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Rumalla K, Thommen R, Kazim SF, Segura AC, Kassicieh AJ, Schmidt MH, Bowers CA. Risk Analysis Index and 30-Day Mortality after Brain Tumor Resection: A Multicenter Frailty Analysis of 31,776 Patients from 2012 to 2020. J Neurol Surg B Skull Base 2024; 85:168-171. [PMID: 38449581 PMCID: PMC10914459 DOI: 10.1055/a-2015-1162] [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: 11/12/2022] [Accepted: 01/12/2023] [Indexed: 01/20/2023] Open
Abstract
Introduction The aim of this study was to evaluate the discriminative accuracy of the preoperative Risk Analysis Index (RAI) frailty score for prediction of mortality or transition to hospice within 30 days of brain tumor resection (BTR) in a large multicenter, international, prospective database. Methods Records of BTR patients were extracted from the American College of Surgeons National Surgical Quality Improvement Program (2012-2020) database. The relationship between the RAI frailty scale and the primary end point (mortality or discharge to hospice within 30 days of surgery) was assessed using linear-by-linear proportional trend tests, logistic regression, and receiver operating characteristic (ROC) curve analysis (area under the curve as C-statistic). Results Patients with BTR ( N = 31,776) were stratified by RAI frailty tier: 16,800 robust (52.8%), 7,646 normal (24.1%), 6,593 frail (20.7%), and 737 severely frail (2.3%). The mortality/hospice rate was 2.5% ( n = 803) and was positively associated with increasing RAI tier: robust (0.9%), normal (3.3%), frail (4.6%), and severely frail (14.2%) ( p < 0.001). Isolated RAI was a robust discriminatory of primary end point in ROC curve analysis in the overall BTR cohort (C-statistic: 0.74; 95% confidence interval [CI]: 0.72-0.76) as well as the malignant (C-statistic: 0.74; 95% CI: 0. 67-0.80) and benign (C-statistic: 0.71; 95% CI: 0.70-0.73) tumor subsets (all p < 0.001). RAI score had statistically significantly better performance compared with the 5-factor modified frailty index and chronological age (both p < 0.0001). Conclusions RAI frailty score predicts 30-day mortality after BTR and may be translated to the bedside with a user-friendly calculator ( https://nsgyfrailtyoutcomeslab.shinyapps.io/braintumormortalityRAIcalc/ ). The findings hope to augment the informed consent and surgical decision-making process in this patient population and provide an example for future study designs.
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Affiliation(s)
- Kavelin Rumalla
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, New Mexico, United States
| | - Rachel Thommen
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, New Mexico, United States
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, New Mexico, United States
| | - Aaron C. Segura
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, New Mexico, United States
| | - Alexander J. Kassicieh
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, New Mexico, United States
| | - Meic H. Schmidt
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, New Mexico, United States
| | - Christian A. Bowers
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, New Mexico, United States
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Roy JM, Kazim SF, Macciola D, Rangel DN, Rumalla K, Karimov Z, Link R, Iqbal J, Riaz MA, Skandalakis GP, Venero CV, Sidebottom RB, Dicpinigaitis AJ, Kassicieh CS, Tarawneh O, Conlon MS, Thommen R, Alvarez-Crespo DJ, Chhabra K, Sridhar S, Gill A, Vellek J, Nguyen PA, Thompson G, Robinson M, Bowers CA. Frailty as a predictor of postoperative outcomes in neurosurgery: a systematic review. J Neurosurg Sci 2024; 68:208-215. [PMID: 37878249 DOI: 10.23736/s0390-5616.23.06130-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Baseline frailty status has been utilized to predict a wide range of outcomes and guide preoperative decision making in neurosurgery. This systematic review aims to analyze existing literature on the utilization of frailty as a predictor of neurosurgical outcomes. EVIDENCE ACQUISITION We conducted a systematic review following PRISMA guidelines. Studies that utilized baseline frailty status to predict outcomes after a neurosurgical intervention were included in this systematic review. Studies that utilized sarcopenia as the sole measure of frailty were excluded. PubMed, EMBASE, and Cochrane library was searched from inception to March 1st, 2023, to identify relevant articles. EVIDENCE SYNTHESIS Overall, 244 studies met the inclusion criteria. The 11-factor modified frailty index (mFI-11) was the most utilized frailty measure (N.=91, 37.2%) followed by the five-factor modified Frailty Index (mFI-5) (N.=80, 32.7%). Spine surgery was the most common subspecialty (N.=131, 53.7%), followed by intracranial tumor resection (N.=57, 23.3%), and post-operative complications were the most reported outcome (N.=130, 53.2%) in neurosurgical frailty studies. The USA and the Bowers author group published the greatest number of articles within the study period (N.=176, 72.1% and N.=37, 15.2%, respectively). CONCLUSIONS Frailty literature has grown exponentially over the years and has been incorporated into neurosurgical decision making. Although a wide range of frailty indices exist, their utility may vary according to their ability to be incorporated in the outpatient clinical setting.
