scholarly journals Reducing complication rates for repeat craniotomies in glioma patients: a single-surgeon experience and comparison with the literature

2021 ◽  
Author(s):  
Ramin A. Morshed ◽  
Jacob S. Young ◽  
Andrew J. Gogos ◽  
Alexander F. Haddad ◽  
James T. McMahon ◽  
...  
Keyword(s):  
Best Practices ◽  
Multivariate Regression ◽  
Meta Analysis ◽  
Senior Author ◽  
Complication Rates ◽  
Who Grade ◽  
Neurologic Deficits ◽  
Surgeon Experience ◽  
Grade Ii ◽  
Reoperation Rates

Abstract Background There is a concern that glioma patients undergoing repeat craniotomies are more prone to complications. The study’s goal was to assess if the complication profiles for initial and repeat craniotomies were similar, to determine predictors of complications, and to compare results with those in the literature. Methods A retrospective study was conducted of glioma patients (WHO grade II–IV) who underwent either an initial or repeat craniotomy performed by the senior author from 2012 until 2019. Complications were recorded by discharge, 30 days, and 90 days postoperatively. New neurologic deficits were recorded by 90 days postoperatively. Multivariate regression was performed to identify factors associated with complications. A meta-analysis was performed to identify rates of complications based on number of prior craniotomies. Results Within the cohort of 714 patients, 400 (56%) had no prior craniotomies, 218 (30.5%) had undergone 1 prior craniotomy, and 96 (13.5%) had undergone ≥ 2 prior craniotomies. There were 27 surgical and 10 medical complications in 30 patients (4.2%) and 19 reoperations for complications in 19 patients (2.7%) with no deaths by 90 days. Complications, reoperation rates, and new neurologic deficits did not differ based on number of prior craniotomies. On multivariate analysis, older age (OR1.5, 95%CI 1.0–2.2) and significant leukocytosis due to steroid use (OR12.6, 95%CI 2.5–62.9) were predictors of complications. Complication rates in the cohort were lower than rates reported in the literature. Conclusion Contrary to prior reports in the literature, repeat craniotomies can be as safe as initial operations if surgeons implement best practices.

scholarly journals Method for temporal keyhole lobectomies in resection of low- and high-grade gliomas

2018 ◽  
Vol 128 (5) ◽  
pp. 1388-1395 ◽  
Author(s):  
Andrew K. Conner ◽  
Joshua D. Burks ◽  
Cordell M. Baker ◽  
Adam D. Smitherman ◽  
Dillon P. Pryor ◽  
...  
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Extent Of Resection ◽  
Senior Author ◽  
High Grade ◽  
Who Grade ◽  
Prior Surgery ◽  
Grade Ii ◽  
Keyhole Craniotomy ◽  
Invasive Techniques

OBJECTIVEThe purpose of this study was to describe a method of resecting temporal gliomas through a keyhole lobectomy and to share the results of using this technique.METHODSThe authors performed a retrospective review of data obtained in all patients in whom the senior author performed resection of temporal gliomas between 2012 and 2015. The authors describe their technique for resecting dominant and nondominant gliomas, using both awake and asleep keyhole craniotomy techniques.RESULTSFifty-two patients were included in the study. Twenty-six patients (50%) had not received prior surgery. Seventeen patients (33%) were diagnosed with WHO Grade II/III tumors, and 35 patients (67%) were diagnosed with a glioblastoma. Thirty tumors were left sided (58%). Thirty procedures (58%) were performed while the patient was awake. The median extent of resection was 95%, and at least 90% of the tumor was resected in 35 cases (67%). Five of 49 patients (10%) with clinical follow-up experienced permanent deficits, including 3 patients (6%) with hydrocephalus requiring placement of a ventriculoperitoneal shunt and 2 patients (4%) with weakness. Three patients experienced early postoperative anomia, but no patients had a new speech deficit at clinical follow-up.CONCLUSIONSThe authors provide their experience using a keyhole lobectomy for resecting temporal gliomas. Their data demonstrate the feasibility of using less invasive techniques to safely and aggressively treat these tumors.

scholarly journals Comment on “Expression of CD44 and the survival in glioma: a meta-analysis”

