Preoperative ODI and Intake of Analgesics Predict Outcome after Lumbar Microdiskectomy: Results from a Prospective Register

2021 ◽  
Author(s):  
Yessika De Leon Benito Revollo ◽  
Hermien Atassi ◽  
Javier Fandino ◽  
Jenny C. Kienzler
Keyword(s):  
Linear Regression Analysis ◽  
Information Criterion ◽  
Leg Pain ◽  
Neurosurgical Procedures ◽  
Medication Usage ◽  
Lumbar Disk Herniation ◽  
Score Following ◽  
Multivariable Linear Regression Analysis ◽  
Degree Of Disability ◽  
Radicular Symptoms

Abstract Background Lumbar disk herniation (LDH) typically causes leg pain and neurologic deficits, but can also be a source of low back pain (LBP). Lumbar microdiskectomy (LMD) is among the most common neurosurgical procedures to relieve radicular symptoms. It is important for both surgeon and patient to understand potential predictors of outcome after LMD. The aim of this study was to investigate if the presence and intensity of preoperative LBP, the ODI score, and analgesic intake can predict the outcome of patients undergoing LMD. Methods This is a single-center retrospective study based on the analysis of prospectively acquired data of patients in the SwissDisc Registry. A total of 685 surgeries on 640 patients who underwent standardized LMD at our institution to treat LDH were included in this study. We performed multivariable linear regression analysis to determine preoperative predictors for patient outcomes based on the Oswestry Disability Index (ODI) scores, recorded on average 39.77 (±33.77) days after surgery. Results Our study confirmed that surgery overall improves patient degree of disability as measured by ODI score. Following model selection using Aikake Information Criterion (AIC), we observed that higher preoperative ODI scores (β: 0.020 [95% CI: 0.008 to 0.031]) and higher number of analgesic medication usage by patients prior to surgery (β: 0.236 [95% CI: 0.057 to 0.415]) were both associated with an increased postoperative ODI score. Conclusion LDH surgery generally improves patient degree of disability. The analysis of patients with a high preoperative ODI score and increased intake of analgesics before surgery predicted a worsening of patients' disability after LMD in this subgroup.

Application of a Targeted and Quantificational Foraminoplasty Device in Percutaneous  Transforaminal Endoscopic Discectomy for L5-S1 Disc Herniation: Preliminary Clinical Outcomes

2021 ◽  
Author(s):  
Jinlong Liu ◽  
Junlong wu ◽  
Honglei Zhang ◽  
Rui Zuo ◽  
Jiabin Liu ◽  
...  
Keyword(s):  
Leg Pain ◽  
Fluoroscopy Time ◽  
Low Back ◽  
Disk Herniation ◽  
Lumbar Disk Herniation ◽  
Lumbar Disk ◽  
Vas Score ◽  
Endoscopic Discectomy ◽  
Percutaneous Transforaminal Endoscopic Discectomy

