scholarly journals Relevance of comorbidities and antithrombotic medication as risk factors for reoperation in patients with chronic subdural hematoma

2021 ◽  
Author(s):  
Alexander Younsi ◽  
Lennart Riemann ◽  
Cleo Habel ◽  
Jessica Fischer ◽  
Christopher Beynon ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Multivariate Analyses ◽  
Independent Predictor ◽  
Perioperative Complications ◽  
Chronic Subdural Hematoma ◽  
Western Society ◽  
Increased Risk ◽  
Surgical Evacuation ◽  
Antithrombotic Medication ◽  
Univariate Analyses

AbstractIn an aging Western society, the incidence of chronic subdural hematomas (cSDH) is continuously increasing. In this study, we reviewed our clinical management of cSDH patients and identified predictive factors for the need of reoperation due to residual or recurrent hematomas with a focus on the use of antithrombotic drugs. In total, 623 patients who were treated for cSDH with surgical evacuation between 2006 and 2016 at our department were retrospectively analyzed. Clinical and radiological characteristics and laboratory parameters were investigated as possible predictors of reoperation with univariate and multivariate analyses. Additionally, clinical outcome measures were compared between patients on anticoagulants, on antiplatelets, and without antithrombotic medication. In univariate analyses, patients on anticoagulants and antiplatelets presented significantly more often with comorbidities, were significantly older, and their risk for perioperative complications was significantly increased. Nevertheless, their clinical outcome was comparable to that of patients without antithrombotics. In multivariate analysis, only the presence of comorbidities, but not antithrombotics, was an independent predictor for the need for reoperations. Patients on antithrombotics do not seem to necessarily have a significantly increased risk for residual hematomas or rebleeding requiring reoperation after cSDH evacuation. More precisely, the presence of predisposing comorbidities might be a key independent risk factor for reoperation. Importantly, the clinical outcomes after surgical evacuation of cSDH are comparable between patients on anticoagulants, antiplatelets, and without antithrombotics.

scholarly journals Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study

2020 ◽  
Vol 11 ◽  
Author(s):  
Fabio Cofano ◽  
Alessandro Pesce ◽  
Giovanni Vercelli ◽  
Marco Mammi ◽  
Armando Massara ◽  
...  
Keyword(s):  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Recurrence Rates ◽  
Risk Of Recurrence ◽  
Increased Risk ◽  
Surgical Evacuation ◽  
Dexamethasone Therapy ◽  
Postoperative Symptoms ◽  
Postoperative Drainage ◽  
Surgical Drain

Background: Chronic Subdural Hematoma (CSDH) is a common condition in the elderly population. Recurrence rates after surgical evacuation range from 5 to 30%. Factors predicting recurrence remain debated and unclear.Objective: To identify factors associated with increased risk of recurrence.Methods: Cases of CSDHs that underwent surgical treatment between 2005 and 2018 in the Neurosurgery Units of two major Italian hospitals were reviewed. Data extracted from a prospectively maintained database included demographics, laterality, antithrombotic therapy, history of trauma, corticosteroid therapy, preoperative and postoperative symptoms, type of surgical intervention, use of surgical drain, and clinical outcomes.Results: A total of 1313 patients was analyzed. The overall recurrence rate was 10.1%. The risk of recurrence was not significantly different between patients with unilateral or bilateral CSDH (10.4 vs. 8.8%, p = 0.39). The risk of recurrence was higher in patients that underwent surgical procedure without postoperative drainage (16.1 vs. 5.4%, p < 0.01). No relationship was found between recurrence rates and therapy with antithrombotic drugs (p = 0.97). The risk of recurrence was increasingly higher considering craniostomy, craniectomy, and craniotomy (9.3, 11.3, and 18.9%, respectively, p = 0.013). Lower recurrence rates following Dexamethasone therapy were recorded (p = 0.013).Conclusion: No association was found between the risk of recurrence of CSDH after surgical evacuation and age, use of antithrombotic medication, or laterality. Burr-hole craniostomy was found to be associated with lower recurrence rates, when compared to other surgical procedures. Placement of surgical drain and Dexamethasone therapy were significantly associated with reduced risk of recurrence of CSDHs.