2020 ◽  
Vol 40 (10) ◽  
Author(s):  
Chongxian Hou ◽  
Han Lin ◽  
Peng Wang ◽  
Yong Yang ◽  
Siyi Cen ◽  
...  
Keyword(s):  
Stem Cell ◽  
Meta Analysis ◽  
Prognostic Significance ◽  
Stem Cell Marker ◽  
Cancer Stem Cell Marker ◽  
Cell Marker ◽  
Poor Survival ◽  
Who Grade ◽  
Grade Ii ◽  
Meta Analyses

Abstract CD44 has been considered as a cancer stem cell marker in various tumors. With great enthusiasm, we read an article written by Wu et al. entitled “Expression of CD44 and the survival in glioma: a meta-analysis” published in Bioscience Reports. The authors performed meta-analyses to study the prognostic significance of CD44 in gliomas, and drew the conclusion that high expression of CD44 may predict poor survival in glioma, particularly in WHO grade II–III gliomas. However, two major defects exist in the present study, which made the meta-analysis on the prognostic significance of CD44 in all gliomas unreliable. In this commentary, we discussed the limitations and significance of the present study.

scholarly journals Does Percutaneous Achilles Tenotomy Yield Comparable Short-Term Outcomes to Combined Open Achilles Tenotomy with Posterior Capsulotomy in Pediatric Patients with Clubfoot?

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0015
Author(s):  
Marine Coste ◽  
Mikhail Tretiakov ◽  
Neil V. Shah ◽  
Daniel M. Zuchelli ◽  
Joanne C. Dekis ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Multivariate Regression ◽  
Pediatric Patients ◽  
Operative Time ◽  
Complication Rates ◽  
Congenital Clubfoot ◽  
Short Term ◽  
Achilles Tenotomy ◽  
Posterior Capsulotomy ◽  
Reoperation Rates

Category: Hindfoot, Midfoot/Forefoot, Congenital Introduction/Purpose: As the most common musculoskeletal congenital anomaly, clubfoot (congenital talipes equinovarus) represents a commonly-encountered entity for pediatric orthopaedic and foot/ankle surgeons. As we have observed a shift towards more conservative, cost-conscious approaches to management, this study sought to compare short-term (30-day) perioperative and postoperative outcomes (complications and reoperations) in clubfoot patients who underwent either percutaneous Achilles tenotomy (PT) or combined open Achilles tenotomy with posterior capsulotomy (COTC). Methods: The National Surgical Quality Improvement Program (NSQIP) Pediatric Database was queried for all congenital clubfoot patients. Among those, patients who underwent percutaneous Achilles tenotomy (PT; CPT: 27606) or open Achilles tenotomy with posterior capsulotomy (COTC; CPT: 28262) were stratified into two cohorts. Cohorts were 1:1 propensity score-matched for gender, race, congenital clubfoot diagnosis, and ASA score. Demographics, peri- and 30-day postoperative data were collected for each group and compared using appropriate parametric tests. A p-value of 0.05 or lower indicated statistical significance. A binary stepwise multivariate regression model was used to assess the effects of age, gender, race, ASA score, congenital clubfoot, and surgery type on total complication and reoperation rates. Results: 690 patients were included (PT, n=345; COTC, n=345). PT patients were younger than COTC patients (1.58 vs. 4.26 years; p<0.001). However, gender and race distributions were comparable. PT patients incurred shorter operation-to-discharge intervals (0.24 vs. 1.1 days), total anesthesia (71.8 vs. 191.2 mins) and operative time (34.4 vs. 129.3 minutes) (all p<0.001). PT and COTC patients had comparable rates of postoperative complications (0.00 vs. 0.87%; p=0.082). Complications experienced by COTC patients included pneumonia (0.29%) and surgical site (0.29%), and urinary tract infections (0.29%). Both cohorts also had similar reoperation rates (0.58 vs. 1.45%; p=0.253). Multivariate regression analysis revealed that age, female sex, race, congenital clubfoot diagnosis, and type of surgery were not significantly associated with any increase in odds of incurring postoperative complications or reoperations. Conclusion: Patients who underwent PT were younger than those who underwent a COTC. In addition, COTCs were significantly longer and led to a greater length of stay than those who underwent PT. However, there was no significant difference in short-term post-operative complication and reoperation rates. Lastly, surgery type and operative time were not significant predictors for higher complication rates. Therefore, despite lengthier hospital stay and operative time for PT, COTC and PT had comparable and low short-term complication rates and appeared to be safe procedures for treatment of congenital clubfoot in pediatric patients.

