Pub Date : 2024-01-01DOI: 10.1016/j.bas.2024.102878
{"title":"Efficacy of Biphasic Calcium Phosphate Ceramic With a Needle-shaped Surface Topography Versus Autograft in Instrumented Posterolateral Spinals Fusion: A Randomized Trial","authors":"","doi":"10.1016/j.bas.2024.102878","DOIUrl":"10.1016/j.bas.2024.102878","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424001346/pdfft?md5=bd5b6e17d159ba56979e23cc4fd3857f&pid=1-s2.0-S2772529424001346-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.bas.2024.103330
Introduction
Decision-making for the treatment of ruptured aneurysms is an intricate process, which involves several factors. There has been a rapid advancement in endovascular, but also in the surgical treating field of ruptured intracranial aneurysms, with a growing body of evidence for either treatment technique.
Research question
As there is a wide variety of treatment possibilities, it can be hard to understand the intricacies which lie behind the decision-making process for a given aneurysm.
Materials and methods
An overview of the most relevant literature in decision-making on ruptured intracranial aneurysms is given.
Results
Different decision-altering factors were identified, which can be divided into information from the general evidence, to influential factors such as the patient's age, initial presenting status, and aneurysmal factors such as size, morphology and aneurysmal location.
Discussion and conclusion
This review provides an evidence-based overview of the most pertinent literature on these different aspects of decision-making in ruptured aneurysm cases and provides some recommendations after each of these segments. As always, all different aspects of the patient and aneurysmal factors should be taken into consideration before coming to a conclusion, as to obtain the best possible result for an individual patient.
{"title":"An overview of decision-making in cerebrovascular treatment strategies: Part II - Ruptured aneurysms","authors":"","doi":"10.1016/j.bas.2024.103330","DOIUrl":"10.1016/j.bas.2024.103330","url":null,"abstract":"<div><h3>Introduction</h3><p>Decision-making for the treatment of ruptured aneurysms is an intricate process, which involves several factors. There has been a rapid advancement in endovascular, but also in the surgical treating field of ruptured intracranial aneurysms, with a growing body of evidence for either treatment technique.</p></div><div><h3>Research question</h3><p>As there is a wide variety of treatment possibilities, it can be hard to understand the intricacies which lie behind the decision-making process for a given aneurysm.</p></div><div><h3>Materials and methods</h3><p>An overview of the most relevant literature in decision-making on ruptured intracranial aneurysms is given.</p></div><div><h3>Results</h3><p>Different decision-altering factors were identified, which can be divided into information from the general evidence, to influential factors such as the patient's age, initial presenting status, and aneurysmal factors such as size, morphology and aneurysmal location.</p></div><div><h3>Discussion and conclusion</h3><p>This review provides an evidence-based overview of the most pertinent literature on these different aspects of decision-making in ruptured aneurysm cases and provides some recommendations after each of these segments. As always, all different aspects of the patient and aneurysmal factors should be taken into consideration before coming to a conclusion, as to obtain the best possible result for an individual patient.</p></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424005861/pdfft?md5=deb5557c1e2b072f6221710087ba6689&pid=1-s2.0-S2772529424005861-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.bas.2024.102761
Corrado Iaccarino , Salvatore Chibbaro , Thomas Sauvigny , Ivan Timofeev , Ismail Zaed , Silvio Franchetti , Harry Mee , Antonio Belli , Andras Buki , Pasquale De Bonis , Andreas K. Demetriades , Bart Depreitere , Kostantinos Fountas , Mario Ganau , Antonino Germanò , Peter Hutchinson , Angelos Kolias , Dirk Lindner , Laura Lippa , Niklas Marklund , Franco Servadei
Introduction
Planning cranioplasty (CPL) in patients with suspected or proven post-traumatic hydrocephalus (PTH) poses a significant management challenge due to a lack of clear guidance.
Research question
This project aims to create a European document to improve adherence and adapt to local protocols based on available resources and national health systems.
