A Comparison between Pediatric and Adult Patients after Cranioplasty: Aseptic Bone Resorption Causes Earlier Revision in Children

2019 ◽  
Vol 81 (03) ◽  
pp. 227-232 ◽  
Author(s):  
Jennifer Göttsche ◽  
Friederike Fritzsche ◽  
Gertrud Kammler ◽  
Thomas Sauvigny ◽  
Manfred Westphal ◽  
...  
Keyword(s):  
Risk Factor ◽  
Bone Resorption ◽  
Pediatric Patients ◽  
Young Age ◽  
Adult Patients ◽  
Bone Flap ◽  
Complication Rates ◽  
Bone Flap Resorption ◽  
Number Of Patients ◽  
Autologous Bone

Abstract Background and Study Aims/Objective Cranioplasty, a common neurosurgical intervention following decompressive craniectomy (DC), is associated with high complication rates. Bone flap resorption in particular leads to a considerable number of patients requiring further surgery. The aim of this study was to investigate the frequency and time of occurrence of complications following cranioplastic procedures in children and adults. Material and Methods Data of children and adults who underwent cranioplasty between July 2010 and March 2018 were analyzed retrospectively. Clinical data, complications, and risk factors regarding aseptic bone resorption (ABR) were evaluated including patient age, occurrence of shunt-dependent hydrocephalus, and number of fragments in autologous bone flaps. Results Severe traumatic brain injury (TBI) was the leading cause for DC among children (66.7%), associated with a significantly higher number of fragments (p = 0.002). In the adult population, the most common cause was malignant infarction (55.9%) followed by TBI (24.6%). Pediatric patients in our institution received autologous bone flaps less frequently than adult patients (61.1% and 83.1%, respectively). Young age and a higher number of fragments in autologous bone flaps were associated with the occurrence of ABR. Children and adolescents showed significantly higher rates of aseptic bone necrosis (p = 0.007) and revision cranioplasty (p = 0.036). Kaplan-Meier estimates were used to further analyze bone flap resorption in children and adults, showing that revision surgery due to ABR was performed earlier in children (p = 0.001, log-rank test). Conclusion Pediatric patients demand specific care when cranioplasty is performed following DC. We identified age as an independent risk factor. The higher number of fragments appears to be a correlation due to the higher number of TBIs in children. Our data indicate that young age is the most important risk factor for the development of ABR as a frequent and early complication with a shorter revision-free time interval in children. Consequently, the uncritical use of cryopreserved autologous bone flaps should be questioned in this population.

scholarly journals Bone Flap Resorption in Pediatric Patients Following Autologous Cranioplasty

2021 ◽  
Author(s):  
David S Hersh ◽  
Hanna J Anderson ◽  
Graeme F Woodworth ◽  
Jonathan E Martin ◽  
Yusuf M Khan
Keyword(s):  
Risk Factors ◽  
Bone Resorption ◽  
Decompressive Craniectomy ◽  
Pediatric Patients ◽  
Bone Flap ◽  
Calvarial Bone ◽  
Advantages And Disadvantages ◽  
Bone Flap Resorption ◽  
Autologous Bone

Abstract Following a decompressive craniectomy, the autologous bone flap is generally considered the reconstructive material of choice in pediatric patients. Replacement of the original bone flap takes advantage of its natural biocompatibility and the associated low risk of rejection, as well as the potential to reintegrate with the adjacent bone and subsequently grow with the patient. However, despite these advantages and unlike adult patients, the replaced calvarial bone is more likely to undergo delayed bone resorption in pediatric patients, ultimately requiring revision surgery. In this review, we describe the materials that are currently available for pediatric cranioplasty, the advantages and disadvantages of autologous calvarial replacement, the incidence and classification of bone resorption, and the clinical risk factors for bone flap resorption that have been identified to date.

scholarly journals Cranial autologous bone flap resorption after a cranioplasty: A case report