scholarly journals Comparison of second and third generation total ankle arthroplasty learning curves

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0018
Author(s):  
Ryan Callahan ◽  
Michael Aynardi ◽  
Kempland Walley ◽  
Kaitlin Saloky ◽  
Paul Juliano
Keyword(s):  
Learning Curve ◽  
Learning Curves ◽  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Fixed Bearing ◽  
Ankle Arthroplasty ◽  
2Nd Generation ◽  
Significant Difference ◽  
Surgeon Experience ◽  
Reoperation Rates

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) has evolved over the past decades with later generation implants being associated with improved instrumentation and hardware. There have been multiple reports of the “learning curve” associated with total ankle arthroplasty. These report higher complication rates during the initial procedures performed by an inexperienced surgeon. To our knowledge, there is no comparison of the 2nd generation and 3 rd generation implant learning curves. Methods: The clinical outcomes of the first 15 cases (8/2002-4/2005) of a 2nd generation fixed bearing prosthesis (Agility Total Ankle System) and the first 15 cases (6/2007-3/2009) of a 3 rd generation fixed bearing prosthesis (Salto Talaris® TotalAnkle Prosthesis) performed by a single surgeon were retrospectively reviewed to determine complication incidence. The initial cases with each system were also independently reviewed to determine if there was a significant learning curve in regards to complications. Reoperation, infection, gutter impingement, fracture, persistent pain, and periprosthetic cyst formation were included for comparison of complication rates. Results: The overall complication rates for the Agility were 54.9% (28/51) and 35.7% (25/70) for Salto Talaris. There was no significant difference in reoperation rates when comparing the first 15 Agility cases (8/15, 53%) to the remainder of Agility cases (11/36, 30.6%) p=0.2. The initial 15 Salto Talaris cases also demonstrated no significant difference in reoperation rates (1/15, 8%) when compared to the remaining Salto Talaris replacements (7/55, 12.7%) p=1. Reoperation rates were higher in the initial 15 Agility cases (8/15, 53%) compared to the initial 15 Salto cases (1/15, 8%) p=0.01. There was no significant difference in infection, hardware failure, and medial malleolus fracture rates for any of the groups. Conclusion: While this series demonstrated no significant learning curve for each individual total ankle system, there was a significantly higher reoperation rate in the initial cases for the 2nd generation TAA when compared to the initial cases of the 3 rd generation implants. This could be attributed to improved instrumentation and hardware and/or surgeon experience.

scholarly journals Can Specific Implant Designs Implicate Variations in Outcomes of Total Ankle Arthroplasty? A Systematic Review

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0004
Author(s):  
Dahang Zhao ◽  
Dichao Huang ◽  
Chen Wang ◽  
Xin Xin Ma
Keyword(s):  
Case Reports ◽  
Intraoperative Complications ◽  
Total Ankle Arthroplasty ◽  
Implant Design ◽  
Complication Rates ◽  
Radiographic Findings ◽  
Ankle Arthroplasty ◽  
Surgeon Experience ◽  
Comprehensive Search ◽  
Reoperation Rates