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Affiliation(s)
- Joanna M Roy
- Topiwala National Medical College, Mumbai, India
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
| | - Syed F Kazim
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Dylan Macciola
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Dante N Rangel
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Kavelin Rumalla
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Zafar Karimov
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Remy Link
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Javed Iqbal
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Muhammad A Riaz
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | - Georgios P Skandalakis
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
| | | | | | | | | | - Omar Tarawneh
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Matt S Conlon
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Rachel Thommen
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | | | - Karizma Chhabra
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Sahaana Sridhar
- Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - Amanpreet Gill
- Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - John Vellek
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Phuong A Nguyen
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Grace Thompson
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Myranda Robinson
- School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA -
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM, USA
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Alvarez-Crespo DJ, Conlon M, Kazim SF, Skandalakis GP, Bowers CA, Chhabra K, Tarawneh O, Arbuiso S, Cole KL, Dominguez J, Dicpinigaitis AJ, Vellek J, Thommen R, Bisson EF, Couldwell WT, Cole CD, Schmidt MH. Clinical Characteristics and Surgical Outcomes of 2542 Patients with Spinal Schwannomas: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 182:165-183.e1. [PMID: 38006933 DOI: 10.1016/j.wneu.2023.11.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE This study was conducted to systematically analyze the data on the clinical features, surgical treatment, and outcomes of spinal schwannomas. METHODS We conducted a systematic review and meta-analysis under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of bibliographic databases from January 1, 2001, to May 31, 2021, yielded 4489 studies. Twenty-six articles were included in our final qualitative systematic review and quantitative meta-analysis. RESULTS Analysis of 2542 adult patients' data from 26 included studies showed that 53.5% were male, and the mean age ranged from 35.8 to 57.1 years. The most common tumor location was the cervical spine (34.2%), followed by the thoracic spine (26.2%) and the lumbar spine (18.5%). Symptom severity was the most common indicator for surgical treatment, with the most common symptoms being segmental back pain, sensory/motor deficits, and urinary dysfunction. Among all patients analyzed, 93.8% were treated with gross total resection, which was associated with better prognosis and less chance of recurrence than subtotal resection. The posterior approach was the most common (87.4% of patients). The average operative time was 4.53 hours (95% confidence interval [CI], 3.18-6.48); the average intraoperative blood loss was 451.88 mL (95% CI, 169.60-1203.95). The pooled follow-up duration was 40.6 months (95% CI, 31.04-53.07). The schwannoma recurrence rate was 5.3%. Complications were particularly low and included cerebrospinal fluid leakage, wound infection, and the sensory-motor deficits. Most of the patients experienced complete recovery or significant improvement of preoperative neurological deficits and pain symptoms. CONCLUSIONS Our analysis suggests that segmental back pain, sensory/motor deficits, and urinary dysfunction are the most common symptoms of spinal schwannomas. Surgical resection is the treatment of choice with overall good reported outcomes and particularly low complication rates. gross total resection offers the best prognosis with the slightest chance of tumor recurrence and minimal risk of complications.
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Affiliation(s)
| | - Matthew Conlon
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Karizma Chhabra
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Omar Tarawneh
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Sophia Arbuiso
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Kyril L Cole
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Jose Dominguez
- Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, New York, USA
| | | | - John Vellek
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Rachel Thommen
- School of Medicine, New York Medical College, Valhalla, New York, USA
| | - Erica F Bisson
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Chad D Cole
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Meic H Schmidt
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA.
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Varela S, Thommen R, Rumalla K, Faraz Kazim S, Couldwell WT, Schmidt MH, Bowers CA. The risk analysis index demonstrates superior discriminative ability in predicting extended length of stay in pituitary adenoma resection patients when compared to the 5-point modified frailty index. World Neurosurg X 2024; 21:100259. [PMID: 38292022 PMCID: PMC10826816 DOI: 10.1016/j.wnsx.2023.100259] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 07/06/2023] [Accepted: 11/28/2023] [Indexed: 02/01/2024] Open
Abstract
Objective To compare the predictive abilities of two frailty indices on post-operative morbidity and mortality in patients undergoing pituitary adenoma resection. Methods The National Surgical Quality Improvement Program (NSQIP) database was used to retrospectively collect data for patients undergoing pituitary adenoma resection between 2015-2019. To compare the predictive abilities of two of the most common frailty indices, the 5-point modified frailty index (mFI-5) and the risk analysis index (RAI), receiver operating curve analysis (ROC) and area under the curve (AUC)/Cstatistic were used. Results In our cohort of 1,454 patients, the RAI demonstrated superior discriminative ability to the mFI-5 in predicting extended length of stay (C-statistic 0.59, 95% CI 0.56-0.62 vs. C-statistic 0.51, 95% CI: 0.48-0.54, p = 0.0002). The RAI only descriptively appeared superior to mFI-5 in determining mortality (C-statistic 0.89, 95% CI 0.74-0.99 vs. Cstatistic 0.63, 95% CI 0.61-0.66, p=0.11), and NHD (C-statistic 0.68, 95% CI 0.60-0.76 vs. C-statistic 0.60, 95% CI: 0.57-0.62, p=0.15). Conclusions Pituitary adenomas account for one of the most common brain tumors in the general population, with resection being the preferred treatment for patients with most hormone producing tumors or those causing compressive symptoms. Although pituitary adenoma resection is generally safe, patients who experience post-operative complications frequently share similar pre-operative characteristics and comorbidities. Therefore, appropriate pre-operative risk stratification is imperative for adequate patient counseling and informed consent in these patients. Here we present the first known report showing the superior discriminatory ability of the RAI in predicting eLOS when compared to the mFI-5.
