Histologic Remission Is Associated With Lower Risk of Treatment Failure in Patients With Crohn Disease in Endoscopic Remission

Abstract Background Although achieving histologic remission in ulcerative colitis is established, the incremental benefit of achieving histologic remission in patients with Crohn disease (CD) treated to a target of endoscopic remission is unclear. We evaluated the risk of treatment failure in patients with CD in clinical and endoscopic remission by histologic activity status. Methods In a single-center retrospective cohort study, we identified adults with active CD who achieved clinical and endoscopic remission through treatment optimization. We evaluated the risk of treatment failure (composite of clinical flare requiring treatment modification, hospitalization, and/or surgery) in patients who achieved histologic remission vs persistent histologic activity through Cox proportional hazard analysis. Results Of 470 patients with active CD, 260 (55%) achieved clinical and endoscopic remission with treatment optimization; 215 patients with histology were included (median age, 33 years; 46% males). Overall, 132 patients (61%) achieved histologic remission. No baseline demographic, disease, or treatment factor was associated with achieving histologic remission. Over a 2-year follow-up, patients with CD in clinical and endoscopic remission who achieved histologic remission experienced a 43% lower risk of treatment failure (1-year cumulative risk: 12.9% vs 18.2%; adjusted hazard ratio, 0.57 [95% confidence interval, 0.35-0.94]) as compared with persistent histologic activity. Conclusions Approximately 61% of patients with active CD who achieved clinical and endoscopic remission with treatment optimization simultaneously achieved histologic remission, which was associated with a lower risk of treatment failure. Whether histologic remission should be a treatment target in CD requires evaluation in randomized trials.

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P2756Risk of stroke subsequent to infective endocarditis: a nationwide study

European Heart Journal ◽

10.1093/eurheartj/ehz748.1073 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Ostergaard ◽

N W Andersson ◽

S L Kristensen ◽

A Dahl ◽

H Bundgaard ◽

...

Keyword(s):

Infective Endocarditis ◽

Hazard Analysis ◽

Cumulative Risk ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

Cerebral Embolization ◽

Study Population ◽

Recurrent Strokes ◽

Time Periods

Abstract Background Patients with infective endocarditis (IE) are at high risk of cerebral embolization, however little is known about the risk of stroke subsequent to IE in patients with stroke during IE admission. Purpose To investigate the risk of stroke after discharge of IE in patients with stroke during IE admission compared with patients without stroke during IE admission. Methods Using Danish nationwide registries we identified non-surgically treated patients with IE discharged alive, in the period 1996–2016. The study population was grouped in 1) patients with stroke during IE admission and 2) patients without stroke during IE admission. Crude cumulative risk of stoke were calculated using the Aalen-Johansen estimator accounting for death as a competing risk. Multivariable adjusted Cox proportional hazard analysis was used to compare the associated risk of stroke between groups. We identified differentials in the associated risk of stroke during follow-up between groups (p=0.006 for interaction with time), and follow-up was split into 0–1 year and 1–5 years time periods. Results We identified 4,284 patients with IE, 239 patients (5.6%) with stroke during IE admission (median age: 71.9 years, 58.2% males), and 4,045 patients (94.4%) without stroke during IE admission (median age 69.7 years, 64.8% males). The crude cumulative risk of stroke within 1 year of follow-up is shown in Figure Panel A, and with 1 to 5 years of follow-up in Figure Panel B. In multivariable adjusted analyses, the associated risk of stroke was higher in patients with stroke during IE admission within a follow-up period of 1 year, HR 3.21 (95% CI: 1.66–6.20) compared with patients without stroke during IE admission. From 1 to 5 years of follow-up, we identified no difference in the associated risk of stroke between groups, HR 0.91 (95% CI: 0.33–2.50). Cumulative incidence of stroke Conclusion Non-surgically treated patients with IE who had a stroke during IE admission were at significantly higher associated risk of subsequent stroke – although not significant beyond 1 year after discharge from IE. These findings underline the need for identification of causes and mechanisms of recurrent strokes after IE to develop preventive means.

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Lower Risk for Dementia Following Adult Tetanus, Diphtheria and Pertussis (Tdap) Vaccination

The Journals of Gerontology Series A ◽

10.1093/gerona/glab115 ◽

2021 ◽

Author(s):

Jeffrey F Scherrer ◽

Joanne Salas ◽

Timothy L Wiemken ◽

Christine Jacobs ◽

John E Morley ◽

...

Keyword(s):

Lower Risk ◽

Protective Effects ◽

Proportional Hazard ◽

Veterans Health ◽

Cox Proportional Hazard ