses, no differences in outcomes were observed between exact-matched cohorts. CONCLUSIONS The degree of overlap after the critical steps of single-level lumbar fusion did not predict adverse short-term outcomes. This suggests that end-overlap is a safe practice within this surgical population.
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Affiliation(s)
- Austin J Borja
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania
| | - Ali S Farooqi
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania
| | - Ryan S Gallagher
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania
| | - Donald K E Detchou
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania
| | - Gregory Glauser
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania
| | - Kaitlyn Shultz
- McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia
- West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, PA
| | - Scott D McClintock
- West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, PA
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania
- McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia
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Ozair A, Bhat V, Detchou DKE. Authors' Reply to: Additional Considerations for US Residency Selection After Pass/Fail USMLE Step 1. Comment on "The US Residency Selection Process After the United States Medical Licensing Examination Step 1 Pass/Fail Change: Overview for Applicants and Educators". JMIR Med Educ 2023; 9:e50109. [PMID: 37590044 PMCID: PMC10472168 DOI: 10.2196/50109] [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] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/30/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Ahmad Ozair
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United States
| | - Vivek Bhat
- St. John's Medical College, Bangalore, India
| | - Donald K E Detchou
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
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Harris JC, Borja AJ, Glauser G, Detchou DKE, Howard SD, Choudhri OA. Interhemispheric gravity-assisted approach for microsurgical resection of a splenium arteriovenous malformation. Clin Case Rep 2023; 11:e6853. [PMID: 36721683 PMCID: PMC9880385 DOI: 10.1002/ccr3.6853] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/08/2022] [Accepted: 12/29/2022] [Indexed: 01/28/2023] Open
Abstract
The parietal interhemispheric approach employing gravity retraction with skeletonization of bridging veins provides an excellent operative window for safe, curative resection of splenial arteriovenous malformations.
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Affiliation(s)
- Jacob C. Harris
- Department of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Austin J. Borja
- Department of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Gregory Glauser
- Department of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Susanna D. Howard
- Department of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Omar A. Choudhri
- Department of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Ozair A, Bhat V, Detchou DKE. The US Residency Selection Process After the United States Medical Licensing Examination Step 1 Pass/Fail Change: Overview for Applicants and Educators. JMIR Med Educ 2023; 9:e37069. [PMID: 36607718 PMCID: PMC9862334 DOI: 10.2196/37069] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 10/11/2022] [Accepted: 11/29/2022] [Indexed: 06/07/2023]
Abstract
The United States Medical Licensing Examination (USMLE) Step 1, arguably the most significant assessment in the USMLE examination series, changed from a 3-digit score to a pass/fail outcome in January 2022. Given the rapidly evolving body of literature on this subject, this paper aims to provide a comprehensive review of the historical context and impact of this change on various stakeholders involved in residency selection. For this, relevant keyword-based searches were performed in PubMed, Google Scholar, and Scopus to identify relevant literature. Given the unique history of USMLE Step 1 in the US residency selection process and the score's correlation with future performance in board-certifying examinations in different specialties, this scoring change is predicted to significantly impact US Doctor of Medicine students, US Doctor of Osteopathic Medicine students, international medical graduates, and residency program directors, among others. The significance and the rationale of the pass/fail change along with the implications for both residency applicants and educators are also summarized in this paper. Although medical programs, academic institutions, and residency organizing bodies across the United States have swiftly stepped up to ensure a seamless transition and have attempted to ensure equity for all, the conversion process carries considerable uncertainty for residency applicants. For educators, the increasing number of applications conflicts with holistic application screening, leading to the expected greater use of objective measures, with USMLE Step 2 Clinical Knowledge likely becoming the preferred screening tool in lieu of Step 1.