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Affiliation(s)
- Samantha Varela
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Rachel Thommen
- School of Medicine, New York Medical College (NYMC), Valhalla, NY, USA
| | - Kavelin Rumalla
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - William T. Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Meic H. Schmidt
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Christian A. Bowers
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
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Tarawneh OH, Vellek J, Kazim SF, Thommen R, Roster K, Conlon M, Alvarez-Crespo DJ, Cole KL, Varela S, Dominguez JF, Mckee RG, Schmidt MH, Bowers CA. The 5-item modified frailty index predicts spinal osteotomy outcomes better than age in adult spinal deformity patients: an ACS - NSQIP analysis. Spine Deform 2023; 11:1189-1197. [PMID: 37291408 DOI: 10.1007/s43390-023-00712-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/21/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE To evaluate the utility of 5-Item Modified Frailty Index (mFI-5) as compared to chronological age in predicting outcomes of spinal osteotomy in Adult Spinal Deformity (ASD) patients. METHODS Using Current Procedural and Terminology (CPT) codes, the American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP) database was queried for adult patients undergoing spinal osteotomy from 2015 to 2019. Multivariate regression analysis was performed to evaluate the effect of baseline frailty status, measured by mFI-5 score, and chronological age on postoperative outcomes. Receiver-operating characteristic (ROC) curve analysis was performed to analyze the discriminative performance of age versus mFI-5. RESULTS A total of 1,789 spinal osteotomy patients (median age 62 years) were included in the analysis. Among the patients assessed, 38.5% (n = 689) were pre-frail, 14.6% frail (n = 262), and 2.2% (n = 39) severely frail using the mFI-5. Based on the multivariate analysis, increasing frailty tier was associated with worsening outcomes, and higher odds ratios (OR) for poor outcomes were found for increasing frailty tiers as compared to age. Severe frailty was associated with the worst outcomes, e.g., unplanned readmission (OR 9.618, [95% CI 4.054-22.818], p < 0.001) and major complications (OR 5.172, [95% CI 2.271-11.783], p < 0.001). In the ROC curve analysis, mFI-5 score (AUC 0.838) demonstrated superior discriminative performance than age (AUC 0.601) for mortality. CONCLUSIONS The mFI5 frailty score was found to be a better predictor than age of worse postoperative outcomes in ASD patients. Incorporating frailty in preoperative risk stratification is recommended in ASD surgery.
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Affiliation(s)
- Omar H Tarawneh
- School of Medicine, New York Medical College, Valhalla, NY, 10595, USA
| | - John Vellek
- School of Medicine, New York Medical College, Valhalla, NY, 10595, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, 87131, USA
| | - Rachel Thommen
- School of Medicine, New York Medical College, Valhalla, NY, 10595, USA
| | - Katie Roster
- School of Medicine, New York Medical College, Valhalla, NY, 10595, USA
| | - Matthew Conlon
- School of Medicine, New York Medical College, Valhalla, NY, 10595, USA
| | | | - Kyril L Cole
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Samantha Varela
- School of Medicine, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Rohini G Mckee
- Department of Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Meic H Schmidt
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, 87131, USA
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, 87131, USA.
- Department of Neurosurgery MSC10 5615, Albuquerque, NM, 81731, USA.
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Bowers CA, Varela S, Conlon M, Kazim SF, Thommen R, Roster K, Hall DE, Schmidt MH. Comparison of the Risk Analysis Index and the modified 5-factor frailty index in predicting 30-day morbidity and mortality after spine surgery. J Neurosurg Spine 2023; 39:136-145. [PMID: 37029672 DOI: 10.3171/2023.2.spine221019] [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: 09/09/2022] [Accepted: 02/28/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE Frailty's role in preoperative risk assessment in spine surgery has increased in association with the increasing size of the aging population. However, previous frailty assessment tools have significant limitations. The aim of this study was to compare the predictive ability of the Risk Analysis Index (RAI) with the 5-factor modified frailty index (mFI-5) for postoperative spine surgery morbidity and mortality. METHODS Data were collected from the American College of Surgeons National Surgical Quality Improvement Program database for adults > 18 years who underwent spine surgery between 2015 and 2019. Multivariate modeling and receiver operating characteristic curve analysis, including area under the curve/C-statistic calculations, were performed to evaluate the comparative discriminative ability of RAI and mFI-5 on postoperative outcomes. RESULTS In a cohort of 292,225 spine surgery patients, multivariate modeling showed that increasing RAI scores, and not increasing mFI-5 scores, were independent predictors of increased postoperative mortality for the trauma, tumor, and infection subcohorts. In the overall spine cohort, both increasing RAI and increasing mFI-5 scores were associated with increased mortality, but C-statistics indicated that the RAI (C-statistic 0.802 [95% CI 0.800-0.803], p < 0.0001, DeLong test) had superior discrimination compared with the mFI-5 (C-statistic 0.677 [95% CI 0.675-0.679], p < 0.0001, DeLong test). In subgroup analyses, the RAI had superior discriminative ability to mFI-5 for mortality in the trauma and infection groups (p < 0.001 and p = 0.039, respectively). CONCLUSIONS The RAI demonstrates superior discrimination to the mFI-5 for predicting postoperative mortality and morbidity after spine surgery and the RAI maintains conceptual fidelity to the frailty phenotype. Patients with high RAI scores may benefit from knowing the possibility of increased surgical risk with potential spine surgery.
