Supratentorial and Infratentorial Approaches to Pineal Surgery: A Database Analysis

Objectives Neoplasms involving the pineal gland are rare. When they do occur, tumor resection is anatomically challenging and is traditionally addressed by either a supratentorial or an infratentorial approach. To date, no large, multicenter studies have been performed that systematically analyze outcomes comparing these two approaches. This study aimed to evaluate outcomes for patients undergoing pineal neoplasm resection, comparing supratentorial and infratentorial approaches. Design Retrospective database review. Setting Multi-institutional database. Participants From 2005 to 2016, 60 patients were identified, with 13 undergoing a supratentorial approach and 47 undergoing an infratentorial approach. Main Outcome Measures Patient demographics, comorbidities, and 30-day postoperative outcomes were investigated using the American College of Surgeons National Surgical Quality Improvement Program database. Demographics, readmission, reoperation, and complication rates were analyzed and compared with previous studies. Results Patient demographics were similar between these two groups. The overall complication rates for the supratentorial and infratentorial approaches were 30.8 and 17%, respectively, and the difference was not statistically significant. The most common medical complications encountered were respiratory and hematological. Conclusion As the first multi-institutional database analysis of approaches to the pineal gland, this study provides an analysis of patient demographics, comorbidities, and postoperative complications. After controlling for preoperative risk factors and demographic characteristics, no statistically significant differences in postoperative outcomes were found between infratentorial and supratentorial approaches. The mean readmission, reoperation, and complication rates were found to be 2.1, 8.3, and 20%, respectively. The lack of significant difference between approaches suggests that clinical decision-making should depend upon anatomical considerations and physician preference, although the complications illustrated here may provide some preoperative guidance.

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Absence of Association between Preoperative Estimated Glomerular Filtration Rates and Postoperative Outcomes following Elective Gastrointestinal Surgeries: A Prospective Cohort Study

Anesthesiology Research and Practice ◽

10.1155/2018/5710641 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Sivesh K. Kamarajah ◽

Behrad Barmayehvar ◽

Mustafa Sowida ◽

Amirul Adlan ◽

Christina Reihill ◽

...

Keyword(s):

Risk Stratification ◽

Glomerular Filtration ◽

Elective Surgery ◽

Gastrointestinal Surgery ◽

Major Complication ◽

Postoperative Outcomes ◽

Queen Elizabeth Hospital ◽

Complication Rates ◽

Significant Difference ◽

The Impact

Background. Preoperative risk stratification and optimising care of patients undergoing elective surgery are important to reduce the risk of postoperative outcomes. Renal dysfunction is becoming increasingly prevalent, but its impact on patients undergoing elective gastrointestinal surgery is unknown although much evidence is available for cardiac surgery. This study aimed to investigate the impact of preoperative estimated glomerular filtration rate (eGFR) and postoperative outcomes in patients undergoing elective gastrointestinal surgeries. Methods. This prospective study included consecutive adult patients undergoing elective gastrointestinal surgeries attending preassessment screening (PAS) clinics at the Queen Elizabeth Hospital Birmingham (QEHB) between July and August 2016. Primary outcome measure was 30-day overall complication rates and secondary outcomes were grade of complications, 30-day readmission rates, and postoperative care setting. Results. This study included 370 patients, of which 11% (41/370) had eGFR of <60 ml/min/1.73 m2. Patients with eGFR < 60 ml/min/1.73 m2 were more likely to have ASA grade 3/4 (p<0.001) and >2 comorbidities (p<0.001). Overall complication rates were 15% (54/370), with no significant difference in overall (p=0.644) and major complication rates (p=0.831) between both groups. In adjusted models, only surgery grade was predictive of overall complications. Preoperative eGFR did not impact on overall complications (HR: 0.89, 95% CI: 0.45–1.54; p=0.2). Conclusions. Preoperative eGFR does not appear to impact on postoperative complications in patients undergoing elective gastrointestinal surgeries, even when stratified by surgery grade. These findings will help preassessment clinics in risk stratification and optimisation of perioperative care of patients.