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Affiliation(s)
- Ahmad Ozair
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, United States
- Faculty of Medicine, King George's Medical University, Lucknow, India
| | - Vivek Bhat
- St John's Medical College, Bangalore, India
| | - Donald K E Detchou
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
- Thomas William Langfitt Neurosurgical Society, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Siddiqui N, Reddy VP, Rogers JL, Detchou DKE, Casubhoy I, Gopali R, Bhalla S, Janbahan M, Morris E, Peesapati MP, Agarwal N. Trends in Matriculation from Neurological Surgery Training Programs into Academic Versus Private Practice. World Neurosurg 2022; 165:e635-e642. [PMID: 35779756 DOI: 10.1016/j.wneu.2022.06.119] [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: 11/13/2021] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE A career in academic neurosurgery is an arduous endeavor. Specific factors influencing physician practice preferences remain unclear. This study analyzes data from the American Association of Neurological Surgeons membership identifying the impact of several demographic and educational characteristics influencing neurosurgical career choices centered on academia, private practice, or a combination in the United States. METHODS A list of all current neurosurgeons was obtained from the American Association of Neurological Surgeons membership, and information on physician characteristics was collected via internet searches and institutional databases. The practice type of all neurosurgeons considered in this study were categorized as follows: private practice, academic, or a combination of private practice and academic, termed privademic. These data were subsequently correlated to race, gender, current age, training at a top 40 National Institutes of Health-funded medical school or residency program, and current practice. RESULTS The median age of private practice and academic neurosurgeons was 58.18 and 53.61 years, respectively (P < 0.001). Age was significantly associated with practicing in an academic setting (odds ratio 0.96), with younger neurosurgeons pursuing careers in academia. Data indicated a positive and statistically significant contribution of female gender (P < 0.001) and training at a top-40 National Institutes of Health-funded institution to practicing in an academic setting (P < 0.01). CONCLUSIONS Neurosurgery as a field has grown significantly over the past century. The authors recommend that future efforts seek to diversify the neurosurgical workforce by considering practice setting, demographic characteristics, and educational background.
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Affiliation(s)
- Neha Siddiqui
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| | - Vamsi P Reddy
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - James L Rogers
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Donald K E Detchou
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Imaima Casubhoy
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Rhea Gopali
- North Carolina State University, Raleigh, North Carolina, USA
| | - Subhang Bhalla
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Mika Janbahan
- Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign, Illinois, USA
| | - Emily Morris
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Nitin Agarwal
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
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Affiliation(s)
- Chidinma M Wilson
- Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA
| | - Donald K E Detchou
- Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA.,Frazier Scholar Program Department of Neurosurgery Hospital of the University of Pennsylvania Philadelphia, Pennsylvania, USA
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Farooqi AS, Borja AJ, Detchou DKE, Glauser G, Shultz K, McClintock SD, Malhotra NR. Overlap Before the Critical Step of Lumbar Fusion Does Not Lead to Increased Short-Term Morbidity. Neurosurgery 2021; 89:1052-1061. [PMID: 34634816 DOI: 10.1093/neuros/nyab360] [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: 02/17/2021] [Accepted: 07/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few studies have assessed the impact of overlapping surgery during different timepoints of neurosurgical procedures. OBJECTIVE To evaluate the impact of overlap before the critical portion of surgery on short-term patient outcomes following lumbar fusion. METHODS In total, 3799 consecutive patients who underwent single-level, posterior-only lumbar fusion over 6 yr (2013-2019) at an academic hospital system were retrospectively studied. Outcomes included 30-d emergency department (ED) visit, readmission, reoperation, mortality, overall morbidity, and overall morbidity/surgical complications. Duration of overlap that occurred before the critical portion of surgery was calculated as a percentage of total beginning operative time. Univariate logistic regression was used to assess the impact of incremental 1% increases in the duration of overlap within the whole population and patients with beginning overlap. Subsequently, univariate analysis was used to compare exact matched patients with the least (bottom 40%) and most amounts of overlap (100% beginning overlap). Coarsened exact matching was used to match patients on key demographic factors, as well as attending surgeon. Significance was set at a P-value < .05. RESULTS Increased duration of beginning overlap was associated with a decrease in 30-d ED visit (P = .03) within all patients with beginning overlap, but not within the whole population undergoing lumbar fusion. Duration of beginning overlap was not associated with any other short-term morbidity or mortality outcome in either the whole population or patients with beginning overlap. CONCLUSION Increased duration of overlap before the critical step of surgery does not predict adverse short-term outcomes after single-level, posterior-only lumbar fusion.
