The impact of neurosurgical technique on the short- and long-term outcomes of adult patients with Chiari I malformation

Background: Thrombocytopenia (TCP) occurs commonly in patients hospitalized with acute myocardial infarction (AMI). It is unclear whether persistent TCP after discharge among AMI survivors is associated with worse outcomes. Methods: We examined the impact of persistent post-discharge TCP on outcomes in a registry of consecutive AMI patients hospitalized between January 2004 and December 2007. In-hospital (IH) TCP was defined by a nadir platelet count < 150 x 109/L. Resolved TCP was defined as IH TCP which resolved within 3 months after discharge while persistent TCP was defined as IH TCP which did not resolve within 3 months. Results: Of 842 patients hospitalized for a first AMI, we examined data on 617 hospital survivors who had follow-up within 3 months of discharge and documented long-term outcomes. Of those, 474 (76.8%) patients did not experience IH TCP while 42 (6.8%) and 101 (16.4%) had persistent and resolved TCP, respectively (Table). Patients with persistent TCP were older, had worse comorbidities, and were more likely to have TCP at baseline and discharge. There were no inter-group differences in infarct size, major bleeding complications, revascularization, or ejection fraction at discharge. Mortality following discharge was higher at all time-points among AMI patients with persistent TCP compared to patients with resolved or without IH TCP (Figure). Patients with resolved TCP had comparable mortality to those without IH TCP. Conclusion: Persistent TCP within 3 months after hospital discharge for AMI is associated with significantly increased short- and long-term mortality compared to patients with recovered TCP or without IH TCP.

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Impact of Age on Short- and Long-Term Outcomes after Pancreatoduodenectomy for Periampullary Neoplasms

Gastroenterology Research and Practice ◽

10.1155/2020/1793051 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Mario Gruppo ◽

Francesca Tolin ◽

Boris Franzato ◽

Pierluigi Pilati ◽

Ylenia Camilla Spolverato ◽

...

Keyword(s):

Overall Survival ◽

Elderly Patients ◽

Adjuvant Treatment ◽

Long Term Outcomes ◽

Group I ◽

Periampullary Neoplasms ◽

Short And Long Term ◽

Group Ii ◽

The Impact

Background. Although mortality and morbidity of pancreatoduodenectomy (PD) have improved significantly over the past years, the impact of age for patients undergoing PD is still debated. This study is aimed at analyzing short- and long-term outcomes of PD in elderly patients. Methods. 124 consecutive patients who have undergone PD for pancreas neoplasms in our center between 2012 and 2017 were analyzed. Patients were divided into two groups: group I (<75 years) and group II (≥75 years). Demographic features and intraoperative and clinical-pathological data were collected. Primary endpoints were perioperative morbidity and mortality; complications were classified according to the Clavien-Dindo Score. Secondary endpoints included feasibility of adjuvant treatment and overall survival rates. Results. A total of 106 patients were included in this study. There were 73 (68.9%) patients in group I and 33 (31.1%) in group II. Perioperative deceases were 4 (3.6%), and postoperative pancreatic fistulas were 34 (32.1%). Significant difference between two groups was demonstrated for the ASA Score (p=0.004), Karnofsky Score (p=0.025), preoperative jaundice (p=0.004), and pulmonary complications (p=0.034). No significance was shown for diabetes, radicality of resection, stage of disease, operative time, length of stay, postoperative complications according to the Clavien-Dindo Score, postoperative mortality, pancreatic fistula, and reoperation rates. 69.9% of the patients in group I underwent adjuvant treatment vs. 39.4% of the older ones (p=0.012). Mean overall survival was 28.5 months in group I vs. 22 months in group II (p=0.909). Conclusion. PD can be performed safely in elderly patients. Advanced age should not be an absolute contraindication for PD, even if greater frailty should be considered. The outcome of elderly patients who have undergone PD is similar to that of younger patients, even though adjuvant treatment administration is significantly lower, demonstrating that surgery remains the main therapeutic option.