Efficacy of antiseizure prophylaxis in chronic subdural hematoma: a cohort study on routinely collected health data

2020 ◽  
Vol 132 (1) ◽  
pp. 284-288 ◽  
Author(s):  
Pascal Lavergne ◽  
Moujahed Labidi ◽  
Marie-Christine Brunet ◽  
Paule Lessard Bonaventure ◽  
Akli Zetchi ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Multivariate Analyses ◽  
Chronic Subdural Hematoma ◽  
Outcome Data ◽  
Primary Objective ◽  
Quebec City ◽  
Factors Associated ◽  
Routinely Collected Health Data ◽  
Clinical And Radiological Outcome ◽  
Univariate Analyses

OBJECTIVEChronic subdural hematoma (CSDH) is a common neurosurgical condition that can result in significant morbidity. The incidence of epileptic events associated with CSDH reported in the literature varies considerably and could potentially increase morbidity and mortality rates. The effectiveness of antiepileptic prophylaxis for this indication remains unclear. The primary objective of this study was to assess the relevance of anticonvulsant prophylaxis in reducing seizure events in patients with CSDH.METHODSAll consecutive cases of CSDH from January 1, 2005, to May 30, 2014, at the Hôpital de l’Enfant-Jésus in Quebec City were retrospectively reviewed. Sociodemographic data, antiepileptic prophylaxis use, incidence of ictal events, and clinical and radiological outcome data were collected. Univariate analyses were done to measure the effect of antiepileptic prophylaxis on ictal events and to identify potential confounding factors. Multivariate logistic regression was performed to evaluate factors associated with epileptic events.RESULTSAntiepileptic prophylaxis was administered in 28% of the patients, and seizures occurred in 11%. Univariate analyses showed an increase in the incidence of ictal events in patients receiving prophylaxis (OR 5.92). Four factors were identified as being associated with seizures: septations inside the hematoma, membranectomy, antiepileptic prophylaxis, and a new deficit postoperatively. Antiepileptic prophylaxis was not associated with seizures in multivariate analyses.CONCLUSIONSAntiepileptic prophylaxis does not seem to be effective in preventing seizures in patients with CSDH. However, due to the design of this study, it is difficult to conclude definitively about the usefulness of this prophylactic therapy that is widely prescribed for this condition.

INDEPENDENT PREDICTORS FOR RECURRENCE OF CHRONIC SUBDURAL HEMATOMA

Neurosurgery ◽  
2008 ◽  
Vol 63 (6) ◽  
pp. 1125-1129 ◽  
Author(s):  
Kouichi Torihashi ◽  
Nobutake Sadamasa ◽  
Kazumichi Yoshida ◽  
Osamu Narumi ◽  
Masaki Chin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Anticoagulant Therapy ◽  
Subdural Hematoma ◽  
Independent Risk Factor ◽  
Multivariate Analyses ◽  
Independent Predictor ◽  
Chronic Subdural Hematoma ◽  
Time Interval ◽  
Anticoagulant Drugs

Abstract OBJECTIVE Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage with a substantial recurrence rate. We focused on determining independent predictors associated with the recurrence of CSDH. METHODS We retrospectively reviewed 343 consecutive surgical cases of CSDH. Univariate and multivariate analyses were performed to describe the relationships between recurrence of CSDH and factors such as sex, age, hypertension, diabetes mellitus, heart disease, cerebrovascular disease, atrial fibrillation, antiplatelet or anticoagulant therapy, and bilateral CSDH. RESULTS Sixty-one patients experienced a recurrence of CSDH. Univariate and multivariate analyses found that bilateral CSDH was an independent risk factor for the recurrence of CSDH. Although antiplatelet and anticoagulant therapy had no significant effect on recurrence of CSDH, the time interval between the injury and the first operation for patients with antiplatelet and/or anticoagulant therapy was shorter than that for patients without it (29.9 versus 44.2 days). CONCLUSION Bilateral CSDH was an independent predictor for the recurrence of CSDH. Antiplatelet or anticoagulant drugs might facilitate the growth of CSDH. These results may help to identify patients at high risk for the recurrence of CSDH.