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Affiliation(s)
- Ali S Farooqi
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Austin J Borja
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Donald K E Detchou
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory Glauser
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kaitlyn Shultz
- McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania, USA
| | - Scott D McClintock
- The West Chester Statistical Institute and Department of Mathematics, West Chester University, West Chester, Pennsylvania, USA
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wilson CM, Mackenzie ES, Yudien MA, Charles AJ, Tissot MIJ, Churchill SJ, Brown NJ, Shulkin JM, Detchou DKE, Reddy VP, Chambless LB. Letter to the Editor. Overcoming obstacles and breaking barriers for women in neurosurgery. J Neurosurg 2021; 136:935-936. [PMID: 34653976 DOI: 10.3171/2021.5.jns211269] [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] [Indexed: 11/06/2022]
Affiliation(s)
- Chidinma M Wilson
- 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Evalyn S Mackenzie
- 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Mikhal A Yudien
- 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Marianne I J Tissot
- 3Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Sydney J Churchill
- 3Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Jared M Shulkin
- 5Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Donald K E Detchou
- 6Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.,7Hospital of the University of Pennsylvania, Philadelphia, PA
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Prasad MP, Detchou DKE, Wang F, Ledwidge LL, Kingston SE, Wilson Horch H. Transcriptional expression changes during compensatory plasticity in the terminal ganglion of the adult cricket Gryllus bimaculatus. BMC Genomics 2021; 22:742. [PMID: 34649498 PMCID: PMC8518198 DOI: 10.1186/s12864-021-08018-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/14/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Damage to the adult central nervous system often leads to long-term disruptions in function due to the limited capacity for neurological recovery. The central nervous system of the Mediterranean field cricket, Gryllus bimaculatus, shows an unusual capacity for compensatory plasticity, most obviously in the auditory system and the cercal escape system. In both systems, unilateral sensory disruption leads the central circuitry to compensate by forming and/or strengthening connections with the contralateral sensory organ. While this compensatory plasticity in the auditory system relies on robust dendritic sprouting and novel synapse formation, the compensatory plasticity in the cercal escape circuitry shows little obvious dendritic sprouting and instead may rely on shifts in excitatory and inhibitory synaptic strength. RESULTS In order to better understand what types of molecular pathways might underlie this compensatory shift in the cercal system, we used a multiple k-mer approach to assemble a terminal ganglion transcriptome that included ganglia collected one, three, and 7 days after unilateral cercal ablation in adult, male animals. We performed differential expression analysis using EdgeR and DESeq2 and examined Gene Ontologies to identify candidates potentially involved in this plasticity. Enriched GO terms included those related to the ubiquitin-proteosome protein degradation system, chromatin-mediated transcriptional pathways, and the GTPase-related signaling system. CONCLUSION Further exploration of these GO terms will provide a clearer picture of the processes involved in compensatory recovery of the cercal escape system in the cricket and can be compared and contrasted with the distinct pathways that have been identified upon deafferentation of the auditory system in this same animal.
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Affiliation(s)
- Meera P Prasad
- Department of Biology, Bowdoin College, 6500 College Station, Brunswick, ME, 04011, USA
| | - Donald K E Detchou
- Department of Biology, Bowdoin College, 6500 College Station, Brunswick, ME, 04011, USA
| | - Felicia Wang
- Department of Biology, Bowdoin College, 6500 College Station, Brunswick, ME, 04011, USA
| | - Lisa L Ledwidge
- Department of Biology, Bowdoin College, 6500 College Station, Brunswick, ME, 04011, USA
| | - Sarah E Kingston
- Department of Biology, Bowdoin College, 6500 College Station, Brunswick, ME, 04011, USA
- Present address: School of Marine Sciences and Darling Marine Center, University of Maine, 193 Clarks Cove Rd, Walpole, ME, 04573, USA
- University of California Santa Cruz, Ecology and Evolutionary Biology Department and UC Natural Reserves, 1156 High St, Santa Cruz, CA, 95064, USA
| | - Hadley Wilson Horch
- Department of Biology, Bowdoin College, 6500 College Station, Brunswick, ME, 04011, USA.
