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World neurosurgery 210건

  1. [해외논문]   Comparison of Zero-profile Device Versus Plate-and-Cage Implant in the Treatment of Symptomatic Adjacent Segment Disease after Anterior Cervical Discectomy and Fusion: A Minimum 2-Year Follow-Up Study  

    Shen, Yong (To whom correspondence should be addressed: Feng Wang, M.D.) , Du, Wei , Wang, Lin-Feng , Dong, Zhen , Wang, Feng
    World neurosurgery v.115 ,pp. e226 - e232 , 2018 , 1878-8750 ,

    초록

    Objective The purpose of this study was to compare the clinical efficacy of anterior cervical discectomy and fusion (ACDF) with Zero-profile device (Zero-p) and traditional cervical plate-and-cage implant in the treatment of symptomatic adjacent segment disease (ASD) and to determine the optimal reoperation procedure. Methods This was a retrospective study of 58 patients with symptomatic ASD after an initial ACDF surgery and who had undergone a reoperation with ACDF with Zero-p (n = 27) and cervical plate-and-cage (n = 31) at our medical center between January 2010 and December 2015. Results The Japanese Orthopaedic Association score, Neck Disability Index score, Visual Analog Scale score, C2-C7 Cobb angle, and disc height index demonstrated significant improvements compared with the preoperative in both Zero-p and plate-and-cage groups ( P P > 0.05). The reoperation time for the Zero-p group (83.4 ± 18.9 min) was less than that for the plate-and-cage group (96.5 ± 20.1 min), with significant difference ( P P > 0.05). However, the incidence of dysphagia in the plate-and-cage group (38.7%) was higher than in the Zero-p group (7.4%), with a significant difference ( P Conclusions ACDF with Zero-p obtaining the same surgical efficacy, compared with traditional cervical plate-and-cage, can significantly shorten the reoperation time and reduce the incidence of postoperative dysphagia. This option may be preferable for symptomatic patients with ASD qualifying for the anterior approach, in terms of biomechanics and surgical outcomes. Highlights ACDF with a Zero-p and a traditional cervical plate-and-cage are both effective treatments for the ASD after initial ACDF surgery. ACDF with the Zero-p obtains a similar surgical result, compared with a traditional cervical plate-and-cage. ACDF with the Zero-p can significantly shorten the reoperation time and reduce the incidence of postoperative dysphagia. ACDF with the Zero-p may be preferred for symptomatic ASD that qualifies for an anterior approach, in terms of biomechanics and surgical outcomes.

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  2. [해외논문]   Length of Thromboprophylaxis in Patients Operated on for a High-Grade Glioma: A Retrospective Study.  

    Senders, Joeky T. (Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands ) , Snijders, Tom J. (Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands ) , van Essen, Max (Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands ) , van Bentum, Gaby M. (Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands ) , Seute, Tatjana (Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands ) , de Vos, Filip Y. (Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands ) , Smith, Timothy R. (Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School,) , Robe, Pierre A. , Broekman, Marike L.D.
    World neurosurgery v.115 ,pp. e723 - e730 , 2018 , 1878-8750 ,

    초록

    Objective High-grade gliomas are associated with venous thromboembolism (VTE). This retrospective study with a parallel cohort design investigated influence of continuing prophylactic anticoagulation after discharge on rate of VTE and intracranial hemorrhage (ICH) in patients operated on for high-grade glioma. Methods Consecutive adult patients who underwent subtotal or gross total resection for high-grade glioma at a single institution were included. Multivariable logistic regression analysis was used to investigate the association between duration of thromboprophylaxis (dalteparin administered 21 days vs. 0–7 days) and occurrence of VTE and ICH within 21 or 90 days after surgery, corrected for known risk factors. Results Of 301 included patients, 166 received short-term thromboprophylaxis, and 135 received prolonged thromboprophylaxis. In multivariable analysis, prolonged thromboprophylaxis was not significantly associated with occurrence of VTE within 21 days (3.0% vs. 1.2%; P = 0.24) or 90 days (8.9% vs. 4.8%; P = 0.09) after surgery; however, prolonged prophylaxis was associated with occurrence of ICH (5.9% vs. 0.6%; P = 0.03). Additionally, immobility ( P = 0.03) and high body mass index ( P = 0.02) were associated with occurrence of VTE. Conclusions Prophylactic anticoagulation for 21 days postoperatively was not associated with a decreased rate of VTE compared with thromboprophylaxis until discharge. ICH was more common with prolonged thromboprophylaxis. These results provide insufficient evidence to extend duration of prophylaxis beyond hospitalization. Large-scale randomized prospective studies are needed to clarify safety, efficacy, and optimal timing of postoperative thromboprophylaxis in patients with high-grade glioma. Highlights Continuing anticoagulation after discharge was not associated with a lower VTE rate. Prolonged thromboprophylaxis was associated with a higher ICH rate. Immobility and obesity were identified as independent predictors of VTE.