Abstract ObjectivePercutaneous transforaminal endoscopic discectomy (PTED) is minimally invasive and has been widely used to treat patients with lumbar disk herniation(LDH) due to its safety and efficiency. However, due to the unique anatomy of the L5-S1 level, the PTED procedure is often difficult to perform in the region. ZESSYS, a targeted and quantificational foraminoplasty device, may help to overcome these anatomical limitations. In this study, we assessed the efficiency and the short-term effects of PTED with ZESSY at the L5-S1 level.MethodsBetween January to August of 2018, Fifty-six patients with lumbar disk herniation at the single level of L5–S1 and underwent percutaneous transforaminal endoscopic discectomy were enrolled in this retrospective cohort study. They were segregated into the the TESSYS group and the ZESSYS group. The puncture time, foraminoplasty time, decompression time and fluoroscopy time evaluated for the operation efficiency. Clinical outcomes were assessed by visual analog scale(VAS) score and Oswestry Disability Index(ODI) score. The MacNab criteria were used to evaluate patient subjective satisfaction at 12-month follow-up postoperatively.ResultsThe average puncture time (5.29±2.05 minutes), foraminoplasty time (12.82±2.52 minutes) and fluoroscopy time (26.29±5.96 seconds) were all significantly shorter in the ZESSYS group than in the TESSYS group (average puncture time 8.07±3.13 minutes, p<0.01; foraminoplasty time, 17.18±2.92 minutes, p<0.01; fluoroscopy time, 34.73±6.86 seconds; p<0.01). No significant differences were observed between the 2 groups in the decompression time (p=0.057). The VAS score of low back pain and leg pain, as well as the ODI score, improved at all time points postoperatively compared with preoprative , in both the TESSYS group and the ZESSYS group (P < 0.05). There were no significant differences in the VAS score of low back pain, VAS score of leg pain, and ODI score between the TESSYS group and the ZESSYS group at the same time points (P > 0.05). According to the MacNab criteria, the excellent and good rate at 12-month follow-up postoperatively was 85.7% in the TESSYS group and 89.3% in the ZESSYS group (P > 0.05).ConclusionThe targeted and quantificational foraminoplasty device named ZESSYS was more efficient in the puncture and foraminoplasty procedures, effectively protecting the exiting nerve and minimizing the level of radiation exposure. The device is efficient and safe for PTED in treating lumbar disk herniation at the L5-S1 level.

scholarly journals Costs of Hospitalisation Due to Stroke: Linked Registry and Administrative Clinical Costing Study

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Joosup Kim
Keyword(s):  
Length Of Stay ◽  
Disease Burden ◽  
Linear Regression Analysis ◽  
Quality Data ◽  
Clinical Registry ◽  
Costing Study ◽  
Multivariable Linear Regression Analysis ◽  
Hospital Administrative ◽  
Mean Cost ◽  
Administrative Datasets

IntroductionRoutine clinical costing of hospital care provided for a representative sample of patients informs a national price for hospital reimbursement according to the diagnosis related group of a patient. These clinical costing data are available for linkage as part of hospital administrative datasets. Objectives and ApproachThe Australian Stroke Clinical Registry (AuSCR) is a national data collection program used to monitor the quality of care provided to patients who have been hospitalised with a clinical diagnosis of stroke or transient ischaemic attack (TIA). For the Stroke123 project, registrants from the Australian Stroke Clinical Registry in 2009-2013 were linked to hospital administrative datasets in four states (Victoria, Queensland, New South Wales and Western Australia). Clinical costing data were obtained for the cohort in Queensland only. Using these clinical costing data, we aimed to determine the costs of hospitalisations according to clinical and demographic characteristics of patients. Reliability of clinical costing data were tested by assessing the association with disease burden and length of stay using multivariable linear regression analysis. ResultsOf the 5522 patient episodes (from 23 hospitals), clinical costing data were available for 3909 (71%, from 22 hospitals). Patients with clinical costing data were more often aged <65 years (30% vs 24%, p<0.001) and more often male (56% vs 49%, p<0.001) than those without these data. Mean cost of an episode was $12,129. Episodes of intracerebral haemorrhage had a mean cost of $18,315, which was greater than the mean costs of ischaemic stroke ($13,925), TIA ($5,247) and undetermined stroke ($8,996). Greater costs were associated with greater disease burden according to the Charlson Comorbidity Index (p<0.001) and length of stay (p<0.001). Conclusion / ImplicationsIntegration of clinical quality data and costs will enable more holistic assessment and monitoring of the effects of quality improvement initiatives and therapeutic advances.

scholarly journals Factors Affecting Birthweight Decline in Recent Japan Based on Birth Certificates

2020 ◽  
Author(s):  
Noriko Kato ◽  
Catherine Sauvaget ◽  
Honami Yoshida ◽  
Tetsuji Yokoyama ◽  
Nobuo Yoshiike
Keyword(s):  
Birth Order ◽  
Gestational Age ◽  
Maternal Diet ◽  
Linear Regression Analysis ◽  
Vital Statistics ◽  
Birth Certificates ◽  
Factors Affecting ◽  
New Information ◽  
Multivariable Linear Regression Analysis ◽  
Birth Records