Methods
After a thorough non-systematic review, a steering committee (SC) formed a European expert panel (EP) for a two-round questionnaire using the Delphi method. The questionnaire employed a 9-point Likert scale to assess the appropriateness of statements inherent to two sections: "Diagnostic criteria for PTH" and "Surgical strategies for PTH and cranial reconstruction."
Results
The panel reached a consensus on 29 statements. In the "Diagnostic criteria for PTH" section, five statements were deemed "appropriate" (consensus 74.2−90.3 %), two were labeled "inappropriate," and seven were marked as "uncertain."
In the "Surgical strategies for PTH and cranial reconstruction" section, four statements were considered "appropriate" (consensus 74.2−90.4 %), six were "inappropriate," and five were "uncertain."
Discussion and conclusion
Planning a cranioplasty alongside hydrocephalus remains a significant challenge in neurosurgery. Our consensus conference suggests that, in patients with cranial decompression and suspected hydrocephalus, the most suitable diagnostic approach involves a combination of evolving clinical conditions and neuroradiological imaging. The recommended management sequence prioritizes cranial reconstruction, with the option of a ventriculoperitoneal shunt when needed, preferably with a programmable valve. We strongly recommend to adopt local protocols based on expert consensus, such as this, to guide patient care.
{"title":"Consensus-based recommendations for diagnosis and surgical management of cranioplasty and post-traumatic hydrocephalus from a European panel","authors":"Corrado Iaccarino , Salvatore Chibbaro , Thomas Sauvigny , Ivan Timofeev , Ismail Zaed , Silvio Franchetti , Harry Mee , Antonio Belli , Andras Buki , Pasquale De Bonis , Andreas K. Demetriades , Bart Depreitere , Kostantinos Fountas , Mario Ganau , Antonino Germanò , Peter Hutchinson , Angelos Kolias , Dirk Lindner , Laura Lippa , Niklas Marklund , Franco Servadei","doi":"10.1016/j.bas.2024.102761","DOIUrl":"10.1016/j.bas.2024.102761","url":null,"abstract":"<div><h3>Introduction</h3><p>Planning cranioplasty (CPL) in patients with suspected or proven post-traumatic hydrocephalus (PTH) poses a significant management challenge due to a lack of clear guidance.</p></div><div><h3>Research question</h3><p>This project aims to create a European document to improve adherence and adapt to local protocols based on available resources and national health systems.</p></div><div><h3>Methods</h3><p>After a thorough non-systematic review, a steering committee (SC) formed a European expert panel (EP) for a two-round questionnaire using the Delphi method. The questionnaire employed a 9-point Likert scale to assess the appropriateness of statements inherent to two sections: \"Diagnostic criteria for PTH\" and \"Surgical strategies for PTH and cranial reconstruction.\"</p></div><div><h3>Results</h3><p>The panel reached a consensus on 29 statements. In the \"Diagnostic criteria for PTH\" section, five statements were deemed \"appropriate\" (consensus 74.2−90.3 %), two were labeled \"inappropriate,\" and seven were marked as \"uncertain.\"</p><p>In the \"Surgical strategies for PTH and cranial reconstruction\" section, four statements were considered \"appropriate\" (consensus 74.2−90.4 %), six were \"inappropriate,\" and five were \"uncertain.\"</p></div><div><h3>Discussion and conclusion</h3><p>Planning a cranioplasty alongside hydrocephalus remains a significant challenge in neurosurgery. Our consensus conference suggests that, in patients with cranial decompression and suspected hydrocephalus, the most suitable diagnostic approach involves a combination of evolving clinical conditions and neuroradiological imaging. The recommended management sequence prioritizes cranial reconstruction, with the option of a ventriculoperitoneal shunt when needed, preferably with a programmable valve. We strongly recommend to adopt local protocols based on expert consensus, such as this, to guide patient care.</p></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424000171/pdfft?md5=2658d98eac368822d11ea0a7bc4f27dc&pid=1-s2.0-S2772529424000171-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139632963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.bas.2024.102766
Guillermo A. Ricciardi , Juan P. Cabrera , Oscar Martínez , Javier Matta , Hugo Vilchis , Jeasson Javier Perez Ríos , Charles A. Carazzo , Michael Dittmar , Ratko Yurac , the AO Spine Latin America Trauma Study Group
Introduction
There is a wide variation in the clinical presentation of spinal gunshot wounds ranging from isolated minor stable fractures to extremely severe injuries with catastrophic neurological damage.