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Affiliation(s)
- Christian A Bowers
- 1Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque
| | - Samantha Varela
- 2School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Matthew Conlon
- 3School of Medicine, New York Medical College, Valhalla, New York
| | - Syed Faraz Kazim
- 1Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque
| | - Rachel Thommen
- 3School of Medicine, New York Medical College, Valhalla, New York
| | - Katie Roster
- 3School of Medicine, New York Medical College, Valhalla, New York
| | - Daniel E Hall
- 4Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh
- 7Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Meic H Schmidt
- 1Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque
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Thommen R, Kazim SF, Rumalla K, Kassicieh AJ, Kalakoti P, Schmidt MH, McKee RG, Hall DE, Miskimins RJ, Bowers CA. Correction to: Preoperative frailty measured by risk analysis index predicts complications and poor discharge outcomes after Brain Tumor Resection in a large multi-center analysis. J Neurooncol 2022; 160:763. [DOI: 10.1007/s11060-022-04212-3] [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: 12/14/2022]
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Conlon M, Thommen R, Kazim SF, Dicpinigaitis AJ, Schmidt MH, McKee RG, Bowers CA. Risk Analysis Index and Its Recalibrated Version Predict Postoperative Outcomes Better Than 5-Factor Modified Frailty Index in Traumatic Spinal Injury. Neurospine 2022; 19:1039-1048. [PMID: 36597640 PMCID: PMC9816576 DOI: 10.14245/ns.2244326.163] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/14/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To assess the discriminative ability of the Risk Analysis Index-administrative (RAI-A) and its recalibrated version (RAI-Rev), compared to the 5-factor modified frailty index (mFI-5), in predicting postoperative outcomes in patients undergoing surgical intervention for traumatic spine injuries (TSIs). METHODS The Current Procedural Terminology (CPT) and International Classification of Disease-9 (ICD-9) and ICD-10 codes were used to identify patients ≥ 18 years who underwent surgical intervention for TSI from National Surgical Quality Improvement Program (ACS-NSQIP) database 2015-2019 (n = 6,571). Multivariate analysis and receiver operating characteristic (ROC) curve analysis were conducted to evaluate the comparative discriminative ability of RAI-Rev, RAI-A, and mFI-5 for 30-day postoperative outcomes. RESULTS Multivariate regression analysis showed that with all 3 frailty scores, increasing frailty tiers resulted in worse postoperative outcomes, and patients identified as frail and severely frail using RAI-Rev and RAI-A had the highest odds of poor outcomes. In the ROC curve/C-statistics analysis for prediction of 30-day mortality and morbidity, both RAI-Rev and RAI-A outperformed mFI-5, and for many outcomes, RAI-Rev showed better discriminative performance compared to RAI-A, including mortality (p = 0.0043, DeLong test), extended length of stay (p = 0.0042), readmission (p < 0.0001), reoperation (p = 0.0175), and nonhome discharge (p < 0.0001). CONCLUSION Both RAI-Rev and RAI-A performed better than mFI-5, and RAI-Rev was superior to RAI-A in predicting postoperative mortality and morbidity in TSI patients. RAI-based frailty indices can be used in preoperative risk assessment of spinal trauma patients.
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Affiliation(s)
- Matthew Conlon
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Rachel Thommen
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | | | - Meic H. Schmidt
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Rohini G. McKee
- Department of Surgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Christian A. Bowers
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA,Corresponding Author Christian A. Bowers Department of Neurosurgery, University of New Mexico Health Sciences Center, 1 University New Mexico, MSC10 5615, Albuquerque, NM 81731, USA
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Cole KL, Kassicieh AJ, Rumalla K, Kazim SF, Thommen R, Conlon M, Schmidt MH, Bowers CA. Frailty predicts worse outcomes for spine surgery patients with interhospital transfer status: Analysis of 295,875 patients from the National Surgical Quality Improvement Program (NSQIP) 2015-2019. Clin Neurol Neurosurg 2022; 224:107519. [PMID: 36436435 DOI: 10.1016/j.clineuro.2022.107519] [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: 09/20/2022] [Revised: 10/29/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022]
Abstract
STUDY DESIGN Retrospective analysis of a prospectively maintained database. OBJECTIVES To evaluate the effects of interhospital transfer (IHT) status, age, and frailty on postoperative outcomes in patients who underwent spine surgery. METHODS The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent spine surgeries from 2015 to 2019 (N = 295,875). Univariate and multivariable analyses were utilized to analyze the effect of IHT on postoperative outcomes and the contribution of baseline frailty status (mFI-5 score stratified into "pre-frail", "frail", and "severely frail") on outcomes in IHT patients. Effect sizes were summarized by odds ratio (OR) with associated 95% confidence intervals (95% CI). RESULTS Of 295,875 patients in the study, 3.3% (N = 9666) were IHT status. On multivariable analysis, controlling for covariates, IHT status was significantly associated with greater likelihood of 30-day mortality (odds ratio [OR] = 9.3), major complications (OR=5.0), Clavien-Dindo (CD) grade IV complications (OR=7.0), unplanned readmission (OR=2.1), unplanned reoperation (OR=2.6), eLOS (OR=16.1), and discharge to non-home destination (OR=12.7) (all P < 0.001). Increasing frailty was significantly associated with poor outcomes in spine surgery patients with IHT status compared to chronological age. CONCLUSIONS This study provides evidence that IHT status is associated with poor outcomes in spine surgery patients. Furthermore, increasing frailty more than increasing age was a robust predictor of poor outcomes among IHT spine surgical patients. Baseline frailty status, as measured by the mFI-5, may be utilized for preoperative risk stratification of patients with IHT status with anticipated spine surgery.
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Affiliation(s)
- Kyril L Cole
- School of Medicine, University of Utah, Salt Lake City, UT 84132, USA
| | - Alexander J Kassicieh
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM 87106, USA
| | - Kavelin Rumalla
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM 87106, USA
| | - Syed Faraz Kazim
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM 87106, USA
| | - Rachel Thommen
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA; School of Medicine, New York Medical College, Valhalla, NY 10595, USA; Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY 10595, USA
| | - Matthew Conlon
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA; Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY 10595, USA
| | - Meic H Schmidt
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM 87106, USA
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA; Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, NM 87106, USA.
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Thommen R, Kazim SF, Rumalla K, Kassicieh AJ, Kalakoti P, Schmidt MH, McKee RG, Hall DE, Miskimins RJ, Bowers CA. Preoperative frailty measured by risk analysis index predicts complications and poor discharge outcomes after Brain Tumor Resection in a large multi-center analysis. J Neurooncol 2022; 160:285-297. [PMID: 36316568 DOI: 10.1007/s11060-022-04135-z] [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: 08/23/2022] [Accepted: 09/14/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the independent effect of frailty, as measured by the Risk Analysis Index-Administrative (RAI-A) for postoperative complications and discharge outcomes following brain tumor resection (BTR) in a large multi-center analysis. METHODS Patients undergoing BTR were queried from the National Surgical Quality Improvement Program (NSIQP) for the years 2015 to 2019. Multivariable logistic regression was performed to evaluate the independent associations between frailty tools (age, 5-factor modified frailty score [mFI-5], and RAI-A) on postoperative complications and discharge outcomes. RESULTS We identified 30,951 patients who underwent craniotomy for BTR; the median age of our study sample was 59 (IQR 47-68) years old and 47.8% of patients were male. Overall, increasing RAI-A score, in an overall stepwise fashion, was associated with increasing risk of adverse outcomes including in-hospital mortality, non-routine discharge, major complications, Clavien-Dindo Grade IV complication, and extended length of stay. Multivariable regression analysis (adjusting for age, sex, BMI, non-elective surgery status, race, and ethnicity) demonstrated that RAI-A was an independent predictor for worse BTR outcomes. The RAI-A tiers 41-45 (1.2% cohort) and > 45 (0.3% cohort) were ~ 4 (Odds Ratio [OR]: 4.3, 95% CI: 2.1-8.9) and ~ 9 (OR: 9.5, 95% CI: 3.9-22.9) times more likely to have in-hospital mortality compared to RAI-A 0-20 (34% cohort). CONCLUSIONS AND RELEVANCE Increasing preoperative frailty as measured by the RAI-A score is independently associated with increased risk of complications and adverse discharge outcomes after BTR. The RAI-A may help providers present better preoperative risk assessment for patients and families weighing the risks and benefits of potential BTR.
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Affiliation(s)
- Rachel Thommen
- School of Medicine, New York Medical College, Valhalla, NY 10595, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA
| | - Syed Faraz Kazim
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87131, USA
| | - Kavelin Rumalla
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87131, USA
| | - Alexander J Kassicieh
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87131, USA
| | - Piyush Kalakoti
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Meic H Schmidt
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87131, USA
| | - Rohini G McKee
- Department of Surgery, University of New Mexico Hospital (UNMH), Albuquerque, NM 87131, USA
| | - Daniel E Hall
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Wolff Center at UPMC, Pittsburgh, PA, USA
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Richard J Miskimins
- Department of Surgery, University of New Mexico Hospital (UNMH), Albuquerque, NM 87131, USA
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM 87131, USA.
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87131, USA.
- Department of Neurosurgery MSC10 5615, University of New Mexico, Albuquerque, NM 81731, USA.