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Surgical Treatment of Chiari I Malformation—Analysis of Intraoperative Findings, Complications, and Outcome for 371 Foramen Magnum Decompressions

Neurosurgery ◽

10.1227/neu.0b013e31825c3426 ◽

2012 ◽

Vol 71 (2) ◽

pp. 365-380 ◽

Cited By ~ 98

Author(s):

Jörg Klekamp

Keyword(s):

Clinical Symptoms ◽

Foramen Magnum ◽

Chiari I Malformation ◽

Outcome Data ◽

Long Term Outcomes ◽

Recurrence Rates ◽

Surgical Morbidity ◽

Suboccipital Craniectomy ◽

Chiari I

Abstract BACKGROUND: Foramen magnum decompression is widely accepted as the treatment of choice for Chiari I malformation. However, important surgical details of the procedure are controversial. OBJECTIVE: This study analyzes 371 decompressions focusing on intraoperative findings, analysis of complications, and long-term outcomes. METHODS: Among 644 patients between 1985 and 2010, 359 patients underwent 371 decompressions. Surgery for symptomatic patients consisted of suboccipital craniectomy, C1 laminectomy, arachnoid dissection, and duraplasty. Short-term results were determined after 3 months; long-term outcomes were evaluated with Kaplan-Meier statistics. RESULTS: The mean age was 40 ± 16 years; mean follow-up was 49 ± 56 months; 75.8% demonstrated syringomyelia. The complication rate was 21.8% with permanent surgical morbidity of 3.2% and surgical mortality of 1.3%. Of the patients, 73.6% reported improvement after 3 months; 21% were unchanged. Overall, 14.3% demonstrated a neurological deterioration within 5 years and 15.4% within 10 years. The severity of neurological symptoms correlated with the grade of arachnoid pathology. Outcome data correlated with the number of previous decompressions, severity of arachnoid pathology, handling of the arachnoid, type of duraplasty, and surgical experience. First-time decompressions with arachnoid dissection and an alloplastic duraplasty resulted in surgical morbidity for 2.0%, a 0.9% mortality rate, postoperative improvement after 3 months for 82%, and neurological recurrence rates of 7% after 5 years and 8.7% after 10 years. CONCLUSION: Arachnoid pathology in Chiari I malformation has an impact on clinical symptoms and postoperative results. Decompressions with arachnoid dissection and an alloplastic duraplasty performed by surgeons experienced with this pathology offer a favorable long-term prognosis.

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The Impact of Age at Time of Ileal Pouch Anal Anastomosis on Short and Long-Term Outcomes in Adults

Inflammatory Bowel Diseases ◽

10.1093/ibd/izy087 ◽

2018 ◽

Vol 24 (8) ◽

pp. 1857-1865 ◽

Cited By ~ 5

Author(s):

Nicholas P McKenna ◽

Kellie L Mathis ◽

John H Pemberton ◽

Amy L Lightner

Keyword(s):

Ileal Pouch ◽

Ileal Pouch Anal Anastomosis ◽

Long Term Outcomes ◽

Anal Anastomosis ◽

Short And Long Term ◽

The Impact

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P13. The impact of extremes of age on short and long-term outcomes following surgical resection of oesophageal malignancy

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2012.07.134 ◽

2012 ◽

Vol 38 (11) ◽

pp. 1109

Author(s):

Sheraz Markar ◽

Donald Low

Keyword(s):

Surgical Resection ◽

Long Term Outcomes ◽

Short And Long Term ◽

The Impact

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Impact of major vascular resection on short- and long-term outcomes in patients with intrahepatic cholangiocarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.275 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 275-275

Author(s):

Bradley Reames ◽

Timothy M. Pawlik ◽

Aslam Ejaz ◽

Hugo Marques ◽

Luca Aldrighetti ◽

...