Research question
we aim to analyze the risk factors for early complications and impact of surgical treatment in patients with spinal gunshot wounds.
Material and methods
This is a multicentre retrospective case-control study to compare patients with spinal gunshot wounds who had early complications with those who did not. The following matching criteria were used: sex (1:1), injury level (1:1) and age (±5 years). Univariate and multivariate analyses were performed using logistic regression.
Results
Results: Among 387 patients, 36.9 % registered early complications, being persistent pain (n = 32; 15 %), sepsis/septic shock (n = 28; 13 %), pneumonia (n = 27; 13 %) and neurogenic bladder (n = 27; 12 %) the most frequently reported. After case-control matched analysis, we obtained 133 patients who suffered early complications (cases) and 133 patients who did not as control group, not differing significantly in sex (p = 1000), age (p = 0,535) and injury level (p = 1000), while the 35 % of complications group required surgical treatment versus 15 % of the non-complication group (p < 0.001). On multivariable analysis, significant predictors of complications were surgical treatment for spinal injury (OR = 3.50, 95 % CI = 1.68–7.30), dirty wound (3.32, 1.50–7.34), GCS ≤8 (3.56, 1.17–10.79), hemodynamic instability (2.29, 1.07–4.88), and multiple bullets (1.97, 1.05–3.67).
Discussion and conclusion
Spinal gunshot wounds are associated with a high risk of early complications, especially when spinal surgery is required, and among patients with dirty wound, low level of consciousness, hemodynamic instability, and multiple bullets.
{"title":"Predicting early complications in patients with spinal gunshot wounds: A multicenter study","authors":"Guillermo A. Ricciardi , Juan P. Cabrera , Oscar Martínez , Javier Matta , Hugo Vilchis , Jeasson Javier Perez Ríos , Charles A. Carazzo , Michael Dittmar , Ratko Yurac , the AO Spine Latin America Trauma Study Group","doi":"10.1016/j.bas.2024.102766","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102766","url":null,"abstract":"<div><h3>Introduction</h3><p>There is a wide variation in the clinical presentation of spinal gunshot wounds ranging from isolated minor stable fractures to extremely severe injuries with catastrophic neurological damage.</p></div><div><h3>Research question</h3><p>we aim to analyze the risk factors for early complications and impact of surgical treatment in patients with spinal gunshot wounds.</p></div><div><h3>Material and methods</h3><p>This is a multicentre retrospective case-control study to compare patients with spinal gunshot wounds who had early complications with those who did not. The following matching criteria were used: sex (1:1), injury level (1:1) and age (±5 years). Univariate and multivariate analyses were performed using logistic regression.</p></div><div><h3>Results</h3><p>Results: Among 387 patients, 36.9 % registered early complications, being persistent pain (n = 32; 15 %), sepsis/septic shock (n = 28; 13 %), pneumonia (n = 27; 13 %) and neurogenic bladder (n = 27; 12 %) the most frequently reported. After case-control matched analysis, we obtained 133 patients who suffered early complications (cases) and 133 patients who did not as control group, not differing significantly in sex (p = 1000), age (p = 0,535) and injury level (p = 1000), while the 35 % of complications group required surgical treatment versus 15 % of the non-complication group (p < 0.001). On multivariable analysis, significant predictors of complications were surgical treatment for spinal injury (OR = 3.50, 95 % CI = 1.68–7.30), dirty wound (3.32, 1.50–7.34), GCS ≤8 (3.56, 1.17–10.79), hemodynamic instability (2.29, 1.07–4.88), and multiple bullets (1.97, 1.05–3.67).</p></div><div><h3>Discussion and conclusion</h3><p>Spinal gunshot wounds are associated with a high risk of early complications, especially when spinal surgery is required, and among patients with dirty wound, low level of consciousness, hemodynamic instability, and multiple bullets.</p></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424000225/pdfft?md5=7333513106906bccf3c79cbe9486e07a&pid=1-s2.0-S2772529424000225-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140015901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Both intracranial pressure (ICP) and cerebral arterial blood volume (CaBV) have a pulsatile character related to the cardiac cycle. The evolution of the shape of ICP pulses under increasing ICP or decreasing intracranial compliance is well documented. Nevertheless, the exact origin of the alterations in the ICP morphology remains unclear.