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Kazim SF, Dicpinigaitis AJ, Bowers CA, Shah S, Couldwell WT, Thommen R, Alvarez-Crespo DJ, Conlon M, Tarawneh OH, Vellek J, Cole KL, Dominguez JF, Mckee RN, Ricks CB, Shin PC, Cole CD, Schmidt MH. Frailty Status Is a More Robust Predictor Than Age of Spinal Tumor Surgery Outcomes: A NSQIP Analysis of 4,662 Patients. Neurospine 2022; 19:53-62. [PMID: 35130424 PMCID: PMC8987561 DOI: 10.14245/ns.2142770.385] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/22/2021] [Indexed: 11/19/2022] Open
Abstract
Objective The present study aimed to evaluate the effect of baseline frailty status (as measured by modified frailty index-5 [mFI-5]) versus age on postoperative outcomes of patients undergoing surgery for spinal tumors using data from a large national registry.
Methods The National Surgical Quality Improvement Program database was used to collect spinal tumor resection patients’ data from 2015 to 2019 (n = 4,662). Univariate and multivariate analyses for age and mFI-5 were performed for the following outcomes: 30-day mortality, major complications, unplanned reoperation, unplanned readmission, hospital length of stay (LOS), and discharge to a nonhome destination. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminative performance of age versus mFI-5.
Results Both univariate and multivariate analyses demonstrated that mFI-5 was a more robust predictor of worse postoperative outcomes as compared to age. Furthermore, based on categorical analysis of frailty tiers, increasing frailty was significantly associated with increased risk of adverse outcomes. ‘Severely frail’ patients were found to have the highest risk, with odds ratio 16.4 (95% confidence interval [CI],11.21–35.44) for 30-day mortality, 3.02 (95% CI, 1.97–4.56) for major complications, and 2.94 (95% CI, 2.32–4.21) for LOS. In ROC curve analysis, mFI-5 score (area under the curve [AUC] = 0.743) achieved superior discrimination compared to age (AUC = 0.594) for mortality.
Conclusion Increasing frailty, as measured by mFI-5, is a more robust predictor as compared to age, for poor postoperative outcomes in spinal tumor surgery patients. The mFI-5 may be clinically used for preoperative risk stratification of spinal tumor patients.
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Affiliation(s)
- Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA
| | | | | | - Smit Shah
- Department of Neurology, Prisma Health–Midlands/University of South Carolina School of Medicine, Columbia, SC, USA
| | - William T. Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Rachel Thommen
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | | | - Matthew Conlon
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | | | - John Vellek
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Kyrill L. Cole
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jose F. Dominguez
- Department of Neurosurgery, Westchester Medical Center & New York Medical College, Valhalla, NY, USA
| | - Rohini N. Mckee
- Department of Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Christian B. Ricks
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA
| | - Peter C. Shin
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA
| | - Chad D. Cole
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA
| | - Meic H. Schmidt
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM, USA
- Corresponding Author Meic H. Schmidt https://orcid.org/0000-0003-2259-9459 Department of Neurosurgery, University of New Mexico Hospital, 1 University New Mexico, MSC10 5615, Albuquerque, NM, USA
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Cole KL, Kazim SF, Thommen R, Alvarez-Crespo DJ, Vellek J, Conlon M, Tarawneh OH, Dicpinigaitis AJ, Dominguez J, McKee RG, Schmidt MH, Couldwell WT, Cole CD, Bowers CA. Association of baseline frailty status and age with outcomes in patients undergoing intracranial meningioma surgery: Results of a nationwide analysis of 5818 patients from the National Surgical Quality Improvement Program (NSQIP) 2015–2019. Eur J Surg Oncol 2022; 48:1671-1677. [DOI: 10.1016/j.ejso.2022.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 12/13/2022] Open
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Thommen R, Kazim SF, Cole KL, Olson GT, Shama L, Lovato CM, Gonzales KM, Dicpinigaitis AJ, Couldwell WT, Mckee RN, Cole CD, Schmidt MH, Bowers CA. Worse Pituitary Adenoma Surgical Outcomes Predicted by Increasing Frailty, Not Age. World Neurosurg 2022; 161:e347-e354. [DOI: 10.1016/j.wneu.2022.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/30/2022]
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Varela S, Kazim SF, Schmidt MH, Chaurasia B, Dicpinigaitis AJ, Ogulnick JV, Cole KL, Conlon M, Tarawneh O, Thommen R, Cole CD, Jean WC, Couldwell WT, Litvack ZN, Al-Mufti F, Bowers CA. Neurosurgery virtual education in the COVID-19 pandemic era: results of a global survey. J Neurosurg Sci 2021; 66:274-277. [PMID: 34647717 DOI: 10.23736/s0390-5616.21.05579-x] [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: 11/08/2022]
Affiliation(s)
- Samantha Varela
- School of Medicine, University of New Mexico (UNM), Albuquerque, NM, USA
| | - Syed F Kazim
- Department of Neurosurgery, University of New Mexico (UNM) School of Medicine, Albuquerque, NM, USA
| | - Meic H Schmidt
- Department of Neurosurgery, University of New Mexico (UNM) School of Medicine, Albuquerque, NM, USA
| | - Bipin Chaurasia
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | | | - Kyril L Cole
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Matthew Conlon
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Omar Tarawneh