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Baerveldt shunt surgery versus combined Baerveldt shunt and phacoemulsification: a prospective comparative study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-310698 ◽

2017 ◽

Vol 102 (9) ◽

pp. 1248-1253 ◽

Cited By ~ 1

Author(s):

Mohamad El Wardani ◽

Ciara Bergin ◽

Kenza Bradly ◽

Eamon Sharkawi

Keyword(s):

Complication Rates ◽

Failure Rates ◽

Shunt Surgery ◽

Patient Demographics ◽

Aqueous Shunt ◽

Included Patient ◽

Significant Difference ◽

Negative Effect ◽

Prospective Comparative Study ◽

Baerveldt Tube

AimTo examine the efficacy and safety of Baerveldt tube (BT) implantation compared with combined phacoemulsification and Baerveldt tube (PBT) implantation in patients with refractory glaucoma.MethodsSeventy-six eyes of 76 patients were enrolled, 38 pseudophakic eyes underwent BT implantation alone and 38 phakic eyes underwent the BT implantation combined with phacoemulsification. Groups were matched for preoperative intraocular pressure (IOP) and number of glaucoma medications. Preoperative and postoperative measures recorded included patient demographics, visual acuity (VA), IOP, number of antiglaucoma medications and all complications. Patients were followed up for a minimum of 36 months. Failure was defined as: inadequate IOP control (IOP≤5 mm Hg/>21 mm Hg/<20% reduction from baseline, reoperation for glaucoma, loss of light perception vision, or removal of the implant).ResultsThere was a significant difference in failure rates between groups at 36 months (PBT 37% vs BT 15%, P=0.02). There was no significant difference for PBT versus BT in preoperative baseline ocular characteristics. At 36 months: median IOP=14 mm Hg vs 12 mm Hg, P=0.04; mean number of antiglaucomatous medications=1.7 vs 1.3, P=0.61; median VA=0.8 vs 0.7, P=0.44. Postoperative complication rates were similar in both groups (n=5 vs 5; 13% vs 13%).ConclusionsFailure rates were significantly greater in the PBT group at 3 years. Median IOP was also significantly higher in the PBT group. These results suggest that combining phacoemulsification with aqueous shunt surgery may have a negative effect on long-term shunt bleb survival.

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Evaluation of Minimally Invasive Surgical Therapies for Ulcerative Colitis

The American Surgeon ◽

10.1177/0003134820934417 ◽

2020 ◽

Vol 86 (7) ◽

pp. 782-786 ◽

Cited By ~ 1

Author(s):

Salini Hota ◽

Salvatore Parascandola ◽

Richard Amdur ◽

Vincent Obias

Keyword(s):

Ulcerative Colitis ◽

Minimally Invasive ◽

Postoperative Outcomes ◽

Open Group ◽

Open Approach ◽

Cardiac Events ◽

Improvement Program ◽

Robotic Assisted ◽

Confounding Variables ◽

Significant Difference

Introduction Ulcerative colitis (UC) is a chronic inflammatory intestinal disorder that can be managed surgically with a proctocolectomy. Minimally invasive techniques such as laparoscopic or robotic-assisted surgery are available based on the surgeon’s preference and familiarity. To date, there is a paucity of literature evaluating the safety of these techniques in comparison to the open approach in patients with UC. Methods We surveyed the National Surgical Quality Improvement Program (NSQIP) database to select patients with the diagnosis of UC who underwent either robotic, laparoscopic, or open proctocolectomy between 2012 and 2017. A total of 2129 patients were included in the study. The 30-day postoperative outcomes were compared using multivariable logistic regression models after adjusting for confounding variables. The confounding variables were defined as any preoperative variable that was associated with the type of procedure. Results The 30-day postoperative outcomes reported in the NSQIP database were reviewed for each of the treatment groups (open, laparoscopic, and robotic). The anastomotic leak rate was significantly higher in the open group ( P = .022). The robotic and laparoscopic groups had significantly fewer occurrences of postoperative ileus ( P = .0006) and wound infections ( P < .0001). There were significantly more strokes, cardiac events, and pulmonary events in the open surgical group. Operative time was significantly shorter in the open group ( P < .0001). Reintervention rates were not significantly different among the groups. Conclusions Minimally invasive proctocolectomy has significantly fewer postoperative complications compared with open proctocolectomy for UC. There is no significant difference in the postoperative outcomes between robotic-assisted and laparoscopic proctocolectomy.

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Surgery Delay Increases Length of Stay in Thoracolumbar Trauma

Neurosurgery ◽

10.1093/neuros/nyz310_446 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Lawrence Zeldin ◽

Sean N Neifert ◽

Robert J Rothrock ◽

Ian T McNeill ◽

Jonathan S Gal ◽

...

Keyword(s):

Length Of Stay ◽

Spinal Injury ◽

Specific Effect ◽

Spinal Trauma ◽

Spine Injury ◽

Complication Rates ◽

Improvement Program ◽

Delayed Surgery ◽

Significant Difference ◽

Surgery Timing

Abstract INTRODUCTION The ideal timing from admission of a thoracolumbar spinal trauma patient to the start of surgery at US trauma centers remains a hotly contested area of debate. The effect of surgical latency on patient outcomes in thoracolumbar trauma remains unclear. METHODS All 2013 to 2015 thoracolumbar spinal trauma cases from the American College of Surgeons Trauma Quality Improvement Program (TQIP) were analyzed. Patients with unsurvivable spine injury, polytraumas (serious injuries in more than one bodily region), and those discharged within 24 h were excluded. Patients were classified into 3 groups by surgery timing: less than 8 h (early, N = 1699), between 8 and 24 h (normal, N = 946), and over 24 h (delayed, N = 1601). Mortality, length of stay (LOS), and complication rates were compared between groups. Demographic variables and complication rates were compared. Multivariate logistic regression was utilized to determine the specific effect of surgery timing on outcomes. RESULTS Patients with earlier surgery presented with more severe spinal trauma (P < .0001). Patients in the normal surgical timing cohort were most likely to have altered mental status (4.97% vs 3.24%, P = .05), and less likely to suffer from UTI (4.97% vs 3.24%, P = .03). Patients in the delayed cohort were older (46.2 vs 43.7 yr, P = .0003), more likely to have a longer LOS (11.3 vs 10.6 d, P = .02), return to the ICU (2.94% vs 1.29%, P = .001), experience unplanned intubation (2.06% vs 1%, P = .01) and suffer from cardiac arrest (0.53% vs 1.19%, P = .04). Upon multivariate analysis, delayed surgery was an independent risk factor for prolonged LOS (OR: 1.21, 95% CI: 0.56-1.87, P = .0003). CONCLUSION Patients with earlier surgery possessed more severe spinal injury. When adjusting for demographics and severity, no significant difference is seen in mortality between the different surgery times; however, LOS is prolonged in patients with delayed surgery.

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Clinicopathological analysis of KRAS mutation in an Irish population.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.467 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 467-467

Author(s):

M. Teo ◽

S. O'Reilly ◽

E. Moylan ◽

D. G. Power

Keyword(s):