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Wilson CM, Brown NJ, Detchou DKE. Letters to the Editor. Black women in neurosurgery: a proposal for increased recruitment. Neurosurg Focus 2021; 51:E12. [PMID: 34598128 DOI: 10.3171/2021.6.focus21366] [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] [Indexed: 11/06/2022]
Affiliation(s)
- Chidinma M Wilson
- 1Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Donald K E Detchou
- 1Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,3Hospital of the University of Pennsylvania, Philadelphia, PA
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Farooqi AS, Borja AJ, Detchou DKE, Glauser G, Shultz K, McClintock SD, Malhotra NR. Postoperative outcomes and the association with overlap before or after the critical step of lumbar fusion. J Neurosurg Spine 2021:1-10. [PMID: 34598156 DOI: 10.3171/2021.5.spine202105] [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: 11/26/2020] [Accepted: 05/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study assesses how degree of overlap, either before or after the critical operative portion, affects lumbar fusion outcomes. METHODS The authors retrospectively studied 3799 consecutive patients undergoing single-level, posterior-only lumbar fusion over 6 years (2013-2019) at a university health system. Outcomes recorded within 30-90 and 0-90 postoperative days included emergency department (ED) visit, readmission, reoperation, overall morbidity, and mortality. Furthermore, morbidity and mortality were recorded for the duration of follow-up. The amount of overlap that occurred before or after the critical portion of surgery was calculated as a percentage of total beginning or end operative time. Subsequent to initial whole-population analysis, coarsened exact-matched cohorts of patients were created with the least and most amounts of either beginning or end overlap. Univariate analysis was performed on both beginning and end overlap exact-matched cohorts, with significance set at p < 0.05. RESULTS Equivalent outcomes were observed when comparing exact-matched patients. Among the whole population, the degree of beginning overlap was correlated with reduced ED visits within 30-90 and 0-90 days (p = 0.007, p = 0.009; respectively), and less 0-90 day morbidity (p = 0.037). Degree of end overlap was correlated with fewer 30-90 day ED visits (p = 0.015). When comparing only patients with overlap, degree of beginning overlap was correlated with fewer 0-90 day reoperations (p = 0.022), and no outcomes were correlated with degree of end overlap. CONCLUSIONS The degree of overlap before or after the critical step of surgery does not lead to worse outcomes after lumbar fusion.
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Affiliation(s)
- Ali S Farooqi
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and
| | - Austin J Borja
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and
| | - Donald K E Detchou
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and
| | - Gregory Glauser
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and
| | - Kaitlyn Shultz
- 2West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, Pennsylvania
| | - Scott D McClintock
- 2West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, Pennsylvania
| | - Neil R Malhotra
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; and
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Affiliation(s)
- Chidinma M Wilson
- 1Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Donald K E Detchou
- 3Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,4Hospital of the University of Pennsylvania, Philadelphia, PA
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Affiliation(s)
- Chidinma M Wilson
- 1Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nolan J Brown
- 2University of California, Irvine School of Medicine, Orange, CA and
| | - Donald K E Detchou
- 1Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,3Hospital of the University of Pennsylvania, Philadelphia, PA
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Barpujari A, Wilson CM, Detchou DKE, Reddy VP. Letter: Max Brödel and the Practice of Putting Art Into Medicine. Neurosurg open 2021. [DOI: 10.1093/neuopn/okab023] [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: 11/14/2022] Open
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Glauser G, Detchou DKE, Choudhri OA. Eagle syndrome: a rare pathology presented in a 3-Dimensional reconstructed view. Br J Neurosurg 2021:1-2. [PMID: 34410201 DOI: 10.1080/02688697.2021.1968339] [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: 10/07/2020] [Revised: 07/29/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
A 42-year-old male presented with 3-month history of constant right-sided frontal headaches, severe right-sided intermittent sharp jaw pain, odynophagia, globus pharyngis, and worsening episodes of blurry vision in his right eye. Cervicocerebral angiography demonstrated a prominent, 4 cm right sided styloid process with close proximity to the right internal carotid artery (ICA). The patient was referred to otorhinolaryngology for styloidectomy and continued care.
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Affiliation(s)
- Gregory Glauser
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Donald K E Detchou
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Omar A Choudhri
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Glauser G, Detchou DKE, Arena J, Choudhri O. Combined Endovascular and Microsurgical Management of a Tentorial Arteriovenous Malformation in a Hybrid Neurovascular Operating Room: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2021; 21:E272-E273. [PMID: 33956984 DOI: 10.1093/ons/opab142] [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: 09/22/2020] [Accepted: 03/14/2021] [Indexed: 11/14/2022] Open
Abstract
Tentorial margin arteriovenous malformations (AVMs) at the cerebello-mesencephalic fissure are deep lesions, which can be safely resected via a lateral supracerebellar infratentorial approach. This video illustrates the case of a patient who presented with hemorrhage from a tentorial AVM. He was managed in the hybrid neurovascular operating room with Onyx (Medtronic) embolization of a superior cerebellar artery feeder followed by resection of the AVM, which included cerebellar relaxation from lumbar cerebrospinal fluid (CSF) drainage and lateral positioning. Wide cisternal arachnoid dissection at the quadrigeminal cistern allowed for a straight trajectory to the AVM without fixed retraction. Intraoperative transradial angiography confirmed complete AVM exclusion. This video was deemed Institutional Review Board (IRB) exempt by the University of Pennsylvania IRB as it is considered a case report, which does not require IRB approval or patient consent. The patient consented to the procedure.