2018 ◽  
Vol 9 (1) ◽  
pp. 61 ◽  
Author(s):  
SabrinaA de França ◽  
ThalesB Nepomuceno ◽  
WellingsonS Paiva ◽  
AlmirF Andrade ◽  
ManoelJ Teixeira ◽  
...  
Keyword(s):  
Case Report ◽  
Bone Flap ◽  
Bone Flap Resorption ◽  
Autologous Bone

scholarly journals Subcutaneous bone flap storage after emergency craniectomy: cost-effectiveness and rate of resorption

2018 ◽  
Vol 129 (6) ◽  
pp. 1604-1610 ◽  
Author(s):  
Griffin Ernst ◽  
Fares Qeadan ◽  
Andrew P. Carlson
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Bone Resorption ◽  
Decompressive Craniectomy ◽  
Significant Risk ◽  
Bone Flap ◽  
Type I ◽  
Custom Implant ◽  
Autologous Bone ◽  
Clinically Significant

OBJECTIVEDecompressive craniectomy is used for uncontrolled intracranial pressure in traumatic brain injury and malignant hemispheric stroke. Subcutaneous preservation of the autologous bone flap in the abdomen is a simple, portable technique but has largely been abandoned due to perceived concerns of resorption. The authors sought to characterize their experience with subcutaneous preservation of the bone flap and cranioplasty.METHODSThe authors performed a retrospective single-institution review of subcutaneous preservation of the autologous bone flap after decompressive craniectomy from 2005 to 2015. The primary outcome was clinically significant bone resorption, defined as requiring a complete mesh implant at the time of cranioplasty, or delayed revision. The outcome also combined cases with any minor bone resorption to determine predictors of this outcome. Logistic regression modeling was used to determine the risk factors for predicting resorption. A cost comparison analysis was also used via the 2-sided t-test to compare the cost of cranioplasty using an autologous bone flap with standard custom implant costs.RESULTSA total of 193 patients with craniectomy were identified, 108 of whom received a cranioplasty. The mean time to cranioplasty was 104.31 days. Severe resorption occurred in 10 cases (9.26%): 4 were clinically significant (2 early and 2 late) and 6 demonstrated type II (severe) necrosis on CT, but did not require revision. Early resorption of any kind (mild or severe) occurred in 28 (25.93%) of 108 cases. Of the 108 patients, 26 (24.07%) required supplemental cranioplasty material. Late resorption of any kind (mild or severe) occurred in 6 (5.88%) of 102 cases. Of these, a clinically noticeable but nonoperative deformity was noted in 4 (3.92%) and minor (type I) necrosis on CT in 37 (37%) of 100. Bivariate analysis identified fragmentation of bone (OR 3.90, 95% CI 1.03–14.8), shunt-dependent hydrocephalus (OR 7.97, 95% CI 1.57–40.46), and presence of post-cranioplasty drain (OR 9.39, 95% CI 1.14–1000) to be significant risk factors for bone resorption. A binary logistic regression optimized using Fisher’s scoring determined the optimal multivariable combination of factors. Fragmentation of bone (OR 5.84, 95% CI 1.38–28.78), diabetes (OR 7.61, 95% CI 1.37–44.56), and shunt-dependent hydrocephalus (OR 9.35, 95% CI 1.64–56.21) were found to be most predictive of resorption, with a C value of 0.78. Infections occurred in the subcutaneous pocket in 5 (2.60%) of the 193 cases and after cranioplasty in 10 (9.26%) of the 108 who underwent cranioplasty. The average cost of cranioplasty with autologous bone was $2156.28 ± $1144.60 (n = 15), and of a custom implant was $35,118.60 ± $2067.51 (3 different sizes; p < 0.0001).CONCLUSIONSCraniectomy with autologous bone cranioplasty using subcutaneous pocket storage is safe and compares favorably to cryopreservation in terms of resorption and favorably to a custom synthetic implant in terms of cost. While randomized data are required to definitively prove the superiority of one method, subcutaneous preservation has enough practical advantages with low risk to warrant routine use for most patients.

scholarly journals Self-Reported Complications after Tonsillectomy: Comparison of Responders and Nonresponders to a Mailed Questionnaire