Metastatic Disease ◽

Tumor Resection ◽

Irish Population ◽

Wild Type ◽

Patient Demographics ◽

Disease Characteristics ◽

Clinicopathological Analysis ◽

Kras Status ◽

Significant Difference ◽

Sites Of Metastases

467 Background: Clinical trials have shown that tumor KRAS status predicts response to anti-EGFR monoclonal antibodies in metastatic colorectal cancer (mCRC). We sought to compare distribution of wild-type and mutated KRAS in an Irish population and identify clinicopathologic correlates. Methods: From our prospectively maintained database we retrospectively identified patients with mCRC and documented KRAS status between Jan 2007 to June 2010. Medical notes were examined for patient demographics and disease characteristics. Variables were extracted and compared using unpaired t test and chi2 test. Results: 52 patients were identified, 29 (55.8%) with mutated (mt) and 23 (44.2%) with wild type (wt) KRAS from tumor tissue. Males accounted for 61.5% (n=31). Median age at diagnosis of metastatic disease for the KRASmt group was 66.4 years (range 56.7-82.1) and for the KRAS wt group was 64.2 years (40.1-76.8), p= 0.08. 21 (72.4%) of the KRASmt group and 16 (69.6%) of the KRASwt group had metastatic disease at presentation (p=0.81). For patients who presented initially with localised disease, time to development of metastases was 22.5mo (range 14-37.6) for the KRASmt group and 16.7mo (3.2-123.7) for the KRASwt (p=0.30). 21 (72.4%) of KRASmt and 17 (74.1%) of KRASwt tumors had left-sided primary (p = 0.84) with equal numbers of primary tumor resection in both groups. There was no statistical difference in TN-stage or the presence of liver metastases. Numbers of patients with KRASmt tumors with one, two and three or more different sites of metastases was 22 (75.9%), 5 (17.2%), and 2 (6.9%), and in KRASwt tumors there was no significant difference: 18 (78.3%), 4 (17.4%), and 1 (4.3%), respectively (p = 0.93). Median CEA at diagnosis for both groups were 19.7 μg/l (range 1.2-5958) and 6.1 (1.3-696.9; p = 0.11). Conclusions: We found that the ratio of KRASmt to KRASwt tumours in an Irish population is comparable to that in large international trials. Our analysis revealed no association between KRAS status and clinicopathologic variables. The inclusion of BRAF status, not readily available in our institution, may help define poor prognosis tumors. At present there is no validated molecular biomarker that is superior to standard clinicopathologic variables. No significant financial relationships to disclose.

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Complication Profile Associated With S1 Pedicle Subtraction Osteotomy Compared to Other Spinal Levels

Neurosurgery ◽

10.1093/neuros/nyz310_441 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Darryl Lau ◽

Vedat Deviren ◽

Christopher P Ames

Keyword(s):

Complication Rate ◽

Diastolic Heart Failure ◽

Adult Spinal Deformity ◽

Neurological Complication ◽

Pedicle Subtraction Osteotomy ◽

Senior Author ◽

Complication Rates ◽

Multicenter Studies ◽

Complication Risk ◽

Significant Difference

Abstract INTRODUCTION S1 pedicle subtraction osteotomy (PSO) is rarely indicated. Therefore, its complication profile is not well defined. This study compares complication rates following S1 PSO to PSO performed at other spinal levels. METHODS A retrospective study of a consecutive cohort of adult spinal deformity (ASD) patients who underwent thoracolumbar 3 column osteotomy (3CO) by the senior author from 2006 to 2018 was performed. Multivariate analysis was used to asses complication risk stratified by osteotomy level. RESULTS A total of 363 patients underwent 3CO: 54 lower thoracic, 305 lumbar, and 6 S1. The number of lumbar PSO by level are as fsollows: L1 (24), L2 (26), L3 (135), L4 (102), and L5 (16). The indications for S1 PSO in this series were: high grade spondylolisthesis (spondyloptosis) in 4 cases and sacral fracture in 2 cases. Overall complication rate was 27.5%. Surgical and neurologic complications occurred in 7.7% and 5.8% of cases, respectively. Complication rate by 3CO level are as follows: thoracic (31.5%), L1 (29.2%), L2 (34.6%), L3 (20.7%), L4 (32.4%), L5 (12.5%), and S1 (50.0%). Relative to the thoracic level, S1 PSO was independently associated higher complication with an increase odd ratio of 39.60 (CI 3.12-503.41, P = .005). For S1 PSO, surgical and neurological complication rate was 16.7% for both outcomes; there was no significant difference between the 3CO levels. Specific complications encountered was a case of atrial flutter causing diastolic heart failure, a case of anaphylactic transfusion reaction, and a case with L5 weakness requiring hematoma evacuation and reduction of correction. One patient (16.7%) required revision surgery secondary to pseudarthrosis. Mean follow-up was 35.7 mo. CONCLUSION S1 PSO is a formidable procedure and associated with significantly higher complication rates than PSO performed at other levels. However, the technique is feasible with experienced surgeons. Large multicenter studies are needed to investigate this further.