Keyword(s):

Intrahepatic Cholangiocarcinoma ◽

Major Complication ◽

Vascular Resection ◽

Perioperative Outcomes ◽

Vascular Involvement ◽

Long Term Outcomes ◽

Short And Long Term ◽

Vein Resection ◽

The Impact

275 Background: Major vascular (IVC or portal vein) resection for Intrahepatic Cholangiocarcinoma (ICC) has traditionally been considered a relative contraindication to resection. We sought to define perioperative outcomes and survival of ICC patients undergoing liver surgery with major vascular resection using a multi-institutional database. Methods: 1,087 ICC patients who underwent liver resection between 1990-2016 were identified from 13 participating institutions. Multivariable logistic and cox regressions were used to determine the impact of major vascular resection on perioperative outcomes and long-term overall survival. Results: Of 1,087 patients who underwent resection, 128(11.8%) also underwent major vascular resection [21(16.4%)IVC resections, 98(76.6%)PV resections, 9(7.0%)combined resections]. One hundred eighty-seven(17.2%) patients received neoadjuvant therapy. Most patients underwent a major hepatectomy involving ≥ 3 liver segments(n = 664,61.1%). On final pathology, the majority of patients had T1(40.4%) or T2(35.5%) tumors; 194(17.8%) had lymph node metastasis. Patients undergoing major vascular resection had more advanced T3/T4 tumors [44(34.4%) vs. 137(14.3%) without resection;P < 0.001]. Of note, major vascular resection was not associated with the risk of any complication (OR .680,95%CI 0.32-1.45) or major complication (OR 0.69,95%CI 0.35-1.33); post-operative mortality was also comparable between groups (OR 1.06, 95%CI 0.32-3.48). In addition, median recurrence-free (14.0 months vs.14.7 months, HR.737,95%CI .49-1.10) and overall (33.4 months vs.40.2 months, HR .709,95%CI.36-1.40) survival were similar among patients who did and did not undergo major vascular resection, respectively(both P > 0.05). Conclusions: Among patients with ICC, major vascular resection was not associated with increased peri-operative morbidity or mortality at major centers. Long-term outcomes following resection of ICC requiring vascular resection were also comparable to outcomes following resection of tumors without vascular involvement. Concurrent major vascular resection should be considered in appropriately selected ICC patients.

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The Impact of Obesity on Short- and Long-term Outcomes After Lumbar Fusion

Spine ◽

10.1097/brs.0000000000000655 ◽

2015 ◽

Vol 40 (1) ◽

pp. 56-61 ◽

Cited By ~ 59

Author(s):

Rafael De la Garza-Ramos ◽

Mohamad Bydon ◽

Nicholas B. Abt ◽

Daniel M. Sciubba ◽

Jean-Paul Wolinsky ◽

...

Keyword(s):

Lumbar Fusion ◽

Long Term Outcomes ◽

Short And Long Term ◽

The Impact

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The Female Secondary Stipend and Assistance Program in Bangladesh: What Did It Accomplish?

10.22617/wps210021-2 ◽

2021 ◽

Author(s):

Shahidur Rahman Khandker ◽

Hussain Akhterus Samad ◽

Nobuhiko Fuwa ◽

Ryotaro Hayashi

Keyword(s):

Labor Force ◽

Labor Force Participation ◽

Female Education ◽

Long Term Outcomes ◽

Female Labor ◽

Assistance Program ◽

Age At Marriage ◽

Short And Long Term ◽

The Impact

Are subsidies to female education worth supporting to enhance socioeconomic and demographic changes? This paper examines whether or not the Female Secondary Stipend and Assistance Program (FSSAP) in Bangladesh matters. If it does, how much and in what way—on both observed short- and long- term outcomes associated with female education? How did FSSAP impact the education of children, and boys in particular? The paper also explores the impact on female labor force participation, as well as age at marriage, fertility, and other effects on society.

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