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Affiliation(s)
- Gregory Glauser
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Donald K E Detchou
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Arena
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Omar Choudhri
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Glauser G, Detchou DKE, Choudhri OA. Microsurgical Clip Reconstruction of a Ruptured Internal Carotid Artery Terminus Blister Aneurysm Using a Reverse Picket Fence Technique. Oper Neurosurg (Hagerstown) 2021; 21:E187-E192. [PMID: 34098578 DOI: 10.1093/ons/opab184] [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: 09/29/2020] [Accepted: 04/04/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Blister aneurysms are rare, technically challenging lesions that are typically ill defined and arise at nonbranch points of arteries. OBJECTIVE To describe the microsurgical treatment of a ruptured blister aneurysm at the internal carotid artery (ICA) terminus using the reverse picket fence clipping technique. METHODS The patient was a 60-yr-old male. He presented with a Hunt and Hess Grade 2, Fisher Grade 3 subarachnoid hemorrhage located in the bilateral sylvian fissures (right > left) and suprasellar cisterns. Computed tomography angiography demonstrated 2 aneurysms: a 2-mm right middle cerebral artery (MCA) aneurysm and a 2.5-mm right internal carotid artery (ICA) terminus blister aneurysm. Transradial cerebral angiography was undertaken which showed these similar sized aneurysms. Microsurgical treatment was chosen, and the patient underwent a right pterional craniotomy for clipping of his aneurysms. The patient consented to the procedure. RESULTS The combination of stacked fenestrated clips repaired the vessel, with intraoperative fluorescein and indocyanine green angiography demonstrated normal filling of the MCA and ICA circulation with no delay. Intraoperative angiography confirmed induced moderate stenosis of the ICA terminus at about 50%, which is essential to close the blister aneurysm site by utilizing a portion of the normal vessel wall. CONCLUSION Ruptured blister aneurysms at the ICA terminus can be safely repaired using the reverse picket fence technique for clipping.
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Affiliation(s)
- Gregory Glauser
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Donald K E Detchou
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Omar A Choudhri
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Affiliation(s)
- Chidinma M Wilson
- Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA
| | - Nolan J Brown
- University of California, Irvine School of Medicine Irvine, California, USA
| | - Donald K E Detchou
- Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA
- Frazier Scholar Program Department of Neurosurgery Hospital of the University of Pennsylvania Philadelphia, Pennsylvania, USA
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Farooqi AS, Detchou DKE, Glauser G, Strouz K, McClintock SD, Malhotra NR. Overlapping single-level lumbar fusion and adverse short-term outcomes. J Neurosurg Spine 2021:1-12. [PMID: 34359028 DOI: 10.3171/2020.12.spine201861] [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: 10/17/2020] [Accepted: 12/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is a paucity of research on the safety of overlapping surgery. The purpose of this study was to evaluate the impact of overlapping surgery on a homogenous population of exactly matched patients undergoing single-level, posterior-only lumbar fusion. METHODS The authors retrospectively analyzed case data of 3799 consecutive adult patients who underwent single-level, posterior-only lumbar fusion during a 6-year period (June 7, 2013, to April 29, 2019) at a multihospital university health system. Outcomes included 30-day emergency department (ED) visit, readmission, reoperation, and morbidity and mortality following surgery. Thereafter, coarsened exact matching was used to match patients with and without overlap on key demographic factors, including American Society of Anesthesiologists (ASA) class, Charlson Comorbidity Index (CCI) score, sex, and body mass index (BMI), among others. Patients were subsequently matched by both demographic data and by the specific surgeon performing the operation. Univariate analysis was carried out on the whole population, the demographically matched cohort, and the surgeon-matched cohort, with significance set at a p value < 0.05. RESULTS There was no significant difference in morbidity or any short-term outcome, including readmission, reoperation, ED evaluation, and mortality. Among the demographically matched cohort and surgeon-matched cohort, there was no significant difference in age, sex, history of prior surgery, ASA class, or CCI score. Overlapping surgery patients in both the demographically matched cohort and the matched cohort limited by surgeon had longer durations of surgery (p < 0.01), but no increased morbidity or mortality was noted. Patients selected for overlap had fewer prior surgeries and lower ASA class and CCI score (p < 0.01). Patients with overlap also had a longer duration of surgery (p < 0.01) but not duration of closure. CONCLUSIONS Exactly matched patients undergoing overlapping single-level lumbar fusion procedures had no increased short-term morbidity or mortality; however, duration of surgery was 20 minutes longer on average for overlapping operations. Further studies should assess long-term patient outcomes and the impact of overlap in this and other surgical procedures.