Research question
Does ICP pulse waveform become similar to non-invasively estimated CaBV pulse during ICP plateau waves.
Material and methods
A total of 15 plateau waves recorded in 15 traumatic brain injured patients were analyzed. CaBV pulse waveforms were calculated using global cerebral blood flow model from transcranial Doppler cerebral blood flow velocity (CBFV) signals. The difference index (DI) was used to quantify the similarity between ICP and CaBV waveforms. DI was calculated as the sum of absolute sample-by-sample differences between ICP and CaBV waveforms, representing the area between the pulses.
Results
ICP increased (19.4 mm Hg [Q1–Q3: 18.2–23.4 mm Hg] vs. 42.7 mm Hg [Q1–Q3: 36.5–45.1 mm Hg], p < 0.001) while CBFV decreased (44.2 cm/s [Q1–Q3: 34.8–69.5 cm/s] vs. 32.9 cm/s [Q1–Q3: 24.7–68.2 cm/s], p = 0.002) during plateau waves. DI was smaller during the plateau waves (20.4 [Q1–Q3: 15.74–23.0]) compared to the baselines (26.3 [Q1–Q3: 24.2–34.7], p < 0.001).
Discussion and conclusion
The area between corresponding ICP and CaBV pulse waveforms decreased during the plateau waves which suggests they became similar in shape. CaBV may play a significant role in determining the shape of ICP pulses during the plateau waves and might be a driving force in formulating ICP elevation.
导言颅内压(ICP)和脑动脉血容量(CaBV)都具有与心动周期相关的搏动特性。在 ICP 增加或颅内顺应性降低的情况下,ICP 脉冲形状的演变已被充分记录。材料和方法分析了 15 名脑外伤患者记录的共 15 个高原波。根据经颅多普勒脑血流速度(CBFV)信号,使用全局脑血流模型计算 CaBV 脉搏波形。差值指数(DI)用于量化 ICP 和 CaBV 波形之间的相似性。DI 计算为 ICP 和 CaBV 波形之间逐个样本绝对差异的总和,代表脉冲之间的区域。4 mm Hg] vs. 42.7 mm Hg [Q1-Q3: 36.5-45.1 mm Hg], p < 0.001),而 CBFV 在高原波期间下降(44.2 cm/s [Q1-Q3: 34.8-69.5 cm/s] vs. 32.9 cm/s [Q1-Q3: 24.7-68.2 cm/s],p = 0.002)。在高原波期间,DI(20.4 [Q1-Q3:15.74-23.0])小于基线(26.3 [Q1-Q3:24.2-34.7],p <0.001)。讨论和结论在高原波期间,相应的 ICP 和 CaBV 脉冲波形之间的面积减小,这表明它们的形状变得相似。在高原波期间,CaBV 在决定 ICP 脉冲波形方面可能起着重要作用,并可能是形成 ICP 升高的驱动力。
{"title":"Quantitative analysis of similarity between cerebral arterial blood volume and intracranial pressure pulse waveforms during intracranial pressure plateau waves","authors":"Arkadiusz Ziółkowski , Magdalena Kasprowicz , Agnieszka Kazimierska , Marek Czosnyka","doi":"10.1016/j.bas.2024.102832","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102832","url":null,"abstract":"<div><h3>Introduction</h3><p>Both intracranial pressure (ICP) and cerebral arterial blood volume (C<sub>a</sub>BV) have a pulsatile character related to the cardiac cycle. The evolution of the shape of ICP pulses under increasing ICP or decreasing intracranial compliance is well documented. Nevertheless, the exact origin of the alterations in the ICP morphology remains unclear.</p></div><div><h3>Research question</h3><p>Does ICP pulse waveform become similar to non-invasively estimated C<sub>a</sub>BV pulse during ICP plateau waves.