Abstract Background:Birthweight is declining consistently for more than 30 years in Japan. Rapid rise in low birth weight infant counts one of the worst among OECD countries.Objective: To add new information for clarifying the factors associated with the decline in birthweight in Japan.Methods: Government vital statistics records were used under permission. 40,968,266 birth records born between 1980 and 2004 were analyzed. Multivariable linear regression analysis was used to examine whether the decline in the birthweight could be explained by obstetrical variables such as gestational age and plurality.Results: From 1980 to 2004, we observed a decline in mean birthweight with yearly effect of -8.07g, which got steeper after 1985 and persisted until 1999, and plateaued thereafter. After adjustment for gestational age, neonatal gender, birth order, plurality, father age, yearly effect became -5.13g, between 1980 and 2004. Conclusion：Recent decreases in birthweight among Japanese neonates were not fully explained by trends of gestational age, sex, birth order, plurality and father age. We should consider additional factors such as pre-pregnant maternal BMI and maternal diet.

scholarly journals Analysis of an overlapping surgery policy change on costs in a high-volume neurosurgical department

2019 ◽  
Vol 131 (3) ◽  
pp. 903-910 ◽  
Author(s):  
Jian Guan ◽  
Michael Karsy ◽  
Andrea A. Brock ◽  
William T. Couldwell ◽  
John R. W. Kestle ◽  
...  
Keyword(s):  
Policy Change ◽  
Linear Regression Analysis ◽  
Hospital Costs ◽  
Medical Community ◽  
Neurosurgical Procedures ◽  
Multivariate Linear Regression Analysis ◽  
Neurosurgical Department ◽  
Total Hospital ◽  
Entire Cohort ◽  
Significant Difference

OBJECTIVEOverlapping surgery remains a controversial topic in the medical community. Although numerous studies have examined the safety profile of overlapping operations, there are few data on its financial impact. The authors assessed direct hospital costs associated with neurosurgical operations during periods before and after a more stringent overlapping surgery policy was implemented.METHODSThe authors retrospectively reviewed the records of nonemergency neurosurgical operations that took place during the periods from June 1, 2014, to October 31, 2014 (pre–policy change), and from June 1, 2016, to October 31, 2016 (post–policy change), by any of the 4 senior neurosurgeons authorized to perform overlapping cases during both periods. Cost data as well as demographic, surgical, and hospitalization-related variables were obtained from an institutional tool, the Value-Driven Outcomes database.RESULTSA total of 625 hospitalizations met inclusion criteria for cost analysis; of these, 362 occurred prior to the policy change and 263 occurred after the change. All costs were reported as a proportion of the average total hospitalization cost for the entire cohort. There was no significant difference in mean total hospital costs between the prechange and postchange period (0.994 ± 1.237 vs 1.009 ± 0.994, p = 0.873). On multivariate linear regression analysis, neither the policy change (p = 0.582) nor the use of overlapping surgery (p = 0.273) was significantly associated with higher total hospital costs.CONCLUSIONSA more restrictive overlapping surgery policy was not associated with a reduction in the direct costs of hospitalization for neurosurgical procedures.

The Association of Atherosclerotic Cardiovascular Disease and Statin Use With Inflammation and Treatment Outcomes in Tuberculosis

2021 ◽  
Author(s):  
Vignesh Chidambaram ◽  
Jennie Ruelas Castillo ◽  
Amudha Kumar ◽  
Justin Wei ◽  
Siqing Wang ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Linear Regression Analysis ◽  
Elevated Serum ◽  
University Hospital ◽  
Sputum Smear ◽  
Atherosclerotic Cardiovascular Disease ◽  
All Cause Mortality ◽  
Multivariable Linear Regression Analysis ◽  
Related Mortality ◽  
Statin Use