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  3. [해외논문]   A Comparative Analysis of the Usefulness of Survival Prediction Models for Patients with Glioblastoma in the Temozolomide Era: The Importance of Methylguanine Methyltransferase Promoter Methylation, Extent of Resection, and Subventricular Zone Location  

    Woo, Peter (Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China ) , Ho, Jason (Department of Neurosurgery, Tuen Mun Hospital, Hong Kong, China ) , Lam, Sandy (Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China ) , Ma, Eric (Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China ) , Chan, Danny (Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, Hong Kong, China ) , Wong, Wai-Kei (Department of Neurosurgery, Princess Margaret Hospital, Hong Kong, China ) , Mak, Calvin (Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, China ) , Lee, Michael (Department of Neurosurgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China ) , Wong, Sui-To (Department of Neurosurgery, Tuen Mun Hospital, Hong Kong, China ) , Chan, Kwong-Yau (Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, China ) , Poon, Wai-Sang (Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, Hong Kong, China)
    World neurosurgery v.115 ,pp. e375 - e385 , 2018 , 1878-8750 ,

    초록

    Objective Several survival prediction models for patients with glioblastoma have been proposed, but none is widely used. This study aims to identify the predictors of overall survival (OS) and to conduct an independent comparative analysis of 5 prediction models. Methods Multi-institutional data from 159 patients with newly diagnosed glioblastoma who received adjuvant temozolomide concomitant chemoradiotherapy (CCRT) were collected. OS was assessed by Cox proportional hazards regression and adjusted for known prognostic factors. An independent CCRT patient cohort was used to externally validate the 1) RTOG (Radiation Therapy Oncology Group) recursive partitioning analysis (RPA) model, 2) Yang RPA model, and 3) Wee RPA model, Chaichana model, and the RTOG nomogram model. The predictive accuracy for each model at 12-month survival was determined by concordance indices. Calibration plots were performed to ascertain model prediction precision. Results The median OS for patients who received CCRT was 19.0 months compared with 12.7 months for those who did not ( P 85% (HR, 0.59; 95% CI, 0.4–0.9). For 12-month OS prediction, the RTOG nomogram model was superior to the RPA models with a c-index of 0.70. Calibration plots for 12-month survival showed that none of the models was precise, but the RTOG nomogram performed relatively better. Conclusions The RTOG nomogram best predicted 12-month OS. Methylguanine methyltransferase promoter methylation status, subventricular zone tumor location, and volumetric extent of resection should be considered when constructing prediction models. Highlights MGMT promoter methylation, SVZ location and EOR ≥85% are independent predictors of OS. Only the RTOG nomogram model can be considered as accurate and relatively precise in predicting 12-month survival. Future prediction models should include MGMT promoter methylation, SVZ location, and volumetric EOR as covariates.

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  4. [해외논문]   Long-Term Clinical and Radiologic Postoperative Outcomes After C1-C2 Pedicle Screw Techniques for Pediatric Atlantoaxial Rotatory Dislocation  

    Wu, Xinjie (Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China ) , Li, Yafeng (Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China ) , Tan, Mingsheng (Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China ) , Yi, Ping (Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China ) , Yang, Feng (Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China ) , Tang, Xiangsheng (Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China ) , Hao, Qingying (Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, China)
    World neurosurgery v.115 ,pp. e404 - e421 , 2018 , 1878-8750 ,

    초록

    Background Although C1-C2 pedicle screw techniques have been extensively reported in pediatric series, reports on their use have examined only small series with short follow-up periods. The aim of this study was to report pediatric patients with atlantoaxial rotatory dislocation treated with these techniques with a minimum 5-year follow-up. Methods Retrospective review was performed of 27 pediatric patients with atlantoaxial rotatory dislocation who underwent C1-C2 pedicle screw fixation between 2004 and 2012. Clinical and radiographic outcomes were collected and compared with a control group. Results Follow-up period was 60–142 months (mean 84 months). Torticollis was completely corrected postoperatively in all but 1 patient. All patients experienced significant pain relief and improvement in range of motion, and 6 patients with neurologic deficits experienced significant improvement postoperatively. Both atlantodental interval and space available for the cord were significantly improved compared with preoperative values. At final follow-up, curvature was lordotic in 20 cases and straight in 7 cases. Compared with the control group, range of motion of the patient group was not significantly different in any direction except in flexion and rotation. Mean anteroposterior diameters of the spinal canal at C1 and C2 levels were not significantly different from the control group. Conclusions C1-C2 pedicle screw techniques are safe and effective for treatment of atlantoaxial rotatory dislocation and result in no obvious limitation on growth in older children. Highlights Pediatric patients with AARD were treated with C1-C2 pedicle screw techniques and followed for a minimum of 5 years. Compensation for ROM was achieved after atlantoaxial fusion via joint remodeling or increased ligamentous laxity. C1-C2 pedicle screw techniques do not result in obvious limitation on growth.