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Role of minimally invasive glaucoma surgery in the management of chronic open-angle glaucoma

Scientific Reports ◽

10.1038/s41598-021-00808-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ojasvi Sharma ◽

Didar Abdulla ◽

Anthony King ◽

Monali Chakrabarti ◽

Tarun Sharma

Keyword(s):

Success Rate ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Case Series ◽

Glaucoma Surgery ◽

Complication Rates ◽

Open Angle ◽

Patient Demographics ◽

Significant Difference ◽

Advanced Glaucoma

AbstractTo compare the safety and efficacy of phacoemulsification combined with ab-interno trabeculectomy (Trabectome) and phacoemulsification combined with I-Stent inject in patients with medically uncontrolled primary open-angle glaucoma (POAG). A retrospective comparative case series. 70 eyes of 66 patients completed 2 years follow up after these treatments performed in 2017–2018. 35 eyes of 33 patients underwent combined Phaco-Trabectome (PT); and 35 eyes of 33 patients underwent combined Phaco-I-Stent inject (Pi). Patient demographics and preoperative characteristics are comparable. A 20% drop in IOP was achieved in 27 eyes (77.14%) in PT group and 28 eyes (80%) in Pi group (p = 0.77). Success rate (target IOP achieved and maintained for 2 years) in advance glaucoma was 25% in PT group and 30.7% in Pi group (p = 0.90). In mild to moderate glaucoma, success rate was 85.71% in PT group and 90% in Pi group (p = 0.67). There was no significant difference between two groups with regards to mean reduction in glaucoma medications and complication rates. Trabectome and I-Stent combined with phacoemulsification are equally efficacious and safe for treating patients with medically uncontrolled mild and moderate primary open-angle glaucoma (POAG). However, they are not an effective treatment for patients with advanced glaucoma.

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The impact of the Covid-19 pandemic on care of women with ectopic pregnancy in a tertiary London hospital

Facts, Views and Vision in ObGyn ◽

10.52054/fvvo.13.4.042 ◽

2021 ◽

Vol 13 (4) ◽

pp. 395-398

Author(s):

J.E. Gaughran ◽

D.M. Geddes-Barton ◽

T Cliff ◽

F Bailey ◽

C Ovadia ◽

...

Keyword(s):

Complication Rates ◽

Telephone Triage ◽

Management Options ◽

Triage System ◽

Patient Demographics ◽

Significant Difference ◽

Diagnosis Rate ◽

Ectopic Pregnancies ◽

Operative Findings ◽

The Impact

Background: In response to the COVID-19 pandemic, a central London tertiary referral hospital’s nurse-led Early Pregnancy & Acute Gynaecology Unit (EPAGU) suspended its walk-in service in favour of a telephone triage system with scheduled appointments. Objective: To assess if the pandemic and this adaptation to clinical services had an impact on the presentation, management and complication rate of ectopic pregnancies. Materials and Methods: A retrospective review was performed of ectopic pregnancies diagnosed in the EPAGU between 5th of March 2020 – 15th of July 2020 (pandemic) and 5th of March 2019 – 15th of July 2019 (pre-pandemic). Main outcome measures: Ultrasound findings, patient demographics, serum hCG concentrations, operative findings and complications. Results: There was a 36% reduction in attendances to the unit during the pandemic. Allowing for this, there was no significant difference in the diagnosis rate between the two periods. There was no significant difference in the gestation at diagnosis, serum hCG concentration or volume of mass at presentation. There was also no significant difference in rate of surgical intervention or complications including rupture of fallopian tube, haemoperitoneum or need for blood transfusion. Conclusion: This study suggests this is a safe means of caring for women with ectopic pregnancies which does not limit management options nor lead to higher complication rates. What is new: Other EPAGUs may choose to adopt a telephone triage system with reassurance of its safety.

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Risk factors and outcomes for failure of biological reconstruction after resection of primary malignant bone tumors in the extremities

Scientific Reports ◽

10.1038/s41598-021-00092-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Taweechok Wisanuyotin ◽

Permsak Paholpak ◽

Winai Sirichativapee ◽

Weerachai Kosuwon

Keyword(s):

