scholarly journals Laminectomy alone versus laminectomy with fusion for degenerative cervical myelopathy: a long-term study of a national cohort

2021 ◽  
Author(s):  
Eddie de Dios ◽  
Robert F. Heary ◽  
Lars Lindhagen ◽  
Anna MacDowall
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Clinical Outcomes ◽  
Cervical Myelopathy ◽  
Outcome Measure ◽  
Instrumented Fusion ◽  
Patient Reported ◽  
National Cohort ◽  
Degenerative Cervical Myelopathy

Abstract Purpose To compare patient-reported 5-year clinical outcomes between laminectomy alone versus laminectomy with instrumented fusion in patients with degenerative cervical myelopathy in a population-based cohort. Methods All patients in the national Swedish Spine Register (Swespine) from January 2006 until March 2019, with degenerative cervical myelopathy, were assessed. Multiple imputation and propensity score matching based on clinicodemographic and radiographic parameters were used to compare patients treated with laminectomy alone with patients treated with laminectomy plus posterior-lateral instrumented fusion. The primary outcome measure was the European Myelopathy Score, a validated patient-reported outcome measure. The scale ranges from 5 to 18, with lower scores reflecting more severe myelopathy. Results Among 967 eligible patients, 717 (74%) patients were included. Laminectomy alone was performed on 412 patients (mean age 68 years; 149 women [36%]), whereas instrumented fusion was added for 305 patients (mean age 68 years; 119 women [39%]). After imputation, the propensity for smoking, worse myelopathy scores, spondylolisthesis, and kyphosis was slightly higher in the fusion group. After imputation and propensity score matching, there were on average 212 pairs patients with a 5-year follow-up in each group. There were no important differences in patient-reported clinical outcomes between the methods after 5 years. Due to longer hospitalization times and implant-related costs, the mean cost increase per instrumented patient was approximately $4700 US. Conclusions Instrumented fusions generated higher costs and were not associated with superior long-term clinical outcomes. These findings are based on a national cohort and can thus be regarded as generalizable.

scholarly journals Perioperative Complications of Surgery for Degenerative Cervical Myelopathy: A Comparison Between 3 Procedures

2021 ◽  
pp. 219256822199830
Author(s):  
Mohamed Kamal Mesregah ◽  
Blake Formanek ◽  
John C. Liu ◽  
Zorica Buser ◽  
Jeffrey C. Wang
Keyword(s):  
Propensity Score ◽  
Cervical Myelopathy ◽  
Perioperative Complications ◽  
International Classification Of Diseases ◽  
Significance Level ◽  
Chi Squared ◽  
Retrospective Comparative Study ◽  
Posterior Laminectomy ◽  
Degenerative Cervical Myelopathy ◽  
New Onset

Study Design: Retrospective comparative study. Objectives: To compare the perioperative complications of propensity score-matched cohorts of patients with degenerative cervical myelopathy (DCM), who were treated with anterior cervical discectomy and fusion (ACDF), posterior laminectomy with fusion, or laminoplasty. Methods: The Humana PearlDiver Patient Record Database was queried using the International Classification of Diseases (ICD-9 and ICD-10) and the Current Procedural Terminology (CPT) codes. Propensity score-matched analysis was done using multiple Chi-squared tests with Bonferroni correction of the significance level. Results: Cohorts of 11,790 patients who had ACDF, 2,257 patients who had posterior laminectomy with fusion, and 477 patients who had laminoplasty, were identified. After propensity score matching, all the 3 groups included 464 patients. The incidence of dysphagia increased significantly following ACDF compared to laminoplasty, P < 0.001, and in laminectomy with fusion compared to laminoplasty, P < 0.001. The incidence of new-onset cervicalgia was higher in ACDF compared to laminoplasty, P = 0.005, and in laminectomy with fusion compared to laminoplasty, P = 0.004. The incidence of limb paralysis increased significantly in laminectomy with fusion compared to ACDF, P = 0.002. The revision rate at 1 year increased significantly in laminectomy with fusion compared to laminoplasty, P < 0.001, and in ACDF compared to laminoplasty, P < 0.001. Conclusions: The incidence of dysphagia following laminectomy with fusion was not different compared to ACDF. Postoperative new-onset cervicalgia and revisions were least common in laminoplasty. The highest rate of postoperative limb paralysis was noticed in laminectomy with fusion.

312 Retrospective Analysis of Long-Term Scarring Outcomes in Paediatric Burns Patients

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Mistry
Keyword(s):  
Outcome Measure ◽  
Patient Reported Outcome ◽  
Burn Patients ◽  
Burn Scar ◽  
Common Presentation ◽  
Paediatric Burns ◽  
Significant Difference ◽  
Patient Reported

Abstract Introduction Paediatric burns are a common presentation to a plastic surgery unit. The long-term scar outcomes in paediatric burns patients are relatively unknown as most are discharged after 6 weeks follow up. We aimed to determine whether the long-term scarring outcomes are significantly different in those who had surgical treatment with Versajetâ debridement and Biobraneâ, versus those treated conservatively with non-adherent dressings, in a cohort of paediatric burns patients. Method The parents of all paediatric burns patients admitted to Stoke Mandeville Hospital from October 2014 to September 2017 were contacted by telephone to fill in the Brisbane Burn Scar Impact Profile (BBSIP), a patient reported outcome measure specifically aimed at children. The results from the questionnaires underwent statistical analysis to see if there was a significant difference in questionnaire scores between children treated surgically versus those treated conservatively. Results A total of 107 children were admitted in the timeframe, responses were received from 34 patients with 13 having been treated surgically and 21 having been treated conservatively. In all 58 questions that make up the BBSIP, there was no statistically significant difference observed in the scores of those treated surgically versus those treated conservatively. For 31 questions on the BBSIP, the lowest score indicating the best outcome was observed in all patients in both groups. Conclusions We found no statistically significant difference in the long-term scar outcomes as assessed by the BBSIP in paediatric burn patients treated with Versajetâ debridement and Biobraneâ, versus those treated conservatively with non-adherent dressings.