Abstract Objective: Tuberculosis (TB) and atherosclerotic cardiovascular disease (ASCVD) have a close epidemiological and pathogenetic overlap. Thus, it becomes essential to understand the relationship between ASCVD and TB outcomes.Methods:From our retrospective cohort on drug-susceptible TB patients at the National Taiwan University Hospital, we assessed the association of pre-existing ASCVD (coronary artery disease (CAD) and atherothrombotic stroke (ATS)) with 9-month all-cause and infection-related mortality and the extent of mediation by systemic inflammatory markers. We determined the effect of pre-existing ASCVD on 2-month sputum microbiological status. Among ASCVD patients, we assessed the association of statin use on mortality.Results:Nine-month all-cause mortality was higher in CAD patients with prior acute myocardial infarction (CAD+AMI+) (adjusted HR 2.01, 95%CI 1.38-3.00) and ATS patients (aHR 2.79, 95%CI 1.92-4.07) and similarly, for infection-related mortality was higher in CAD+AMI+ (aHR 1.95, 95%CI 1.17-3.24) and ATS (aHR 2.04, 95%CI 1.19-3.46) after adjusting for confounding factors. Pre-existing CAD (AMI- or AMI+) or ATS did not change sputum culture conversion or sputum smear AFB positivity at 2 months. The CAD+AMI+ group had significantly higher levels of CRP at TB diagnosis in the multivariable linear regression analysis (Adjusted B(SE) 1.24(0.62)). CRP mediated 66% (p=0.048) and 25% (p=0.033) of the association all-cause mortality with CAD+AMI- and CAD+AMI+, respectively. ConclusionsIn summary, patients with ASCVD have higher hazards of 9-month all-cause and infection-related mortality, with elevated serum inflammation mediating one to three-quarters of this association when adjusted for confounders. Statin use was associated with lower all-cause mortality among patients with ASCVD.

scholarly journals Effect of Number of Clinics and Panel Size on Patient Continuity for Medical Residents

2009 ◽  
Vol 1 (2) ◽  
pp. 310-315 ◽  
Author(s):  
Maureen D. Francis ◽  
Whitney E. Zahnd ◽  
Andrew Varney ◽  
Steven L. Scaife ◽  
Mark L. Francis
Keyword(s):  
Regression Analysis ◽  
Linear Regression ◽  
Linear Regression Analysis ◽  
Medical Residents ◽  
Panel Size ◽  
Medical Education Program ◽  
Internal Medicine Residency Training ◽  
Multivariable Linear Regression Analysis ◽  
Linear Regression Modeling ◽  
Attending Physician

Abstract Background Accreditation Council for Graduate Medical Education program requirements for internal medicine residency training include a longitudinal, continuity experience with a panel of patients. Objective To determine whether the number of resident clinics, the resident panel size, and the supervising attending physician affect patient continuity. To determine the number of clinics and the panel size necessary to maximize patient continuity. Design We used linear regression modeling to assess the effect of number of attended clinics, the panel size, and the attending physician on patient continuity. Participants Forty medicine residents in an academic medicine clinic. Measurements Percent patient continuity by the usual provider of care method. Results Unadjusted linear regression analysis showed that patient continuity increased 2.3% ± 0.7% for each additional clinic per 9 weeks or 0.4% ± 0.1% for each additional clinic per year (P  =  .003). Conversely, patient continuity decreased 0.7% ± 0.4% for every additional 10 patients in the panel (P  =  .04). When simultaneously controlling for number of clinics, panel size, and attending physician, multivariable linear regression analysis showed that patient continuity increased 3.3% ± 0.5% for each additional clinic per 9 weeks or 0.6% ± 0.1% for each additional clinic per year (P &lt; .001). Conversely, patient continuity decreased 2.2% ± 0.4% for every additional 10 patients in the panel (P &lt; .001). Thus, residents who actually attend at least 1 clinic per week with a panel size less than 106 patients can achieve 50% patient continuity. Interestingly, the attending physician accounted for most of the variability in patient continuity (51%). Conclusions Patient continuity for residents significantly increased with increasing numbers of clinics and decreasing panel size and was significantly influenced by the attending physician.