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  5. [해외논문]   Endoscopic Transseptal Approach with Bilateral Nasoseptal Flap in Challenging Skull-Base Tumors  

    Kim, Do Hyun (Department of Otolaryngology‒Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea ) , Hong, Yong-Kil (Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea ) , Jeun, Sin-Soo (Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea ) , Park, Jae-Sung (Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea ) , Kim, Soo Whan (Department of Otolaryngology‒Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea ) , Cho, Jin Hee (Department of Otolaryngology‒Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea ) , Park, Yong Jin (Department of Otolaryngology‒Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea ) , Kim, Sung Won (D)
    World neurosurgery v.115 ,pp. e178 - e184 , 2018 , 1878-8750 ,

    초록

    Objective We sought to examine the utility of an endoscopic transseptal approach and creation of a bilateral nasoseptal flap using a 2-nostrils/4-hands technique in patients with challenging skull-base tumors. Methods The medical records of patients operated on via an endoscopic transseptal approach between 2009 and 2017 were retrospectively reviewed. Two patients with ossifying fibroma, 2 with orbital hemangioma, 2 with trigeminal nerve schwannoma, and 1 patient each with juvenile angiofibroma, meningioma, and myxofibrosarcoma were included in the study. The surgical technique and endoscopic anatomy are presented. Results The mean age of the 4 male and 5 female patients was 39.9 ± 14.8 years. By using this technique, all 7 tumors were resected with minimal nasal morbidity after a mean follow-up of 15.2 ± 9.4 months. Conclusions The endoscopic transseptal approach, by creation of a bilateral nasoseptal flap using a 2-nostrils/4-hands technique, improves surgical visualization and increases instrument maneuverability. Surgical access to challenging skull-base tumors is therefore afforded. The procedure also reduces nasal morbidity by preserving the lacrimal apparatus and anterior maxilla structures and avoiding septal perforation and traumatic nose traction. Highlights The approach improves visualization and increases instrument maneuverability. Surgical access to challenging skull-base tumors is afforded. The procedure also reduces nasal morbidity.

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  6. [해외논문]   Long-Term Follow-Up of Patients with Metastatic Epidural Spinal Cord Compression from Solid Tumors Submitted for Surgery Followed by Radiation Therapy  

    Pessina, Federico (Department of Neurosurgical Oncology and Neurosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy ) , Navarria, Pierina (Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy ) , Carta, Giulio Alberto (Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy ) , D'Agostino, Giuseppe Roberto (Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy ) , Clerici, Elena (Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy ) , Nibali, Marco Conti (Department of Neurosurgical Oncology and Neurosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy ) , Costa, Francesco (Department of Neurosurgical Oncology and Neurosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy ) , Fornari, Maurizio (Department of Neurosurgical Oncology and Neurosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy ) , Scorsetti, Marta (Department of Radiotherapy and R)
    World neurosurgery v.115 ,pp. e681 - e687 , 2018 , 1878-8750 ,

    초록

    Objective To evaluate the outcome of patients with epidural spinal cord compression from different solid tumors treated with a combined approach, surgery plus radiotherapy (RT), with a follow-up longer than 10 years. Methods Ninety-seven patients treated between 2002 and 2009 were included. Surgical treatment was performed in patients with good performance status, limited metastatic disease, life expectancy longer than 3 months, and progressive neurologic deficit and/or intractable pain. RT was performed delivering a median total dose of 30 Gy in 10 fractions. Clinical outcome was evaluated using the modified visual analog scale for pain, the Frankel scale for neurologic deficit, and magnetic resonance imaging before treatment, after treatment, and every 3 months thereafter. Results Palliative decompression was performed in 27% of patients, tumor curettage (debulking) was performed in 51%, and total vertebrectomy was performed in 22%, followed by RT in 78% of cases. Pain remission was obtained in 98% of patients, and recovery of neurologic function was obtained in 51%. The median follow-up time was 135 months (range, 96–209 months). The 5- and 10-year local control rates were 82.8% and 82.8%, respectively. The median and 5- and 10-year progression-free survival rates were 12 months, 16.9%, and 11.3%, respectively; the median and 5- and 10-year overall survival rates were 18 months, 21.3%, and 12%, respectively. On univariate and multivariate analysis, factors recorded as conditioning survival were the performance status and the presence of other metastases at the time of vertebral treatment ( P Conclusions Our update confirmed that surgery plus RT is a safe and feasible treatment with limited morbidity. In selected patients with favorable prognostic factors, the combined treatment may significantly impact on survival. Highlights Spinal cord compression is a frequent source of morbidity in cancer patients. A multimodal approach is recommended to choose the most appropriate treatment. Safety and feasibility of surgery plus radiotherapy is confirmed with a long follow-up.

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  7. [해외논문]   Prevalence of Incidental Clinoid Segment Saccular Aneurysms  

    Revilla-Pacheco, Francisco (To whom correspondence should be addressed: Francisco Revilla-Pacheco, M.D., Ph.D.) , Escalante-Seyffert, Marí , a Cecilia , Herrada-Pineda, Tenoch , Manrique-Guzman, Salvador , Perez-Zuniga, Irma , Rangel-Suarez, Sergio , Rubalcava-Ortega, Johnatan , Loyo-Varela, Mauro
    World neurosurgery v.115 ,pp. e244 - e251 , 2018 , 1878-8750 ,

    초록

    Introduction Clinoid segment aneurysms are cerebral vascular lesions recently described in the neurosurgical literature. They arise from the clinoid segment of the internal carotid artery, which is the segment limited rostrally by the dural carotid ring and caudally, by the carotid-oculomotor membrane. Even although clinoid segment aneurysms represent a common incidental finding in magnetic resonance studies, its prevalence has not been yet reported. Objective To determine the prevalence of incidental clinoid segment saccular aneurysms diagnosed by magnetic resonance imaging as well as their anatomic architecture and their association with smoking, arterial hypertension, age, and sex of patients. Methods A total of 500 patients were prospectively studied with magnetic resonance imaging time-of-flight sequence and angioresonance with contrast material, to search for incidental saccular intracranial aneurysms. The site of primary interest was the clinoid segment, but the presence of aneurysms in any other location was determined for comparison. The relation among the presence of clinoid segment aneurysms, demographic factors, and secondary diagnosis of arterial hypertension, smoking, and other vascular/neoplastic cerebral lesions was analyzed. Results We found a global prevalence of incidental aneurysms of 7% (95% confidence interval, 5–9), with a prevalence of clinoid segment aneurysms of 3% (95% confidence interval, 2–4). Univariate logistic regression analysis showed a statistically significant relationship among incidental aneurysms, systemic arterial hypertension ( P = 0.000), and smoking ( P = 0.004). Conclusions In the studied population, incidental clinoid segment aneurysms constitute the variety with highest prevalence. Highlights Description of prevalence of a particular variety of saccular aneurysms. Prevalence of clinoid segment aneurysms not previously described. Extended discussion of a complex anatomy area. Prevalence of incidental saccular intracranial aneurysm in a specific population. Remarks on anatomic detail are crucial to determining aneurysms that are born and grow intradurally.

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  8. [해외논문]   Stand-Alone Anterolateral Interbody Fusion Versus Extended Posterior Fusion for Symptomatic Adjacent-Segment Degeneration: A Retrospective Study of 2 Years' Follow-up  

    Tu, Zhiming (To whom correspondence should be addressed: Bing Wang, M.D., Ph.D.) , Li, Lei , Wang, Bing , Li, Yawei , Lv, Guohua , Dai, Yuliang
    World neurosurgery v.115 ,pp. e748 - e755 , 2018 , 1878-8750 ,

    초록

    Objective To evaluate the clinical and radiologic outcome of stand-alone anterolateral lumbar interbody fusion (ALLIF) using self-locked cages in comparison with extended posterior lumbar interbody fusion (PLIF) for symptomatic adjacent-segment degeneration (ASD) after posterior lumbar fusion. Methods This retrospective study enrolled 40 symptomatic patients with ASD who were treated with ALLIF ( n = 13) or extended PLIF ( n = 27) between January 2011 and January 2015. Evaluations were performed preoperatively, at 3, 12, and 24 months postoperatively. Clinical outcome measurements included visual analog scale scores for low-back and leg pain, Oswestry Disability Index score for function assessment, Short-Form 36 Questionnaire for quality of life, and modified Macnab criteria for patient satisfaction. Radiologic outcome measurements included fusion rate, cage subsidence, disc height, and lumbar lordosis. Results There were no significant differences in the baseline data for the ALLIF and PLIF groups ( P > 0.05). Mean operative time, blood loss, and length of hospital stay were significantly decreased for the ALLIF group ( P P P Conclusions Stand-alone ALLIF could achieve satisfactory safety and efficacy for the treatment of symptomatic ASD with less trauma and faster recovery, and it may serve as an alternative surgical treatment for symptomatic ASD with appropriate indication. Highlights This study focused on the treatments of symptomatic ASD and proposed a novel approach ALLIF. We evaluated the clinical and radiologic outcome of stand-alone ALLIF versus extended PLIF for symptomatic ASD. Stand-alone ALLIF achieves satisfactory safety and efficacy for symptomatic ASD with less trauma and faster recovery.