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Rachel Thommen
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Chad D Cole
- Department of Neurosurgery, University of New Mexico (UNM) School of Medicine, Albuquerque, NM, USA
| | - Walter C Jean
- Department of Neurosurgery, George Washington University, Washington, WA, USA
| | - William T Couldwell
- Department of Neurosurgery, University of Utah, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Zachary N Litvack
- Department of Neurosurgery, Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico (UNM) School of Medicine, Albuquerque, NM, USA -
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Ahlquist S, Thommen R, Park HY, Sheppard W, James K, Lord E, Shamie AN, Park DY. Implications of sagittal alignment and complication profile with stand-alone anterior lumbar interbody fusion versus anterior posterior lumbar fusion. J Spine Surg 2020; 6:659-669. [PMID: 33447668 DOI: 10.21037/jss-20-595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Anterior lumbar interbody fusion (ALIF) is commonly utilized in lumbar degenerative pathologies. Standalone ALIF (ST-ALIF) systems were developed to avoid added morbidity, surgical time, and cost of anterior and posterior fusion (APF). Controversy exists in the literature about which of these two techniques yields superior clinical and radiographic outcomes, and few studies have directly compared them. This study seeks to compare ST-ALIF and APF in terms of sagittal correction and surgical complications. Methods Ninty-two consecutive ALIF cases performed from 2013-2018 were retrospectively reviewed and separated into 2 groups. Radiographic measurements were performed on pre- and post-operative radiographs, including segmental lordosis (SL), lumbar lordosis (LL), and pelvic incidence-lumbar lordosis mismatch (PI-LL). Surgical complications were determined. Statistical analysis was performed using chi-square test of homogeneity, Fisher's exact test, and independent sample t-test. Comparisons between groups were deemed statistically significant at the P<0.05 threshold. Results Fifty-seven ST-ALIF, 35 APF were identified. There were no differences in age, gender, BMI, Charlson Comorbidity Index (CCI), preoperative diagnosis, or surgical level between the 2 cohorts. Bone Morphogenetic Protein (BMP) was utilized in 24.6% of ST-ALIF versus none of APF (P=0.001). No differences were detected in SL, LL, and PI-LL mismatch. ST-ALIF cohort had significantly greater risk of subsidence and revision surgery versus APF (12.3% vs. 0%, RD 95% CI: 3.8-20.8%, P=0.042). Recurrent spondylolisthesis occurred in 5 ST-ALIF cases, 3 cases with implant failure, and 2 nonunions versus none in the APF group. Conclusions ST-ALIF was associated with significantly greater subsidence and revision surgery versus APF. Careful patient selection is paramount when considering ST-ALIF. The potential for revision surgery may offset the potential benefit in avoiding posterior fusion. Despite the greater risk of subsidence, sagittal alignment was not significantly affected.
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Affiliation(s)
- Seth Ahlquist
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Rachel Thommen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Howard Y Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - William Sheppard
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Kevin James
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Elizabeth Lord
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Arya N Shamie
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Don Y Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
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Selz OM, Thommen R, Pierotti MER, Anaya-Rojas JM, Seehausen O. Differences in male coloration are predicted by divergent sexual selection between populations of a cichlid fish. Proc Biol Sci 2017; 283:rspb.2016.0172. [PMID: 27147097 DOI: 10.1098/rspb.2016.0172] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 02/17/2016] [Accepted: 04/11/2016] [Indexed: 12/27/2022] Open
Abstract
Female mating preferences can influence both intraspecific sexual selection and interspecific reproductive isolation, and have therefore been proposed to play a central role in speciation. Here, we investigate experimentally in the African cichlid fish Pundamilia nyererei if differences in male coloration between three para-allopatric populations (i.e. island populations with gene flow) of P. nyererei are predicted by differences in sexual selection by female mate choice between populations. Second, we investigate if female mating preferences are based on the same components of male coloration and go in the same direction when females choose among males of their own population, their own and other conspecific populations and a closely related para-allopatric sister-species, P. igneopinnis Mate-choice experiments revealed that females of the three populations mated species-assortatively, that populations varied in their extent of population-assortative mating and that females chose among males of their own population based on different male colours. Females of different populations exerted directional intrapopulation sexual selection on different male colours, and these differences corresponded in two of the populations to the observed differences in male coloration between the populations. Our results suggest that differences in male coloration between populations of P. nyererei can be explained by divergent sexual selection and that population-assortative mating may directly result from intrapopulation sexual selection.