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Rolf Haye ◽  
Liv Kari Døsen ◽  
Caryl Gay ◽  
Magnus TarAngen ◽  
Olga Shiryaeva
Keyword(s):  
Hospital Readmission ◽  
Pediatric Patients ◽  
Response Rate ◽  
Response Rates ◽  
Private Practitioner ◽  
Adult Patients ◽  
Complication Rates ◽  
Private Practitioners ◽  
Telephone Interviews ◽  
Total Response Rate

Some studies of tonsillectomy outcomes have low response rates to mailed quality control questionnaires. This study evaluated the effect of nonresponders to mailed questionnaires about posttonsillectomy complications by determining whether mail responders and nonresponders differ. Questionnaires were mailed to patients 3–6 weeks after tonsillectomy to assess postoperative complications, defined as contact with a private practitioner and/or hospital readmission related to postsurgical bleeding, pain, or infection. Nonresponders to the mailed questionnaire were interviewed by telephone 7–11 weeks postoperatively, and responses of mail and telephone responders were compared. Of 818 patients undergoing tonsillectomy during the study period, 66.3% responded by mail, and 29.5% were interviewed by telephone, for a total response rate of 95.7%. The mail response rate was significantly higher among parents of pediatric patients than among adult patients (71.4% versus 58.7%, p<0.001). In the pediatric group, overall complication rates were 65% higher among mail responders than telephone responders (20.9% versus 12.7%, p=0.049), likely due to their higher rates of both visits to private practitioners and infection, as there were no differences in rates of pediatric readmission, bleeding, or pain between the responder groups. Among adult patients, mail and telephone responders did not differ with respect to their overall complication rate (40.9% versus 34.1%, p=0.226) or their rates of readmission or bleeding. However, similar to the pediatric group, visits to a private practitioner were slightly more common among adult mail responders than telephone responders (30.6% versus 21.1%, p=0.065), as were reports of pain (p=0.001) and infection (p=0.006). Studies relying on mailed questionnaires with low response rates likely overestimate the rate of minor complications handled outside the hospital, but rates of major complications involving readmission are unlikely to be seriously biased by low response rates. Supplementing mailed questionnaires with telephone interviews may increase the validity of surgical outcome studies.

scholarly journals Predictors of primary autograft cranioplasty survival and resorption after craniectomy

2019 ◽  
Vol 130 (5) ◽  
pp. 1672-1679 ◽  
Author(s):  
Tommi K. Korhonen ◽  
Sami Tetri ◽  
Jukka Huttunen ◽  
Antti Lindgren ◽  
Jaakko M. Piitulainen ◽  
...  
Keyword(s):  
Removal Rate ◽  
Bone Flap ◽  
University Hospitals ◽  
Neurosurgical Procedure ◽  
Factors Affecting ◽  
Bone Flap Resorption ◽  
Multicenter Cohort ◽  
Younger Age ◽  
Autologous Bone

OBJECTIVECraniectomy is a common neurosurgical procedure that reduces intracranial pressure, but survival necessitates cranioplasty at a later stage, after recovery from the primary insult. Complications such as infection and resorption of the autologous bone flap are common. The risk factors for complications and subsequent bone flap removal are unclear. The aim of this multicenter, retrospective study was to evaluate the factors affecting the outcome of primary autologous cranioplasty, with special emphasis on bone flap resorption.METHODSThe authors identified all patients who underwent primary autologous cranioplasty at 3 tertiary-level university hospitals between 2002 and 2015. Patients underwent follow-up until bone flap removal, death, or December 31, 2015.RESULTSThe cohort comprised 207 patients with a mean follow-up period of 3.7 years (SD 2.7 years). The overall complication rate was 39.6% (82/207), the bone flap removal rate was 19.3% (40/207), and 11 patients (5.3%) died during the follow-up period. Smoking (OR 3.23, 95% CI 1.50–6.95; p = 0.003) and age younger than 45 years (OR 2.29, 95% CI 1.07–4.89; p = 0.032) were found to independently predict subsequent autograft removal, while age younger than 30 years was found to independently predict clinically relevant bone flap resorption (OR 4.59, 95% CI 1.15–18.34; p = 0.03). The interval between craniectomy and cranioplasty was not found to predict either bone flap removal or resorption.CONCLUSIONSIn this large, multicenter cohort of patients with autologous cranioplasty, smoking and younger age predicted complications leading to bone flap removal. Very young age predicted bone flap resorption. The authors recommend that physicians extensively inform their patients of the pronounced risks of smoking before cranioplasty.