</p></div><div><h3>Material and methods</h3><p>A total of 15 plateau waves recorded in 15 traumatic brain injured patients were analyzed. C<sub>a</sub>BV pulse waveforms were calculated using global cerebral blood flow model from transcranial Doppler cerebral blood flow velocity (CBFV) signals. The difference index (DI) was used to quantify the similarity between ICP and C<sub>a</sub>BV waveforms. DI was calculated as the sum of absolute sample-by-sample differences between ICP and C<sub>a</sub>BV waveforms, representing the area between the pulses.</p></div><div><h3>Results</h3><p>ICP increased (19.4 mm Hg [Q1–Q3: 18.2–23.4 mm Hg] vs. 42.7 mm Hg [Q1–Q3: 36.5–45.1 mm Hg], p < 0.001) while CBFV decreased (44.2 cm/s [Q1–Q3: 34.8–69.5 cm/s] vs. 32.9 cm/s [Q1–Q3: 24.7–68.2 cm/s], p = 0.002) during plateau waves. DI was smaller during the plateau waves (20.4 [Q1–Q3: 15.74–23.0]) compared to the baselines (26.3 [Q1–Q3: 24.2–34.7], p < 0.001).</p></div><div><h3>Discussion and conclusion</h3><p>The area between corresponding ICP and C<sub>a</sub>BV pulse waveforms decreased during the plateau waves which suggests they became similar in shape. C<sub>a</sub>BV may play a significant role in determining the shape of ICP pulses during the plateau waves and might be a driving force in formulating ICP elevation.</p></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424000882/pdfft?md5=cb91f4e586115f1f4d5f0930aa841ab9&pid=1-s2.0-S2772529424000882-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140901248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.bas.2024.102921
{"title":"Reevaluating heparin reversal in managing intraprocedural ruptures: A call for tailored approaches in endovascular treatment of intracranial aneurysms","authors":"","doi":"10.1016/j.bas.2024.102921","DOIUrl":"10.1016/j.bas.2024.102921","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424001772/pdfft?md5=e83c55a25c4be70cf1869aec78ca2a3c&pid=1-s2.0-S2772529424001772-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142041163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.bas.2024.102764
Joseph Donnelly , Erta Beqiri , Frederick A. Zeiler , Peter Smielewski , Marek Czosnyka
Introduction
Secondary insults due to high intracranial pressure (ICP), low cerebral perfusion pressure (CPP) and impaired cerebral pressure reactivity (PRx) predict outcome after severe traumatic brain injury (TBI).
Research question
What is the prevalence, co-occurrence and prognostic importance of secondary insults due to deranged ICP, CPP or PRx after TBI.
Material and methods
Severe TBI patients requiring ICP monitoring were included. Secondary insults due to ICP, PRx, and CPP were defined as having at least 1 h with a mean value above (or below for CPP) a respective threshold (ICP 20, CPP 60, and PRx 0.25). Percentage time with isolated or co-occurring insults was calculated (impaired ICP only, CPP only, PRx only, ICP and PRx, ICP and CPP, CPP and PRx, ICP CPP and PRx). Prognostic importance for mortality was assessed using a logistic regression model.