scholarly journals A Stepwise Logistic Regression Analysis: An application toward Poultry Farm Data in Johor

2018 ◽  
Vol 7 (3.28) ◽  
pp. 68
Author(s):  
Siti Afiqah Muhamad Jamil ◽  
Mohd Asrul Affendi Abdullah ◽  
Kek Sie Long ◽  
Nur Fazilla Mohd Jupri ◽  
Mustafa Mamat
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Linear Regression Analysis ◽  
Information Criterion ◽  
Stepwise Logistic Regression ◽  
Ratio Test ◽  
Poultry Farm ◽  
Omnibus Test ◽  
Stepwise Logistic Regression Analysis ◽  
Spss Software

The aims of this study are to fit a logistic regression model towards the fly problem in a farm and to identify the variables that are associated with the fly problem in a poultry farm. By using SPSS software, this study used ‘FORWARD STEPWISE’ and ‘BACKWARD STEPWISE’ methods to perform the analysis. Compared to linear regression analysis, logistic regression does not require rigorous assumptions to be met. This study used Likelihood Ratio test, Omnibus test and Hosmer and Lemeshow test to validate and to test the fit of poultry farm data. Akaike Information Criterion (AIC) is calculated to observe the difference between the methods of stepwise used by SPSS software in this study. As a result, logistic regression is fit towards poultry farm data by a stepwise procedure. BACKWARD STEPWISE seems to be more suitable for conducting the stepwise method of analysis. Besides, variables that influence the problem of fly in a poultry are the wasps, distance and number of flies. 

scholarly journals Clinic Design and Continuity in Internal Medicine Resident Clinics: Findings of the Educational Innovations Project Ambulatory Collaborative

2015 ◽  
Vol 7 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Maureen D. Francis ◽  
Mark L. Wieland ◽  
Sean Drake ◽  
Keri Lyn Gwisdalla ◽  
Katherine A. Julian ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Linear Regression Analysis ◽  
Internal Medicine Resident ◽  
Cross Sectional Study ◽  
Analysis Of Covariance ◽  
Block Model ◽  
Cross Sectional ◽  
Educational Innovations ◽  
Medicine Resident ◽  
Multivariable Linear Regression Analysis

Abstract Background Many internal medicine (IM) programs have reorganized their resident continuity clinics to improve trainees' ambulatory experience. Downstream effects on continuity of care and other clinical and educational metrics are unclear. Methods This multi-institutional, cross-sectional study included 713 IM residents from 12 programs. Continuity was measured using the usual provider of care method (UPC) and the continuity for physician method (PHY). Three clinic models (traditional, block, and combination) were compared using analysis of covariance. Multivariable linear regression analysis was used to analyze the effect of practice metrics and clinic model on continuity. Results UPC, reflecting continuity from the patient perspective, was significantly different, and was highest in the block model, midrange in combination model, and lowest in the traditional model programs. PHY, reflecting continuity from the perspective of the resident provider, was significantly lower in the block model than in combination and traditional programs. Panel size, ambulatory workload, utilization, number of clinics attended in the study period, and clinic model together accounted for 62% of the variation found in UPC and 26% of the variation found in PHY. Conclusions Clinic model appeared to have a significant effect on continuity measured from both the patient and resident perspectives. Continuity requires balance between provider availability and demand for services. Optimizing this balance to maximize resident education, and the health of the population served, will require consideration of relevant local factors and priorities in addition to the clinic model.