Abstract 13812: Pulmonary Function Predicts Cardiac Function, Structure & Clinical Outcome in Chronic Heart Failure: Results From the Myovasc Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Marc W Heidorn ◽  
Felix Müller ◽  
Stefanie Steck ◽  
Alexander Schuch ◽  
Sven O Tröbs ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Outcome ◽  
Pulmonary Function ◽  
Cardiac Death ◽  
Independent Predictor ◽  
Left Ventricular ◽  
Study Endpoint ◽  
Primary Study ◽  
Increased Risk

Introduction: A growing body of evidence suggests a relevance of pulmonary function in the pathophysiology of heart failure (HF). Comprehensive data on the role of forced expiratory volume in 1 second (FEV1) in the development & progression of HF is limited. Hypothesis: Given this background, we hypothesized, that (FEV1) is associated with deteriorated left ventricular (LV) functional as well as structural status, & predicts specific clinical outcome in HF. Methods: Data from the MyoVasc Study (n=3,289) were analysed. Comprehensive clinical phenotyping including body plethysmography for the evaluation of FEV1 & standardized echocardiography were performed during a five-hour investigation in a dedicated study center. Worsening of HF (comprising transition from asymptomatic to symptomatic HF, HF hospitalization, & cardiac death) was assessed during a structured follow-up with subsequent validation & adjudication of endpoints. Results: Information on FEV1 was available in 2,998 individuals (age 35-84 years; 34.1% female, mean FEV1 92.4[% predicted]). In multivariable regression analysis adjusted for age, sex, height, cardiovascular risk factors (CVRF) & clinical profile, FEV1 per-1SD was an independent predictor of reduced LV ejection fraction (β:-1.6[95%CI -2.0;-1.3]), elevated E/E’-ratio (β:0.82[0.64;0.99]), & increased LV mass/Height 2.7 (β:1.6[1.1;2.1]) (for all, P<0.001). During a median follow-up of 2.3 (interquartile range 1.1; 4.0) years, FEV1 per-1SD predicted worsening of HF (hazard ratio(HR) 1.46[1.30;1.65], P<0.001) independent of age, sex, height, CVRF & comorbidities. This finding was consistent among the single components of the primary study endpoint: FEV1 per-1SD predicted an increased risk for transition to symptomatic HF (HR 1.57[1.19;2.06]), HF hospitalization (HR 1.35[1.16;1.57]) & for cardiac death (HR 1.84[1.49;2.26]) (for all, P<0.001). FEV1 per-1SD remained an independent predictor of worsening of HF after additional adjustment for NT-proBNP (HR 1.25[1.08;1.45], P=0.002). Conclusion: Impaired FEV1 is directly linked to the pathophysiology of HF & represents a strong & independent predictor of HF outcome highlighting its potential value to advance risk prediction in HF.

scholarly journals Prognostic Roles of BRAF, KIT, NRAS, IGF2R and SF3B1 Mutations in Mucosal Melanomas

Cells ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 2216
Author(s):  
Joanna P. Wróblewska ◽  
Dora Dias-Santagata ◽  
Adam Ustaszewski ◽  
Cheng-Lin Wu ◽  
Masakazu Fujimoto ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Sanger Sequencing ◽  
Multivariate Analyses ◽  
Independent Predictor ◽  
Advanced Stage ◽  
Nras Mutation ◽  
Recurrent Mutations ◽  
Clinicopathologic Parameters ◽  
Univariate Analyses ◽  
Generation Sequencing

Background: The prognostic value of commonly recurrent mutations remains unclear in mucosal melanomas. Methods: Clinicopathologic parameters of 214 cases of mucosal melanomas diagnosed in 1989–2020 in several clinical institutions were analyzed. NRAS, KIT, BRAF, IGF2R and SF3B1 mutational analyses by Sanger sequencing and next generation sequencing-based assay were performed in a subset of cases. Results: Of the triple (BRAF, NRAS, NF1)-negative cases, APC, KIT and KRAS are detected mainly in sinonasal, vulvovaginal and anorectal melanomas, respectively. NRAS, KIT, BRAF, IGF2R and SF3B1 mutations are detected in 19% (37/198), 22% (44/197), 12% (25/201), 16% (22/138) and 15% (20/133) of cases, respectively. In univariate analyses, advanced stage (p = 0.016), 65 years or older (p = 0.048) and presence of ulceration (p = 0.027) are significantly correlated with worse overall survival (OS), respectively. NRAS mutation significantly correlates with worse OS (p = 0.028) and worse melanoma-specific survival (MSS) (p = 0.03) for all cases of mucosal melanomas. In multivariate analyses, NRAS mutation remains as an independent predictor of worse OS (p = 0.036) and worse MSS (p = 0.024). Conclusion: NRAS mutation is a predictor of worse survival, independent of stage in mucosal melanomas. The significance of frequently mutated IGF2R in mucosal melanomas remains unclear.