Risk Factors ◽

Functional Outcomes ◽

Bone Tumors ◽

Tumor Resection ◽

Tumor Location ◽

Complication Rates ◽

Malignant Bone Tumors ◽

Biological Reconstruction ◽

Significant Difference ◽

Autograft Group

AbstractBiological reconstruction is widely used to reconstruct bone defects after resection of bone tumors in the extremities. This study aimed to identify risk factors for failure and to compare outcomes of the allograft, nonvascularized autograft, and recycled frozen autograft reconstruction after resection of primary malignant bone tumors in the extremities. A retrospective study was performed at a single center between January 1994 and December 2017. Ninety patients with primary malignant bone tumors of the extremities were treated with tumor resection and reconstruction using one of three bone graft methods: nonvascularized autograft (n = 27), allograft (n = 34), and recycled frozen autograft (n = 29). The median time for follow-up was 59.2 months (range 24–240.6 months). Overall failure of biological reconstruction occurred in 53 of 90 patients (58.9%). The allograft group had the highest complication rates (n = 21, 61.8%), followed by the recycled frozen autograft (n = 17, 58.6%) and nonvascularized autograft (n = 15, 55. 6%) groups. There was no statistically significant difference among these three groups (p = 0.89). The mean MSTS score was 22.6 ± 3.4 in the nonvascularized autograft group, 23.4 ± 2.6 in the allograft group, and 24.1 ± 3.3 in the recycled frozen autograft group. There was no significant difference among the groups (p = 0.24). After bivariate and multivariable analyses, patient age, sex, tumor location, graft length, methods, and type of reconstruction had no effects on the failure of biological reconstruction. Biological reconstruction using allograft, nonvascularized autograft, and recycled frozen autograft provide favorable functional outcomes despite high complication rates. This comparative study found no significant difference in functional outcomes or complication rates among the different types of reconstruction.

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Abstract WP14: Higher Aspiration Force Improves Technical Outcomes in ADAPT Thrombectomy for Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.wp14 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Reda M Chalhoub ◽

Ali M Alawieh ◽

Clayton Korson ◽

Mohammad Anadani ◽

Jonathan Lena ◽

...

Keyword(s):

Ischemic Stroke ◽

Lower Number ◽

Stent Retriever ◽

Complication Rates ◽

Procedure Time ◽

Aspiration Thrombectomy ◽

Patient Demographics ◽

Significant Difference ◽

Catheter Size ◽

The Impact

Introduction: Aspiration thrombectomy using the direct aspiration at first pass technique (ADAPT) has been shown to be non-inferior to stent-retriever thrombectomy in ischemic stroke trials. Favorable outcomes after ADAPT are dependent on successful recanalization and lower number of aspiration attempts. We investigated the impact of aspiration force on technical and clinical outcomes of ADAPT by modulating two underlying determinants, the aspiration catheter size and the reperfusion pump power. Methods: We performed a retrospective analysis of patients undergoing ADAPT thrombectomy between 01/2018 and 02/2019. Patient treated using ADAPT were included irrespective of age, onset to groin or whether thrombolytic therapy was administered. Patient demographics and outcomes were reviewed from patient charts and thrombectomy procedure notes. Patients were dichotomized based on the reperfusion pump used (MAX, 28.5 inHb power vs ENGINE, 29.2 inHg power) and further split into the different reperfusion catheters used. Results: This study included 194 patients who underwent ADAPT thrombectomy during the study period with mean age of 69, and of which 48% were females. Comparing patients treated with two different reperfusion pumps, ENGINE (N=73) and MAX (N=118), similar rates of favorable outcomes measured by 90-day modified Rankin score (mRS) were observed. However, patients in the ENGINE groups had significantly shorter procedure time (20 vs 27 min, p<0.05), lower number of aspiration attempts (1.9 vs 2.2 p<0.05), and low rates of rescue stent retriever therapy (14% vs 33%, p<0.05). The use of ENGINE was an independent predictor of shorter procedure time (p<0.05) and lower rates of symptomatic hemorrhage (p<0.1) compared to MAX pump. There was no significant difference in procedure time and rates of functional outcomes among patients undergoing ADAPT using different sizes of large bore catheters ACE 60, ACE68 and Jet 7. Conclusion: Success of ADAPT thrombectomy is dependent on successful aspiration of the occluding clot, and is dependent on the aspiration force. Higher aspiration forces can be achieved by increasing the power of reperfusion pump leading to better technical outcomes without increased complication rates.

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