Percutaneous Endoscopic Interlaminar Unilateral Ventral Dural Approach for Symptomatic Bilateral L5–S1 Herniated Nucleus Pulposus: Technical Note

2018 ◽  
Vol 79 (06) ◽  
pp. 518-523 ◽  
Author(s):  
Sung Choi ◽  
Nitin Adsul ◽  
Ki Kim ◽  
Jeong Kim ◽  
Sung Chung ◽  
...  
Keyword(s):  
Nucleus Pulposus ◽  
Lower Limb ◽  
Leg Pain ◽  
Limb Pain ◽  
Lumbar Disk Herniation ◽  
Interlaminar Approach ◽  
Lower Limb Pain ◽  
Bilateral Lower Limb ◽  
Herniated Nucleus Pulposus

Background Percutaneous endoscopic lumbar diskectomy is a good treatment modality for lumbar disk herniation. However, when a patient complains of bilateral lower limb radicular pain with severe disk protrusion at the L5–S1 level, the transforaminal approach is often unable to resolve both lesions owing to anatomical limitations. It is also very difficult to resolve both lesions in an ipsilateral direction using the percutaneous interlaminar approach. We report our surgical technique and clinical results using a ventral dural approach of percutaneous endoscopic interlaminar lumbar diskectomy for L5–S1 herniated nucleus pulposus (HNP) in patients with bilateral radiculopathy due to a severe disk protrusion. Methods Twenty-seven patients with severe L5–S1 HNP complaining of back pain and bilateral lower limb pain were included in the study. The unilateral ventral dural approach of percutaneous full endoscopic interlaminar lumbar diskectomy technique was used. The visual analog scale (VAS) and Macnab criteria were used for clinical evaluation. All assessments were completed 1 day before surgery, 1 week after surgery, 6 months after surgery, and at final follow-up after surgery. Results The mean preoperative back and leg pain VAS scores decreased from 5.67 ± 0.78 and 7.81 ± 0.83 to 2.44 ± 0.58 and 2.26 ± 0.53 at 1 week, 1.78 ± 0.51 and 1.52 ± 0.58 at 6 months, and 1.56 ± 0.70 and 1.67 ± 0.96, respectively, at the final follow-up after surgery. With respect to the Macnab criteria, 51.85% of the results were excellent, 44.44% were good, and 3.70% were fair. Four cases recurred: three patients underwent conservative treatment and one patient operated with percutaneous endoscopic interlaminar lumbar diskectomy. Conclusion According to the results of this study, the ventral dural approach of percutaneous full endoscopic interlaminar lumbar diskectomy in patients with L5–S1 HNP associated with bilateral lower limb pain due to a severely protruded HNP is a good option for a minimally invasive surgical approach.

scholarly journals Association between Urinary Triclosan and Serum Testosterone Levels in U.S. Adult Males from NHANES, 2011–2012

2020 ◽  
Vol 17 (20) ◽  
pp. 7412 ◽  
Author(s):  
Judy Yan ◽  
Michael A. Joseph ◽  
Simone A. Reynolds ◽  
Laura A. Geer
Keyword(s):  
Endocrine Disruptor ◽  
Linear Regression Analysis ◽  
Serum Testosterone ◽  
Adult Males ◽  
Comprehensive Understanding ◽  
Testosterone Levels ◽  
Adult Men ◽  
Health And Nutrition ◽  
Multivariable Linear Regression Analysis ◽  
Over Time

Triclosan was introduced into the market in the 1970s and has since been used as an antimicrobial agent in a diverse array of consumer and personal care products. Although it has been widely used over a number of years, there is growing concern and debate over its safety and efficacy and its potential as an endocrine disruptor. Although prior animal toxicology studies have shown an association between triclosan and decreased testosterone levels, human studies have been limited, particularly for adult men. Using the National Health and Nutrition Examination Survey data (NHANES, 2011–2012), we examined the association of urinary triclosan on testosterone levels in adult men 18–65 years of age. Multivariable linear regression analysis failed to show an association between triclosan and serum testosterone (β = 0.0003, p = 0.98, 95% CI = −0.024, 0.025). The results suggest there is no association or that triclosan concentrations are too low to cause a significant impact on testosterone levels. Additionally, longitudinal studies would provide a more comprehensive understanding of the direction of change and magnitude of causal relationships over time.

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