Improving Safety of Bilateral Knee Arthroplasty: Impact of Selection Criteria on Perioperative Outcome

2021 ◽  
pp. 155633162110148
Author(s):  
Philipp Gerner ◽  
Stavros G. Memtsoudis ◽  
Crispiana Cozowicz ◽  
Ottokar Stundner ◽  
Mark Figgie ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Selection Criteria ◽  
Perioperative Complications ◽  
Perioperative Outcomes ◽  
Cardiac Complications ◽  
Complication Rates ◽  
Major Complications ◽  
Increased Risk ◽  
Comorbidity Burden ◽  
Rate Ratios

Background: Bilateral total knee arthroplasty (BTKA) procedures are associated with an increased risk of complications when compared with unilateral approaches. In 2006, in an attempt to reduce this risk, our institution implemented selection criteria that specified younger and healthier patients as candidates for BTKA. Questions/Purpose: We sought to investigate the effect of these selection criteria on perioperative outcomes. Methods: In a retrospective cohort study, we used institutional data to identify patients who underwent BTKA between 1998 and 2014. Patients were divided into 2 groups: those who underwent surgery before the 2006 introduction of our selection criteria (1998–2006) and those who underwent surgery after (2007–2014). Groups were compared in terms of demographics, comorbidity burden, and incidence of perioperative complications. Regression analysis was performed, calculating incidence rate ratios to evaluate changes in complication rates. Results: Before the selection criteria were implemented in 2006, patients who underwent BTKA were older and had a higher comorbidity burden. The rate of major complications per 1000 hospital days decreased from 31.5 in 1998 to 7.9 in 2014. A reduction in cardiac complications was the most significant contributor to this decrease in major complications. Conclusion: After stringent criteria for BTKA candidates were implemented at our institution, selection of younger patients with lower comorbidity burden was accompanied by a reduction in the incidence of operative complications. This suggests that introducing such criteria can be associated with a reduction in adverse perioperative outcomes.

Breast Reconstruction Completion in the Obese: Does Reconstruction Technique Make a Difference in Its Achievement?

2021 ◽  
Author(s):  
Christine Velazquez ◽  
Robert C. Siska ◽  
Ivo A. Pestana
Keyword(s):  
Breast Reconstruction ◽  
Perioperative Complications ◽  
Major Complication ◽  
Normal Body Mass Index ◽  
Reconstruction Technique ◽  
Autologous Reconstruction ◽  
Obese Women ◽  
Areolar Complex ◽  
Obese Female ◽  
Increased Risk

Abstract Background Breast mound and nipple creation are the goals of the reconstructive process. Unlike in normal body mass index (BMI) women, breast reconstruction in the obese is associated with increased risk of perioperative complications. Our aim was to determine if reconstruction technique and the incidence of perioperative complications affect the achievement of reconstruction completion in the obese female. Methods Consecutive obese women (BMI ≥30) who underwent mastectomy and implant or autologous reconstruction were evaluated for the completion of breast reconstruction. Results Two hundred twenty-five women with 352 reconstructions were included. Seventy-four women underwent 111 autologous reconstructions and 151 women underwent 241 implant-based reconstructions. Chemotherapy, radiation, and delayed reconstruction timing was more common in the autologous patients. Major perioperative complications (requiring hospital readmission or unplanned surgery) occurred more frequently in the implant group (p ≤ 0.0001). Breast mounds were completed in >98% of autologous cases compared with 76% of implant cases (p ≤ 0.001). Nipple areolar complex (NAC) creation was completed in 57% of autologous patients and 33% of implant patients (p = 0.0009). The rate of successfully completing the breast mound and the NAC was higher in the autologous patient group (Mound odds ratio or OR 3.32, 95% confidence interval or CI 1.36–5.28 and NAC OR 2.7, 95% CI 1.50–4.69). Conclusion Occurrence of a major complication in the implant group decreased the rate of reconstruction completion. Obese women who undergo autologous breast reconstruction are more likely to achieve breast reconstruction completion when compared with obese women who undergo implant-based breast reconstruction.

