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Abstract
Background Lumbar microdiscectomy is the most commonly performed spine surgery procedure. Over time it has evolved to a minimally invasive procedure. Traditionally patients were advised to restrict activity following lumbar spine surgery. However, post-operative instructions are heterogeneous. The purpose of this report is to assess, by survey, the perioperative care practices of Australasian neurosurgeons in the minimally invasive era. Methods A survey was conducted by email invitation sent to all full members of the Neurosurgical Society of Australasia (NSA). This consisted of 11 multi-choice questions relating to operative indications, technique, and post-operative instructions for lumbar microdiscectomy answered by an electronically distributed anonymized online survey. Results The survey was sent to all Australasian Neurosurgeons. In total, 68 complete responses were received (28.9%). Most surgeons reported they would consider a period of either 4 to 8 weeks (42.7%) or 8 to 12 weeks (32.4%) as the minimum duration of radicular pain adequate to offer surgery. Unilateral muscle dissection with unilateral discectomy was practiced by 76.5%. Operative microscopy was the most commonly employed method of magnification (76.5%). The majority (55.9%) always refer patients to undergo inpatient physiotherapy. Sitting restrictions were advised by 38.3%. Lifting restrictions were advised by 83.8%. Conclusions Australasian neurosurgical lumbar microdiscectomy perioperative care practices are generally consistent with international practices and demonstrate a similar degree of heterogeneity. Recommendation of post-operative activity restrictions by Australasian neurosurgeons is still common. This suggests a role for the investigation of the necessity of such restrictions in the era of minimally invasive spine surgery.
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Affiliation(s)
- Christopher D Daly
- Department of Neurosurgery, Monash Medical Centre, Clayton, Victoria, Australia.,Department of Surgery, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia
| | - Kai Zheong Lim
- Department of Neurosurgery, Monash Medical Centre, Clayton, Victoria, Australia.,Department of Surgery, Monash University, Clayton, Victoria, Australia
| | - Peter Ghosh
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia.,Proteobioactives Pty. Ltd., Brookvale, New South Wales, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Medical Centre, Clayton, Victoria, Australia.,Department of Surgery, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia
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Abstract
OBJECTIVE Approximately 20% of patients admitted to hospital with drug overdose will require intensive care unit (ICU) admission. An understanding of the characteristics of these patients may assist with their management and identify those patients at risk of multiple hospital presentations due to drug overdose. Our aim was to examine the characteristics of patients admitted to ICU following drug overdoses and identify the predictors of multiple hospital presentations due to drug overdose. METHODS Patients admitted to a metropolitan ICU over a three-year period following drug overdoses were identified using ICU patient databases, and their medical records. RESULTS There were 254 admissions due to drug overdoses. The majority of overdoses were intentional (82.7%) and included multiple agents (68.1%). Two-thirds of patients had psychiatric diagnosis, and 54% had documented history of substance use disorders. In-hospital mortality was 2.8%. Over half of patients admitted had documented history of prior hospital presentation due to overdoses. Personality disorder and schizophrenia were independent predictors of multiple hospital presentations due to overdoses. CONCLUSION Personality disorders or schizophrenia were independent predictors of patients with multiple overdose presentations. Preventative strategies focusing on these patients may reduce the incidence of their hospital presentations and ICU admissions.
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Affiliation(s)
- Vinit Athavale
- Senior registrar, Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC, Australia
| | - Cameron Green
- Research co-ordinator, Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC, Australia
| | - Kai Zheong Lim
- Medical student, Department of Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC, Australia
| | - Caroline Wong
- Medical student, Department of Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC, Australia
| | - Ravindranath Tiruvoipati
- Consultant in intensive care medicine, Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC, and; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Daly CD, Lim KZ, Lewis J, Saber K, Molla M, Bar-Zeev N, Goldschlager T. Lumbar microdiscectomy and post-operative activity restrictions: a protocol for a single blinded randomised controlled trial. BMC Musculoskelet Disord 2017; 18:312. [PMID: 28728580 PMCID: PMC5520336 DOI: 10.1186/s12891-017-1681-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 07/16/2017] [Indexed: 01/14/2023] Open
Abstract
Background Lumbar microdiscectomy is the most commonly performed spinal surgery procedure, with over 300,000 cases performed annually in the United States alone. Traditionally, patients were advised to restrict post-operative activity as this was believed to reduce the risk of disc reherniation and progressive instability. However, this practice would often delay patients return to work. In contemporary practice many surgeons do not restrict patient post-operative activity due to the perception this practice is unnecessary. We describe a randomised controlled trial to assess the impact of activity restrictions on clinical outcome following lumbar discectomy. Methods/Design The lumbar microdiscectomy and post-operative activity restriction trial is a multi-centre, randomised, controlled single blinded trial. Two hundred ten patients due to undergo single level lumbar microdiscectomy without a history of previous spine surgery, infection or fracture are randomised to be advised either restricted or unrestricted activity for a period of 30 days following lumbar microdiscectomy. Actual adherence with trial allocation will be monitored bioelectronically via a wearable device. Outcome assessment at follow up will occur at 1, 3, 6 and 12 months. The primary outcome will be a composite endpoint comprising changes in Visual Analogue Scale (Leg and Back), Oswestry Disability Index and the absence of intervertebral disc reherniation or secondary intervention. Discussion This randomised controlled trial will directly compare post-operative protocols of activity restrictions and no restrictions following lumbar discectomy with adherence monitored bioelectronically. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12616001360404 (retrospectively registered 30/09/2016).
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Affiliation(s)
- Chris D Daly
- Department of Surgery, Monash University, Clayton, VIC, Australia. .,Department of Neurosurgery, Monash Medical Centre, Clayton, VIC, Australia. .,The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia.
| | - Kai Zheong Lim
- Department of Surgery, Monash University, Clayton, VIC, Australia.,Department of Neurosurgery, Monash Medical Centre, Clayton, VIC, Australia
| | - Jennifer Lewis
- Department of Neurosurgery, Monash Medical Centre, Clayton, VIC, Australia
| | - Kelly Saber
- Department of Physiotherapy, Monash Medical Centre, Clayton, VIC, Australia
| | - Mohammed Molla
- Department of Neurosurgery, Monash Medical Centre, Clayton, VIC, Australia
| | - Naor Bar-Zeev
- Centre for Global Vaccine Research, Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
| | - Tony Goldschlager
- Department of Surgery, Monash University, Clayton, VIC, Australia.,Department of Neurosurgery, Monash Medical Centre, Clayton, VIC, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, VIC, Australia.,Department of Neurosurgery, Cabrini Hospital, Malvern, VIC, Australia
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Vijiaratnam N, Barber D, Lim KZ, Paul E, Jiang M, Chosich B, Wijeratne T. Migraine: Does aura require investigation? Clin Neurol Neurosurg 2016; 148:110-4. [DOI: 10.1016/j.clineuro.2016.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 03/31/2016] [Accepted: 07/02/2016] [Indexed: 12/01/2022]
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