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Affiliation(s)
- Ali S Farooqi
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, and
| | - Donald K E Detchou
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, and
| | - Gregory Glauser
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, and
| | - Krista Strouz
- 2McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia; and
- 3West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, Pennsylvania
| | - Scott D McClintock
- 3West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, Pennsylvania
| | - Neil R Malhotra
- 1Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, and
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Affiliation(s)
- Nolan J Brown
- 1University of California Irvine School of Medicine, Irvine, Orange, CA
| | - Chidinma M Wilson
- 2Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Donald K E Detchou
- 3Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA and.,4Hospital of the University of Pennsylvania, Philadelphia, PA
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Detchou DKE, Glauser G, Choudhri OA. Resolution of hypoglossal nerve palsy after coil embolization of an anterior condylar confluence fistula. Br J Neurosurg 2021; 35:562-563. [PMID: 34338574 DOI: 10.1080/02688697.2021.1917511] [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: 10/20/2022]
Abstract
A 69-year-old female presented with 2-year history of slurred speech, left-sided pulsatile tinnitus, and left-sided hypoglossal nerve palsy. Cerebral angiography demonstrated a left anterior condylar confluence fistula. She was treated with a transvenous coil embolization of the left condylar fistula pocket.
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Affiliation(s)
- Donald K E Detchou
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Glauser
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Omar A Choudhri
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Brown NJ, Lien BV, Wilson CM, Detchou DKE. Letter: A Novel Framework for Network-Targeted Neuropsychiatric Deep Brain Stimulation. Neurosurgery 2021; 89:E281-E282. [PMID: 34332510 DOI: 10.1093/neuros/nyab284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/27/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nolan J Brown
- Irvine Department of Neurological Surgery University of California Orange, California, USA
| | - Brian V Lien
- Irvine Department of Neurological Surgery University of California Orange, California, USA
| | - Chidinma M Wilson
- Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA
| | - Donald K E Detchou
- Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA.,Frazier Scholar Program Department of Neurosurgery Hospital of the University of Pennsylvania Philadelphia, Pennsylvania, USA
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Boyke AE, Shlobin NA, Sharma V, Detchou DKE, Rolle M. Letter: Operationalizing Global Neurosurgery Research in Neurosurgical Journals. Neurosurgery 2021; 89:E171-E172. [PMID: 34114022 DOI: 10.1093/neuros/nyab199] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andre E Boyke
- Albert Einstein College of Medicine Bronx, New York, USA
| | - Nathan A Shlobin
- Northwestern University Feinberg School of Medicine Chicago, Illinois, USA
| | | | - Donald K E Detchou
- Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA.,Frazier Scholar Program Department of Neurosurgery Hospital of the University of Pennsylvania Philadelphia, Pennsylvania, USA
| | - Myron Rolle
- Program in Global Surgery and Social Change Harvard Medical School Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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Borja AJ, Connolly J, Kvint S, Detchou DKE, Glauser G, Strouz K, McClintock SD, Marcotte PJ, Malhotra NR. Charlson Comorbidity Index score predicts adverse post-operative outcomes after far lateral lumbar discectomy. Clin Neurol Neurosurg 2021; 206:106697. [PMID: 34030078 DOI: 10.1016/j.clineuro.2021.106697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/12/2021] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Charlson Comorbidity Index (CCI) score has been shown to predict 10-year all-cause mortality and post-neurosurgical complications but has never been examined in a far lateral disc herniation (FLDH) population. This study aims to correlate CCI score with adverse outcomes following FLDH repair. PATIENTS AND METHODS All patients (n = 144) undergoing discectomy for FLDH at a single, multihospital academic medical system (2013-2020) were retrospectively analyzed. CCI scores were determined for all patients. Univariate logistic regression was used to determine the ability of CCI score to predict adverse outcomes. RESULTS Mean age of the population was 61.72 ± 11.55 years, 69 (47.9%) were female, and 126 (87.5%) were non-Hispanic white. Patients underwent either open (n = 92) or endoscopic (n = 52) FLDH repair. Average CCI score among the patient population was 2.87 ± 2.42. Each additional point in CCI score was significantly associated with higher rates of readmission (p = 0.022, p = 0.014) in the 30-day and 30-90-day post-surgery window, respectively, and emergency department visits (p = 0.011) within 30-days. CCI score also predicted risk of reoperation of any kind (p = 0.013) within 30 days of the index operation. In addition, CCI score was predictive of risk of reoperation of any kind (p = 0.008, p < 0.001; respectively) and repeat neurosurgical intervention (p = 0.027, p = 0.027) within 30-days and 90-days of the index admission (either during the same admission or after discharge). CONCLUSIONS This study suggests that CCI score is a useful metric to predict of numerous adverse postoperative outcomes following discectomy for FLDH.