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  9. [해외논문]   Editor's Choices  


    World neurosurgery v.115 ,pp. xviii - xix , 2018 , 1878-8750 ,

    초록

    Objective To evaluate the clinical and radiologic outcome of stand-alone anterolateral lumbar interbody fusion (ALLIF) using self-locked cages in comparison with extended posterior lumbar interbody fusion (PLIF) for symptomatic adjacent-segment degeneration (ASD) after posterior lumbar fusion. Methods This retrospective study enrolled 40 symptomatic patients with ASD who were treated with ALLIF ( n = 13) or extended PLIF ( n = 27) between January 2011 and January 2015. Evaluations were performed preoperatively, at 3, 12, and 24 months postoperatively. Clinical outcome measurements included visual analog scale scores for low-back and leg pain, Oswestry Disability Index score for function assessment, Short-Form 36 Questionnaire for quality of life, and modified Macnab criteria for patient satisfaction. Radiologic outcome measurements included fusion rate, cage subsidence, disc height, and lumbar lordosis. Results There were no significant differences in the baseline data for the ALLIF and PLIF groups ( P > 0.05). Mean operative time, blood loss, and length of hospital stay were significantly decreased for the ALLIF group ( P P P Conclusions Stand-alone ALLIF could achieve satisfactory safety and efficacy for the treatment of symptomatic ASD with less trauma and faster recovery, and it may serve as an alternative surgical treatment for symptomatic ASD with appropriate indication. Highlights This study focused on the treatments of symptomatic ASD and proposed a novel approach ALLIF. We evaluated the clinical and radiologic outcome of stand-alone ALLIF versus extended PLIF for symptomatic ASD. Stand-alone ALLIF achieves satisfactory safety and efficacy for symptomatic ASD with less trauma and faster recovery.

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  10. [해외논문]   Discrepancy Between Neurosurgery Morbidity and Mortality Conference Discussions and Hospital Quality Metric Standards  

    Rotman, Lauren E. (Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA ) , Davis, Matthew C. (Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA ) , Salehani, Arsalaan A. (Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA ) , Broadwater, Devin R. (School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA ) , Reeve, Nathaniel H. (School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA ) , Riley, Kristen O. (Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA)
    World neurosurgery v.115 ,pp. e105 - e110 , 2018 , 1878-8750 ,

    초록

    Objective Medical institutions use quality metrics to track complications seen in hospital admissions. Similarly, morbidity and mortality (M&M) conferences are held to peer review complications. The purpose of this study was to compare the complications identified in a cohort of patients within 30 days of neurosurgical intervention with those captured in a cohort of M&M conferences. Methods All complications that occurred within 30 days of surgery were obtained for patients admitted to the neurosurgical service between May and September 2013. All patients discussed in M&M conference between August 2012 and February 2015 were included in a second data set. Complications were subdivided into 4 categories and compared between the 2 cohorts. Results A total of 749 postoperative complications were identified, including 52 urinary tract infections, 52 pneumonias, 15 deep vein thromboses, 19 strokes, 75 seizures, 25 wound infections, 6 cardiac arrests, and 162 reoperations. Eighty-five M&M cases were reviewed, identifying 9 strokes, 3 seizures, 8 wound infections, 13 hematomas, 7 intraoperative errors, and 11 postoperative deaths. The M&M cohort showed higher rates of neurologic complications ( P P P = 0.0118) and infectious complications (not surgical wound related, P = 0.0002). Conclusions Both neurosurgical service inpatient complications and complications discussed in M&M provide valuable opportunities for identifying areas in need of quality improvement. As the United States moves toward an outcomes reimbursement model, neurosurgical programs should adjust M&M conferences to reflect both technical operative complications as well as more common complications. Highlights Surgical errors and neurologic complications predominate M&M conferences. More commonplace complications tend to be seen during postoperative admissions. M&M conferences should include technical complications and common complications.

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