scholarly journals Efektifitas Antibiotik Pasien Demam Tifoid RSUP Dr. M. Djamil Padang

2019 ◽  
Vol 2 (2) ◽  
pp. 13-28
Author(s):  
Ayu Rahmawati ◽  
Husni Muchtar ◽  
Hansen Nasif
Keyword(s):  
Typhoid Fever ◽  
Pediatric Patients ◽  
Descriptive Analysis ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Adult Patients ◽  
Cross Sectional ◽  
Length Of Treatment ◽  
Number Of Patients ◽  
Analysis Design

To find out the effectiveness of antibiotics in typhoid fever patients at the SMF of Pediatric and SMF in Internal Medicine Dr. RSUP M. Djamil Padang. This study was a cross-sectional study with a retrospective type of data during 2012 and prospective from June to September 2013, with a descriptive analysis design. The number of patients who met the inclusion criteria were 11 patients. Percentage of antibiotic use in adult patients for ceftriaxone (60%) and chloramphenicol (40%). The percentage of antibiotic use in pediatric patients for ceftriaxone, chloramphenicol, and cefixim are 60%, 27%, and 13%, respectively. Fever free for ceftriaxone and chloramphenicol in pediatric and adult patients, each of which is 2-3 days and 4-6 days; 3-4 days and 4 days. To be free of cefixime fever in pediatric patients is 2 days. The length of treatment required is ceftriaxone and chloramphenicol (children and adults) antibiotics, 6 - 13 days and 9-13, respectively; 11-14 and 7 days. For the duration of cefixime antibiotic treatment for children is 13 days. The results of this study indicate that antibiotics that are used effectively against typhoid fever patients are seen from the time of free of fever and length of stay.

Near-Total Bone Flap Resorption following Autologous Bone Cranioplasty in a Child

2015 ◽  
Vol 51 (2) ◽  
pp. 109-110 ◽  
Author(s):  
Prasad Krishnan ◽  
Rajaraman Kartikueyan ◽  
Siddhartha Roychowdhury
Keyword(s):  
Bone Flap ◽  
Bone Flap Resorption ◽  
Autologous Bone

A Clinical Trial of VVR Rate in Preoperative Autologous Blood Donation by Adults and Pediatrics Patients with or without IV Fluid Infusion.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4112-4112
Author(s):  
Sumiko Kobayashi ◽  
Norihiro Sato ◽  
Satoshi Hashino ◽  
Takeshi Kondo ◽  
Takao Koike
Keyword(s):  
Risk Factor ◽  
Pediatric Patients ◽  
Blood Donation ◽  
Autologous Blood ◽  
Adult Patients ◽  
Autologous Blood Donation ◽  
Preoperative Autologous Blood Donation ◽  
Fluid Infusion ◽  
Infusion Group ◽  
Significant Difference