Bilirubin adsorption for the treatment of severe hyperbilirubinemia after cardiac surgery: A retrospective cohort study

2021 ◽  
pp. 039139882199784
Author(s):  
Xiaolan Chen ◽  
Lu Li ◽  
Ming Bai ◽  
Shiren Sun ◽  
Xiangmei Chen
Keyword(s):  
Cardiac Surgery ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Multivariate Analyses ◽  
Reduction Rate ◽  
Mortality Rates ◽  
Increased Risk ◽  
Bilirubin Adsorption ◽  
Severe Hyperbilirubinemia ◽  
Post Cardiac Surgery

Objective: Severe hyperbilirubinemia after cardiac surgery increases in-hospital and 1-year mortality. Our present study aimed to analyze the safety and efficacy of bilirubin adsorption (BA) in patients with post-cardiac-surgery severe hyperbilirubinemia. Methods: We retrospectively included patients who underwent BA due to severe hyperbilirubinemia after cardiac surgery in our center between January 2015 and December 2018. The change of serum bilirubin, alanine aminotransferase, aspartate aminotransferase, and 30-day and 1-year mortality were assessed as endpoints. Univariate and multivariate analyses were employed to identify the risk factors of patient 30-day mortality. Result: A total of 25 patients with 44 BA treatments were included. One BA treatment reduced total bilirubin (TB) concentration from 431.65 ± 136.34 to 324.83 ± 129.44 µmol/L ( p < 0.001), with a reduction rate of 24.8%. No clinically relevant thrombosis of the extracorporeal circuit occurred during the BA treatment. The 30-day and 1-year mortality rates were 68% ( n = 18) and 84% ( n = 21), respectively. Multivariate analysis identified that TB level before BA treatment (odds ratio [OR] 1.010, 95% confidence interval [CI] 1.000–1.019; p = 0.043) was an independent risk factor of 30-day mortality. Conclusions: BA treatment should be considered as an effective and safe method for the reduction of serum bilirubin in patients with post-cardiac-surgery severe hyperbilirubinemia. Patients with higher TB level before BA treatment had a relatively increased risk of 30-day mortality. Further studies are needed to evaluate the timing of BA for severe hyperbilirubinemia after cardiac surgery.

scholarly journals Prevalence of Epiretinal Membrane among Subjects in a Health Examination Program in Japan

Life ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 93
Author(s):  
Hiroshi Shimizu ◽  
Ryo Asaoka ◽  
Takashi Omoto ◽  
Yuri Fujino ◽  
Shingo Mitaki ◽  
...  
Keyword(s):  
Epiretinal Membrane ◽  
Multivariate Analyses ◽  
Multiple Logistic Regression Analysis ◽  
Body Height ◽  
Older Age ◽  
Health Examination ◽  
Multiple Logistic Regression ◽  
Older Subjects ◽  
Fundus Photographs ◽  
Univariate Analyses

The prevalence of an epiretinal membrane (ERM) was elucidated using a dataset from a health examination program database in Japan. From the cohort database, 5042 eyes of 2552 subjects were included. The presence of an ERM, cellophane macular reflex (CMR), or preretinal macular fibrosis (PMF) was detected using color fundus photographs, and crude and age-standardized prevalence were obtained. To further assess the possible risk factors of ERM, background parameters were compared between ERM+ and − groups, and multiple logistic regression analysis was performed. ERM was detected in fundus photographs of 275 eyes (eye-based prevalence of 5.5%) from 217 subjects (subject-based prevalence of 8.5%). CMR was detected in 169 eyes (3.4%) of 138 subjects (5.4%), and PMF was detected in 106 eyes (2.1%) of 97 subjects (3.8%). By univariate analyses, compared with ERM− eyes or subjects, higher Scheie’s H grade (p < 0.0001), S grade (p < 0.0001), and glaucoma prevalence (p = 0.0440) were found in ERM+ eyes, and older age (p < 0.0001), more frequent histories of hypertension (p = 0.0033) and hyperlipidemia (p = 0.0441), and more frequent uses of medication for hypertension (p = 0.0034) and hyperlipidemia (p = 0.0074), shorter body height (p = 0.0122), and higher systolic blood pressure (p = 0.0078), and thicker intimal medial thickness (p = 0.0318) were found in ERM+ subjects. By multivariate analyses, older age (p < 0.0001, estimate = 0.05/year) was the only significant factor of ERM prevalence. Age-standardized prevalence of ERM was calculated to be 2.4%, 6.7%, and 13.3% for all ages, subjects older than 40 years, and subjects older than 65 years, respectively. We reported the prevalence of ERM and its subclasses in Japanese subjects. Since its prevalence is remarkably high in older subjects, an ERM can be seen as an important cause of visual impairment in Japan and in areas of the world where individuals live to an advanced age.

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