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Affiliation(s)
- O M Selz
- Department of Fish Ecology and Evolution, EAWAG Swiss Federal Institute of Aquatic Science and Technology, Center for Ecology, Evolution and Biogeochemistry, Seestrasse 79, 6047 Kastanienbaum, Switzerland Aquatic Ecology and Evolution, Institute of Ecology and Evolution, University of Bern, Baltzerstrasse 6, 3012 Bern, Switzerland
| | - R Thommen
- Aquatic Ecology and Evolution, Institute of Ecology and Evolution, University of Bern, Baltzerstrasse 6, 3012 Bern, Switzerland
| | - M E R Pierotti
- Naos Laboratories, Smithsonian Tropical Research Institute, Panama, Calzada de Amador, Bd 356, 0843-03092, Panama
| | - J M Anaya-Rojas
- Department of Aquatic Ecology, EAWAG Swiss Federal Institute of Aquatic Science and Technology, Center for Ecology, Evolution and Biogeochemistry, Seestrasse 79, 6047 Kastanienbaum, Switzerland Aquatic Ecology and Evolution, Institute of Ecology and Evolution, University of Bern, Baltzerstrasse 6, 3012 Bern, Switzerland
| | - O Seehausen
- Department of Fish Ecology and Evolution, EAWAG Swiss Federal Institute of Aquatic Science and Technology, Center for Ecology, Evolution and Biogeochemistry, Seestrasse 79, 6047 Kastanienbaum, Switzerland Aquatic Ecology and Evolution, Institute of Ecology and Evolution, University of Bern, Baltzerstrasse 6, 3012 Bern, Switzerland
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Selz OM, Thommen R, Maan ME, Seehausen O. Behavioural isolation may facilitate homoploid hybrid speciation in cichlid fish. J Evol Biol 2013; 27:275-89. [DOI: 10.1111/jeb.12287] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 09/06/2013] [Accepted: 10/27/2013] [Indexed: 01/29/2023]
Affiliation(s)
- O. M. Selz
- Department of Fish Ecology and Evolution; EAWAG Swiss Federal Institute of Aquatic Science and Technology; Center for Ecology, Evolution and Biogeochemistry; Kastanienbaum Switzerland
- Aquatic Ecology and Evolution; Institute of Ecology and Evolution; University of Bern; Bern Switzerland
| | - R. Thommen
- Department of Fish Ecology and Evolution; EAWAG Swiss Federal Institute of Aquatic Science and Technology; Center for Ecology, Evolution and Biogeochemistry; Kastanienbaum Switzerland
- Aquatic Ecology and Evolution; Institute of Ecology and Evolution; University of Bern; Bern Switzerland
| | - M. E. Maan
- Behavioural Biology Research Group; Center for Behaviour and Neurosciences; University of Groningen; Groningen The Netherlands
| | - O. Seehausen
- Department of Fish Ecology and Evolution; EAWAG Swiss Federal Institute of Aquatic Science and Technology; Center for Ecology, Evolution and Biogeochemistry; Kastanienbaum Switzerland
- Aquatic Ecology and Evolution; Institute of Ecology and Evolution; University of Bern; Bern Switzerland
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Thommen R, Humar R, Misevic G, Pepper MS, Hahn AW, John M, Battegay EJ. PDGF-BB increases endothelial migration on cord movements during angiogenesis in vitro. J Cell Biochem 1997; 64:403-13. [PMID: 9057098] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To explore direct effects of platelet-derived growth factor (PDGF) on endothelial cells during angiogenesis in vitro, we have used cloned bovine aortic endothelial cells that spontaneously form cord structures. Recently we have shown that cells forming these endothelial cords express PDGF beta-receptors and that PDGF-BB can contribute to cellular proliferation and cord formation. In this study we investigated whether PDGF-induced cellular migration might also contribute to endothelial repair and angiogenesis in vitro. Ten individual endothelial cells in cords were tracked at an early stage of cord formation by video-timelapse microscopy. PDGF-BB (100 ng/ml) induced an increase in endothelial cell movement of 67 +/- 15% as compared with diluent control. Interestingly, PDGF-BB also increased movements of entire cord structures, followed at branching points, by 53 +/- 12% over diluent control. Taken together, these video-timelapse experiments suggested that the apparent movements of single endothelial cord cells might also be due to the motion of entire underlying cord structures in response to PDGF. To analyze the response of single endothelial cord cells we therefore examined whether PDGF-induced migration contributes to endothelial repair. Abrasions were applied with a razor blade to confluent monolayers of endothelial cells at an intermediate stage of cord formation. PDGF-BB concentration-dependently increased the distance to which cord-forming endothelial cells migrated into the abrasion. An increased number of elongated, i.e., probably migrating, endothelial cells was found in the abrasion in response to PDGF-BB. However, there was no effect of PDGF-BB on the total number of endothelial cells found in the abrasion. PDGF-AA affected neither the distance to which the cells migrated nor the number of elongated cells. Actin and tubulin stainings revealed that these cytoskeletal structures were not appreciably altered by PDGF-BB. Furthermore, urokinase-type plasminogen activator transcripts were not modulated in response to PDGF-BB. We conclude that in this model of angiogenesis in vitro PDGF-BB can elicit the movement of entire cord structures, possibly via u-PA-independent mechanisms. PDGF-BB also controls the migration of single cord-forming endothelial cells. Thus, PDGF-BB possibly contributes to endothelial repair and angiogenesis by direct effects on proliferation and composite movements of PDGF beta-receptor-expressing endothelial cells and cords.
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Affiliation(s)
- R Thommen
- Department of Research, University Hospitals, Basel, Switzerland
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Surmatis JD, Gibas J, Thommen R. The synthesis of 1-(2,6,6-trimethyl-1-cyclohexen-1-yl)-18-(2,6,6-trimethyl-2-cyclohexen-1-ylidene)-3,7,12,16,-tetramethyl-2,4,5,8,10,12,14,16,18-octadecanonaene and its rearrangement to trans-beta-carotene. J Org Chem 1969; 34:3039-41. [PMID: 5811402 DOI: 10.1021/jo01262a054] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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