Category: Ankle Arthritis Introduction/Purpose: Some complications of total ankle arthroplasty could not be reduced by improvement of surgeon experience. The purposes of the study were to determine whether there were variations in term of (1) intraoperative complications, (2) postoperative complication, (3) reoperation, revision and failure, and (4) postoperative radiographic findings among different studies. Methods: A comprehensive search was conducted. There were 953 for initial review. Initially, 136 irrelevant records, 174 review articles, 46 case reports and 1 retracted paper were excluded. Of the remaining 596 papers, 23 ultimately met our inclusion for final review. Results: Intraoperative fractures rates were higher studies of BP-type. Most of the pain or stiffness, malalignments, impingements, cysts were occurred in studies of STAR, HINTEGRA, Agility and Salto. Polyethylene insert fractures were occurred in most studies of STAR. Ten reported postoperative osseous fractures which all resulted from patients used STAR and BP-type. Reoperation rates were higher in studies of STAR, BP-type, Agility and Salto. Arthrodesis rates were lower from HINTEGRA. Arthrodesis rates from STAR, BP-type and Salto were higher than their revision rates. Periprosthetic lucency rates were lower from studies of HINTEGRA. The lucency rates of tibia were higher than talus. Cyst could be more easily observed from studies of STAR, Agility and Salto. All the osteoarthritis were reported in studies of STAR, BP-type and Agility. Conclusion: Currently the complication rates of TAA significantly decrease with modern implants, surgeons experience and patients selection. Some design-specific features of different prostheses were found in our study which could implicate variations in the complications and radiographic findings. We believed that these result could further improve the implant design.

Frontal Keyhole Craniotomy for Resection of Low- and High-Grade Gliomas

Neurosurgery ◽  
2017 ◽  
Vol 82 (3) ◽  
pp. 388-396 ◽  
Author(s):  
Joshua D Burks ◽  
Andrew K Conner ◽  
Phillip A Bonney ◽  
Chad A Glenn ◽  
Adam D Smitherman ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Senior Author ◽  
Brain Lesions ◽  
Minimally Invasive Techniques ◽  
Who Grade ◽  
Prior Surgery ◽  
Grade Ii ◽  
Keyhole Craniotomy ◽  
Invasive Techniques

Abstract BACKGROUND Minimally invasive techniques are increasingly being used to access intra-axial brain lesions. OBJECTIVE To describe a method of resecting frontal gliomas through a keyhole craniotomy and share the results with these techniques. METHODS We performed a retrospective review of data obtained on all patients undergoing resection of frontal gliomas by the senior author between 2012 and 2015. We describe our technique for resecting dominant and nondominant gliomas utilizing both awake and asleep keyhole craniotomy techniques. RESULTS After excluding 1 patient who received a biopsy only, 48 patients were included in the study. Twenty-nine patients (60%) had not received prior surgery. Twenty-six patients (54%) were diagnosed with WHO grade II/III tumors, and 22 patients (46%) were diagnosed with glioblastoma. Twenty-five cases (52%) were performed awake. At least 90% of the tumor was resected in 35 cases (73%). Three of 43 patients with clinical follow-up experienced permanent deficits. CONCLUSION We provide our experience in using keyhole craniotomies for resecting frontal gliomas. Our data demonstrate the feasibility of using minimally invasive techniques to safely and aggressively treat these tumors.

scholarly journals 654 Outcome and Complications Following Revision Shoulder Arthroplasty. A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
V Ravi ◽  
R Murphy ◽  
R Moverley ◽  
M Derias ◽  
J Phadnis
Keyword(s):  
Systematic Review ◽  
Clinical Data ◽  
Revision Surgery ◽  
Shoulder Arthroplasty ◽  
Meta Analysis ◽  
Complication Rates ◽  
Intraoperative Complication ◽  
Patient Reported ◽  
Revision Shoulder Arthroplasty ◽  
Reoperation Rates

Abstract Introduction It is important to understand the rate of complications associated with the increasing burden of revision shoulder arthroplasty. Currently, this has not been well quantified. This review aims to address that deficiency with a focus on (i) shoulder outcome scores, (ii) complication and reoperation rates and (iii) comparison of anatomic and reverse prostheses when used in revision surgery. Method A PRISMA systematic review was performed to identify clinical data for patients undergoing revision shoulder arthroplasty. Data were extracted from the literature and pooled for analysis. Complication and reoperation rates were analysed using a meta-analysis of proportion and continuous variables underwent comparative subgroup analysis. Results 107 studies (5,010 shoulders) were eligible for inclusion, although complete clinical data was not ubiquitous. Indications for revision included component loosening 20% (n = 584/2872), instability 20% (n = 577/2872), rotator cuff failure 18% (n = 528/2872) and infection 17% (n = 490/2872). Revision surgery resulted in a clinically important improvement in patient-reported outcome measures (PROMs). Intraoperative complication, postoperative complication and reoperation rates were 3% (n = 205/4919), 22% (n = 722/3474) and 15% (n = 533/3474) respectively. Intraoperative and postoperative complications included iatrogenic humeral fractures (n = 134/205, 65%) and instability (n = 209/772, 27%). Revision to reverse TSA, rather than revision to anatomic TSA from any index prosthesis resulted in lower complication rates (22% vs. 29%, p &lt; 0.001 odds ratio 1.5) and superior Constant scores (59.9 vs. 53.8, p &lt; 0.001), although no difference in ASES scores. Conclusions Satisfactory improvement in PROMs are reported following revision shoulder arthroplasty; however, revision surgery is associated with high complication rates and better outcomes may be evident following revision to reverse TSA.