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Affiliation(s)
- Austin J Borja
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John Connolly
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Svetlana Kvint
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Donald K E Detchou
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Glauser
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Krista Strouz
- McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, PA, USA; West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, PA, USA
| | - Scott D McClintock
- West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, PA, USA
| | - Paul J Marcotte
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, PA, USA.
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Connolly J, Borja AJ, Kvint S, Detchou DKE, Glauser G, Strouz K, McClintock SD, Marcotte PJ, Malhotra NR. Outcomes Following Discectomy for Far Lateral Disc Herniation Are Not Predicted by Obstructive Sleep Apnea. Cureus 2021; 13:e14921. [PMID: 34123620 PMCID: PMC8189272 DOI: 10.7759/cureus.14921] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Previous studies have demonstrated that obstructive sleep apnea (OSA) is associated with adverse postoperative outcomes, but few studies have examined OSA in a purely spine surgery population. This study investigates the association of the STOP-Bang questionnaire, a screening tool for undiagnosed OSA, with adverse events following discectomy for far lateral disc herniation (FLDH). Methods All adult patients (n = 144) who underwent FLDH surgery at a single, multihospital, academic medical center (2013-2020) were retrospectively enrolled. Univariate logistic regression was performed to evaluate the relationship between risk of OSA (low- or high-risk) according to STOP-Bang score and postsurgical outcomes, including unplanned hospital readmissions, ED visits, and reoperations. Results Ninety-two patients underwent open FLDH surgery, while 52 underwent endoscopic procedures. High risk of OSA according to STOP-Bang score did not predict risk of readmission, ED visit, outpatient office visit, or reoperation of any kind within either 30 days or 30-90 days of surgery. High risk of OSA also did not predict risk of reoperation of any kind or repeat neurosurgical intervention within 30 days or 90 days of the index admission (either during the same admission or after discharge). Conclusion The STOP-Bang questionnaire is not a reliable tool for predicting post-operative morbidity and mortality for FLDH patients undergoing discectomy. Additional studies are needed to assess the impact of OSA on morbidity and mortality in other spine surgery populations.
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Affiliation(s)
- John Connolly
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Austin J Borja
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Svetlana Kvint
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Donald K E Detchou
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Gregory Glauser
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Krista Strouz
- McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia, USA.,Department of Mathematics, West Chester University, West Chester, USA
| | | | - Paul J Marcotte
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Neil R Malhotra
- Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
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Tissot MIJ, Boyke AE, Onyewuenyi A, Glauser G, Mackenzie ES, Thach BJ, Detchou DKE. Letter to the Editor. On the right side of history: expanding diversity within neurosurgery. J Neurosurg 2021:1-2. [PMID: 33892475 DOI: 10.3171/2021.1.jns21176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marianne I J Tissot
- 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | - Alvin Onyewuenyi
- 3Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, IL
| | - Gregory Glauser
- 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Evalyn S Mackenzie
- 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Bethany J Thach
- 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Donald K E Detchou
- 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Kaghazchi F, Borja AJ, Hancin EC, Bhattaru A, Detchou DKE, Seraj SM, Rojulpote C, Hess S, Nardo L, Gabriel PE, Damrauer SM, Werner TJ, Alavi A, Revheim ME. Venous thromboembolism detected by FDG-PET/CT in cancer patients: a common, yet life-threatening observation. Am J Nucl Med Mol Imaging 2021; 11:99-106. [PMID: 34079639 PMCID: PMC8165725] [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] [Grants] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
Cancer patients are at markedly increased risk for venous thromboembolism (VTE). Early detection of VTE may decrease morbidity and mortality in this population. We conducted this study to evaluate the ability of FDG-PET/CT to detect thrombosis in cancer patients. This retrospective study included 131 cancer patients with a history of deep vein thrombosis (DVT) or pulmonary embolism (PE) referred for 2-deoxy-2-[18F]-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT). All subjects underwent PET/CT imaging 60 minutes after FDG injection. Images were visually assessed for increased FDG uptake within the venous lumen. For positive cases, clinical follow-up and Doppler ultrasonography and/or contrast-enhanced CT scans were reviewed. FDG-PET/CT revealed abnormal uptake in the venous system of 26 (19.8%) patients. Eighteen (69.2%) had a history of DVT, and 13 (50%) had a history of PE. The most common site of thrombosis was the inferior vena cava (IVC) (n=14, 53.8%), followed by lower extremities veins (n=9, 34.6%), jugular veins (n=2, 7.7%), and superior vena cava (n=1, 3.8%). The presence of thrombi was confirmed by reviewing clinical follow-up in 6 (23.1%) patients. Among this group, thrombosis was detected in lower extremity veins (n=4, 15.8%), jugular veins (n=1, 3.8%), and IVC (n=1, 3.8%). Our study demonstrates that thrombi prior to their clinical manifestation can be detected by FDG-PET/CT in cancer patients. Moving forward, physicians must carefully consider the venous system when reporting FDG-PET/CT for cancer patients.