Results
822 patients were included of which 76% had elevated ICP, 92% had disturbed pressure reactivity and 55% had low CPP for at least an hour. Out of the total 115,459 h, 46,111 (40%) were spent with at least one variable within the defined secondary injury range. Odds ratios for mortality were greater for combined (impaired ICP, CPP and PRx OR 1.17 95%CI 1.09 to 1.28) than isolated insults (impaired ICP only OR 1.01 95%CI 1.00–1.02, impaired CPP only 1.00 95%CI 0.95–1.05).
Discussion and conclusion
ICP and autoregulation insults are common after TBI and often occur independently. Concurrent ICP, CPP and PRx insults portend worse prognosis than when a single variable is deranged.
{"title":"Secondary insults prevalence, co-occurrence and relationship with outcome after severe TBI","authors":"Joseph Donnelly , Erta Beqiri , Frederick A. Zeiler , Peter Smielewski , Marek Czosnyka","doi":"10.1016/j.bas.2024.102764","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102764","url":null,"abstract":"<div><h3>Introduction</h3><p>Secondary insults due to high intracranial pressure (ICP), low cerebral perfusion pressure (CPP) and impaired cerebral pressure reactivity (PRx) predict outcome after severe traumatic brain injury (TBI).</p></div><div><h3>Research question</h3><p>What is the prevalence, co-occurrence and prognostic importance of secondary insults due to deranged ICP, CPP or PRx after TBI.</p></div><div><h3>Material and methods</h3><p>Severe TBI patients requiring ICP monitoring were included. Secondary insults due to ICP, PRx, and CPP were defined as having at least 1 h with a mean value above (or below for CPP) a respective threshold (ICP 20, CPP 60, and PRx 0.25). Percentage time with isolated or co-occurring insults was calculated (impaired ICP only, CPP only, PRx only, ICP and PRx, ICP and CPP, CPP and PRx, ICP CPP and PRx). Prognostic importance for mortality was assessed using a logistic regression model.</p></div><div><h3>Results</h3><p>822 patients were included of which 76% had elevated ICP, 92% had disturbed pressure reactivity and 55% had low CPP for at least an hour. Out of the total 115,459 h, 46,111 (40%) were spent with at least one variable within the defined secondary injury range. Odds ratios for mortality were greater for combined (impaired ICP, CPP and PRx OR 1.17 95%CI 1.09 to 1.28) than isolated insults (impaired ICP only OR 1.01 95%CI 1.00–1.02, impaired CPP only 1.00 95%CI 0.95–1.05).</p></div><div><h3>Discussion and conclusion</h3><p>ICP and autoregulation insults are common after TBI and often occur independently. Concurrent ICP, CPP and PRx insults portend worse prognosis than when a single variable is deranged.</p></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424000201/pdfft?md5=d012c4832dd32e36072268d5b2c3314a&pid=1-s2.0-S2772529424000201-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140295885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-01DOI: 10.1016/j.bas.2024.102780
Omar H. Tarawneh, Rajkishen Narayanan, Michael McCurdy, Tariq Z. Issa, Yunsoo Lee, Olivia Opara, Nicholas B. Pohl, Alexa Tomlak, Matthew Sherman, Jose A. Canseco, Alan S. Hilibrand, Alexander R. Vaccaro, Gregory D. Schroeder, Christopher K. Kepler
Introduction
As the population of elderly patients continues to rise, the number of these individuals presenting with thoracolumbar trauma is expected to increase.
Research question
To investigate thoracolumbar fusion outcomes for patients with vertebral fractures as stratified by decade. Secondarily, we examined the variability of cost across age groups by identifying drivers of cost of care.
Materials and methods
We queried the United States Nationwide Inpatient Sample(NIS) for adult patients undergoing spinal fusion for thoracolumbar fractures between 2012 and 2017. Patients were stratified by decade 60–69(sexagenarians), 70–79(septuagenarians) and 80–89(octogenarians). Bivariable analysis followed by multivariable regression was performed to assess independent predictors of length of stay(LOS), hospital cost, and discharge disposition.