IDH wild-type WHO grade II diffuse low-grade gliomas. A heterogeneous family with different outcomes. Systematic review and meta-analysis

2018 ◽  
Vol 43 (2) ◽  
pp. 383-395 ◽  
Author(s):  
Davide Tiziano Di Carlo ◽  
Hugues Duffau ◽  
Federico Cagnazzo ◽  
Nicola Benedetto ◽  
Riccardo Morganti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Low Grade ◽  
Wild Type ◽  
Who Grade ◽  
Low Grade Gliomas ◽  
Grade Ii

The impact of surgeon experience on perioperative complications and operative measures following thoracolumbar 3-column osteotomy for adult spinal deformity: overcoming the learning curve

2020 ◽  
Vol 32 (2) ◽  
pp. 207-220 ◽  
Author(s):  
Darryl Lau ◽  
Vedat Deviren ◽  
Christopher P. Ames
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Surgical Complication ◽  
Perioperative Complications ◽  
Adult Spinal Deformity ◽  
Neurological Deficits ◽  
Complication Rates ◽  
Years Of Experience ◽  
Surgeon Experience ◽  
Operative Measures

OBJECTIVEPosterior-based thoracolumbar 3-column osteotomy (3CO) is a formidable surgical procedure. Surgeon experience and case volume are known factors that influence surgical complication rates, but these factors have not been studied well in cases of adult spinal deformity (ASD). This study examines how surgeon experience affects perioperative complications and operative measures following thoracolumbar 3CO in ASD.METHODSA retrospective study was performed of a consecutive cohort of thoracolumbar ASD patients who underwent 3CO performed by the senior authors from 2006 to 2018. Multivariate analysis was used to assess whether experience (years of experience and/or number of procedures) is associated with perioperative complications, operative duration, and blood loss.RESULTSA total of 362 patients underwent 66 vertebral column resections (VCRs) and 296 pedicle subtraction osteotomies (PSOs). The overall complication rate was 29.4%, and the surgical complication rate was 8.0%. The rate of postoperative neurological deficits was 6.2%. There was a trend toward lower overall complication rates with greater operative years of experience (from 44.4% to 28.0%) (p = 0.115). Years of operative experience was associated with a significantly lower rate of neurological deficits (p = 0.027); the incidence dropped from 22.2% to 4.0%. The mean operative time was 310.7 minutes overall. Both increased years of experience and higher case numbers were significantly associated with shorter operative times (p < 0.001 and p = 0.001, respectively). Only operative years of experience was independently associated with operative times (p < 0.001): 358.3 minutes from 2006 to 2008 to 275.5 minutes in 2018 (82.8 minutes shorter). Over time, there was less deviation and more consistency in operative times, despite the implementation of various interventions to promote fusion and prevent construct failure: utilization of multiple-rod constructs (standard, satellite, and nested rods), bone morphogenetic protein, vertebroplasty, and ligament augmentation. Of note, the use of tranexamic acid did not significantly lower blood loss.CONCLUSIONSSurgeon years of experience, rather than number of 3COs performed, was a significant factor in mitigating neurological complications and improving quality measures following thoracolumbar 3CO for ASD. The 3- to 5-year experience mark was when the senior surgeon overcame a learning curve and was able to minimize neurological complication rates. There was a continuous decrease in operative time as the surgeon’s experience increased; this was in concurrence with the implementation of additional preventative surgical interventions. Ongoing practice changes should be implemented and can be done safely, but it is imperative to self-assess the risks and benefits of those practice changes.

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