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Affiliation(s)
- Fatemeh Kaghazchi
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia, PA, USA
| | - Austin J Borja
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia, PA, USA
- Perelman School of Medicine at The University of PennsylvaniaPhiladelphia, PA, USA
| | - Emily C Hancin
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia, PA, USA
- Lewis Katz School of Medicine at Temple UniversityPhiladelphia, PA, USA
| | - Abhijit Bhattaru
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia, PA, USA
| | - Donald K E Detchou
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia, PA, USA
- Perelman School of Medicine at The University of PennsylvaniaPhiladelphia, PA, USA
| | | | - Chaitanya Rojulpote
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia, PA, USA
| | - Soren Hess
- Department of Radiology and Nuclear Medicine, Hospital Southwest JutlandEsbjerg, Denmark
| | - Lorenzo Nardo
- Department of Radiology, University of California DavisSacramento, CA, USA
| | - Peter E Gabriel
- Department of Radiation Oncology, Hospital of The University of PennsylvaniaPhiladelphia, USA
| | - Scott M Damrauer
- Department of Surgery, Hospital of The University of PennsylvaniaPhiladelphia, PA, USA
- Corporal Michael Crescenz VA Medical CenterPhiladelphia, PA, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia, PA, USA
| | - Abass Alavi
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia, PA, USA
| | - Mona-Elisabeth Revheim
- Department of Radiology, Hospital of The University of PennsylvaniaPhiladelphia, PA, USA
- Division of Radiology and Nuclear Medicine, Oslo University HospitalNorway
- Institute of Clinical Medicine, Faculty of Medicine, University of OsloNorway
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Farooqi AS, Borja AJ, Detchou DKE, Glauser G, Strouz K, McClintock SD, Malhotra NR. Duration of overlap during lumbar fusion does not predict outcomes. Clin Neurol Neurosurg 2021; 205:106610. [PMID: 33845404 DOI: 10.1016/j.clineuro.2021.106610] [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: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The relationship between degree of surgical overlap and adverse postoperative outcomes remains poorly defined. This study aims to evaluate the impact of increasing duration of overlap on lumbar fusion outcomes. PATIENTS AND METHODS 1302 adult patients undergoing overlapping surgery during single-level, posterior-only lumbar fusion at a multi-hospital, university health system were retrospectively assessed. Amount of overlap was calculated as a percentage of total overlap time. Patients were separated into groups with the most (top 10% of patients) and least amounts of overlap (bottom 40% of patients). Using Coarsened Exact Matching, patients with the most and least amounts of overlap were matched on demographics alone, then on both demographics and attending surgeon. Univariate analysis was performed for the whole population and both matched cohorts to compare amount of overlap to risk of adverse postsurgical events. Significance for all analyses was p-value < 0.05. RESULTS Duration of overlap was not associated with outcomes in the whole population, demographic-matched, or surgeon-matched analyses. Before exact matching, patients with the most amount of overlap had a significantly higher CCI score (p = 0.031) and shorter length of surgery (p = 0.006). In the demographic matched cohort, patients with increased overlap had a significantly shorter length of surgery (p = 0.001) only. In the surgeon matched cohort, there were no differences in length of surgery or CCI score. CONCLUSIONS Duration of surgical overlap does not predict adverse outcomes following lumbar fusion. These results suggest that overlapping surgery is a safe practice within this common neurosurgical indication.
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Affiliation(s)
- Ali S Farooqi
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Austin J Borja
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Donald K E Detchou
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Glauser
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Krista Strouz
- McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, PA, USA; West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, PA, USA
| | - Scott D McClintock
- West Chester University, The West Chester Statistical Institute and Department of Mathematics, West Chester, PA, USA
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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