Abstract 67: Effects of Single vs Dual Antiplatelet Therapy on Long Term Stroke and Death After Carotid Endarterectomy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Nathan Belkin ◽  
Alexander S Fairman ◽  
Benjamin M Jackson ◽  
Paul J Foley ◽  
Scott M Damrauer ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Propensity Score ◽  
Carotid Endarterectomy ◽  
Propensity Score Matching ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Long Term Effects ◽  
Kaplan Meier ◽  
One Year

Introduction: Current evidence suggests that dual antiplatelet therapy (DAPT) reduces perioperative stroke, but increases bleeding after carotid endarterectomy (CEA). The long term effects of antiplatelet therapy after CEA have yet to be studied. Methods: A retrospective review of patients undergoing CEA in the national Vascular Quality Initiative database (2003-2018) was performed. Based on antiplatelet regimen at discharge, patients were propensity score matched on aspirin monotherapy vs. DAPT. Multivariable logistic regression and Kaplan-Meier analyses were used to investigate the long term effects of antiplatelet regimen on mortality and stroke/TIA. Results: Of the 72,122 patients undergoing CEA, 64.6% were discharged on aspirin, and 35.4% on DAPT. The DAPT group had higher frequencies of comorbidities (COPD, HTN, CHF, smoking, diabetes) as well as atherosclerotic diseases (PAD, CAD, prior PCI, prior CABG). After propensity score matching, two groups of 8,722 patients with comparable comorbidities were formed. While unmatched Kaplan-Meier analysis showed the DAPT cohort to have higher mortality (p=0.001), this difference dissipated after matching. The resultant matched DAPT cohort did not differ from the aspirin group in one year stroke/TIA (1.7% vs. 1.6%, p=0.70), or mortality (3.1% vs. 3.3%, p=0.55). At 5 years, however, patients treated with DAPT did exhibit a mortality benefit (6.4% vs. 7.3%, p=0.02) with multivariable logistic regression identifying DAPT as an independent predictor of reduced mortality (OR 0.94, 95% CI 0.88-0.99, p=0.04). Conclusions: Patients discharged on DAPT after CEA represent a significantly different cohort than those discharged on aspirin monotherapy. After propensity score matching, there was no difference at one year stroke/TIA or mortality outcomes, but DAPT was found to be protective against long-term mortality. Further study is warranted to investigate this finding.

scholarly journals Comparison of Long-term outcomes between Lynch sydrome and sporadic colorectal cancer: a propensity score matching analysis

2020 ◽  
Author(s):  
Yun Xu ◽  
Cong Li ◽  
Charlie Zhi-Lin Zheng ◽  
Yu-Qin Zhang ◽  
Tian-An Guo ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Control Group ◽  
Sporadic Colorectal Cancer ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Tumor Stages

Abstract Background Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome. Comparison of prognosis between LS and sporadic CRC (SCRC) were rare,with conflicting results. This study aimed to compare the long-term outcomes between patients with LS and SCRC. Methods Between June 2008 and September 2018, a total of 47 patients were diagnosed with LS by genetic testing at Fudan University Shanghai Cancer Center. A 1:2 propensity score matching was performed to obtain homogeneous cohorts from SCRC group. Thereafter, 94 SCRC patients were enrolled as control group. The long-term survival rates between the two groups were compared, and the prognostic factors were also analyzed. Results The 5-year OS rate of LS group was 97.6%, which was significantly higher than of 82.6% for SCRC group (p = 0.029). The 5-year PFS rate showed no significant differences between the two groups (78.0% for LS group vs. 70.6% for SCRC patients; p = 0.262). The 5-year TFS rates in LS group was 62.1% for LS patients, which were significantly lower than of 70.6% for SCRC group (p = 0.039). By multivariate analysis, we found that tumor progression of primary CRC and TNM staging were independent risk factors for OS. Conclusion LS patients have better long-term survival prognosis than SCRC patients. Strict regular follow-up monitoring, detection at earlier tumor stages, and effective treatment are key to ensuring better long-term prognosis.

Impact of Elevated Body Mass Index and Obesity on Long-term Surgical Outcomes for Patients With Degenerative Cervical Myelopathy

Spine ◽  
2017 ◽  
Vol 42 (3) ◽  
pp. 195-201 ◽  
Author(s):  
Jefferson R. Wilson ◽  
Lindsay A. Tetreault ◽  
Gregory Schroeder ◽  
James S. Harrop ◽  
Srinivas Prasad ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Surgical Outcomes ◽  
Cervical Myelopathy ◽  
Elevated Body Mass Index ◽  
Degenerative Cervical Myelopathy
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