Results
A total of 2767 patients were included, of which 46%(N = 1268) were sexagenarians, 36% septuagenarians and 18%(N = 502) octogenarians. Septuagenarians and octogenarians had shorter LOS compared to sexagenarians(ß = −0.88 days; p = 0.012) and(ß = -1.78; p < 0.001), respectively. LOS was reduced with posterior approach(-2.46 days[95% CI: 3.73–1.19]; p < 0.001), while Hispanic patients had longer LOS(+1.97 [95% CI: 0.81–3.13]; p < 0.001). Septuagenarians had lower total charges $12,185.70(p = 0.040), while the decrease in charges in octogenarians was more significant, with a decrease of $26,016.30(p < 0.001) as compared to sexagenarians. Posterior approach was associated with a decrease of $24,337.90 in total charges(p = 0.026). Septuagenarians and octogenarians had 1.72 higher odds(p < 0.001) and 4.16 higher odds(p < 0.001), respectively, of discharge to a skilled nursing facility.
Discussion and conclusions
Healthcare utilization in geriatric thoracolumbar trauma is complex. Cost reductions in the acute hospital setting may be offset by unaccounted costs after discharge. Further research into this phenomenon and observed racial/ethnic disparities must be pursued.
{"title":"Evaluation of perioperative care and drivers of cost in geriatric thoracolumbar trauma","authors":"Omar H. Tarawneh, Rajkishen Narayanan, Michael McCurdy, Tariq Z. Issa, Yunsoo Lee, Olivia Opara, Nicholas B. Pohl, Alexa Tomlak, Matthew Sherman, Jose A. Canseco, Alan S. Hilibrand, Alexander R. Vaccaro, Gregory D. Schroeder, Christopher K. Kepler","doi":"10.1016/j.bas.2024.102780","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102780","url":null,"abstract":"<div><h3>Introduction</h3><p>As the population of elderly patients continues to rise, the number of these individuals presenting with thoracolumbar trauma is expected to increase.</p></div><div><h3>Research question</h3><p>To investigate thoracolumbar fusion outcomes for patients with vertebral fractures as stratified by decade. Secondarily, we examined the variability of cost across age groups by identifying drivers of cost of care.</p></div><div><h3>Materials and methods</h3><p>We queried the United States Nationwide Inpatient Sample(NIS) for adult patients undergoing spinal fusion for thoracolumbar fractures between 2012 and 2017. Patients were stratified by decade 60–69(sexagenarians), 70–79(septuagenarians) and 80–89(octogenarians). Bivariable analysis followed by multivariable regression was performed to assess independent predictors of length of stay(LOS), hospital cost, and discharge disposition.</p></div><div><h3>Results</h3><p>A total of 2767 patients were included, of which 46%(N = 1268) were sexagenarians, 36% septuagenarians and 18%(N = 502) octogenarians. Septuagenarians and octogenarians had shorter LOS compared to sexagenarians(ß = −0.88 days; p = 0.012) and(ß = -1.78; p < 0.001), respectively. LOS was reduced with posterior approach(-2.46 days[95% CI: 3.73–1.19]; p < 0.001), while Hispanic patients had longer LOS(+1.97 [95% CI: 0.81–3.13]; p < 0.001). Septuagenarians had lower total charges $12,185.70(p = 0.040), while the decrease in charges in octogenarians was more significant, with a decrease of $26,016.30(p < 0.001) as compared to sexagenarians. Posterior approach was associated with a decrease of $24,337.90 in total charges(p = 0.026). Septuagenarians and octogenarians had 1.72 higher odds(p < 0.001) and 4.16 higher odds(p < 0.001), respectively, of discharge to a skilled nursing facility.</p></div><div><h3>Discussion and conclusions</h3><p>Healthcare utilization in geriatric thoracolumbar trauma is complex. Cost reductions in the acute hospital setting may be offset by unaccounted costs after discharge. Further research into this phenomenon and observed racial/ethnic disparities must be pursued.</p></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2772529424000365/pdfft?md5=ea14ffc91784f9a55319a6df2f8e286a&pid=1-s2.0-S2772529424000365-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140122082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}