Abstract Background: There are no reports that compared with or without a simultaneous IV infusion in the autologous blood donation of adult patients and pediatric patients in the incidence of vasovagal reactions (VVR) rate. These reactions may decrease return donation and disrupt blood donation activities. Objectives:The purpose of our study is whether we can take autologous blood donation safely from the both groups of adults patients and pediatric patients. To determine whether a IV fluid infusion is required during the autologous blood donation in both of adult and pediatric patients and whether a IV infusion influences the incidence of VVR rate. Study design and Methods: Since 1999, a total of the 922patients (1,654 times donations) were enrolled including 40 pediatric patients: we investigated two groups such as with or without IV infusion. In pediatric patients, their original diseases were almost based on orthopedic disorders. We used exactly same size needle (17.5gage) to the adult and pediatric groups. Results: Ten of 394 times donations in 244 adults patients with the IV infusion group were shown in VVR (2.5%). The other group who had not taken an IV infusion in 375 times donation of 164 adult patients had 1.8% incidence rate of VVR (seven of 375 times donations) during autologous blood donation. There was no significant difference between with or without IV infusion groups of adults. In pediatric patients, one of the ten patients with IV infusion group occurred 10% of VVR and 3 of 30 times donations of without IV infusion occurred same percentage of incident rate (10%). We also investigated what is the risk factor of VVR in pediatric patients. What is the risk factor of pediatric patients? The result was that low hemoglobin data (mean 12.7g/dl vs 14.0g/dl) before donation and below 40kg were high risk groups in VVR incidence (P&lt;0.01). Conclusion: Our study shows that there is no significant change between with or without IV fluid infusion in both groups of patients of adults or pediatrics in autologous blood donation before operations. Therefore it is useful that it can be done safely without IV prevention for VVR, particularly in cases of pediatrics patients.

Single-Incision Video-Assisted Thoracic Surgery for an Extralobar Sequestration in a Child

2016 ◽  
Vol 11 (1) ◽  
pp. 64-66 ◽  
Author(s):  
Semih Halezeroğlu ◽  
Erdal Okur ◽  
Gökhan Ergene
Keyword(s):  
Thoracic Surgery ◽  
Pediatric Patients ◽  
Single Incision ◽  
English Literature ◽  
Adult Patients ◽  
Thoracic Cavity ◽  
Video Assisted Thoracic Surgery ◽  
Video Assisted ◽  
Number Of Patients ◽  
Extralobar Sequestration

Uniportal or single-incision video-assisted thoracic surgery (VATS) has been performed successfully in adult patients with different intrathoracic pathologies for years. However, no report in uniportal/single-incision VATS in pediatric patients in the English literature has been published up to date. This may be explained by the limited number of patients and the difficulties in working in very narrow thoracic cavity of babies and children. For these reasons, all the published cases of VATS for extralobar sequestration in infants or children were performed through the three-port approach. We report herein a case of single-incision VATS in a child for the resection of an extralobar sequestration.

scholarly journals Evaluation of Home Medication Reconciliation by Clinical Pharmacists for Adult and Pediatric Cystic Fibrosis Patients

Pharmacy ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 91
Author(s):  
Jessica Louie ◽  
Lisa Hong ◽  
Lisa Garavaglia ◽  
Denise Pinal ◽  
Catherine O’Brien
Keyword(s):  
Cystic Fibrosis ◽  
Medication Reconciliation ◽  
Pediatric Patients ◽  
The United States ◽  
Cross Sectional Study ◽  
Adult Patients ◽  
Care Process ◽  
Cross Sectional ◽  
Clinical Pharmacists ◽  
Number Of Patients

Medication reconciliation is an important aspect of a patient’s care process that is ideally performed by clinical pharmacists. Despite literature supporting this process in other patient populations, cystic fibrosis (CF) lacks research in this area. To address this, we designed a retrospective, multi-centered, non-controlled, cross-sectional study at four CF Foundation-accredited centers in the United States to evaluate the medication reconciliation process for adult and pediatric CF patients by documenting the number of home medications reconciled by clinical pharmacists and the number of patients with home medications that did not align with the current CF guidelines published in 2013. There were 105 adult patients and 72 pediatric patients included in the study analysis with a mean number of medications reconciled by clinical pharmacists of 17.4 (standard deviation (SD) 6.7) for adults and 13 (SD 4.6) for pediatric patients. The mean number of discrepancies from guidelines per patient was 1.61 (SD 1.2) for adult patients and 0.63 (SD 0.9) for pediatric patients. Pharmacists play an essential role in identifying and managing medication interactions and further research is necessary to investigate pharmacist impact on medication reconciliation.

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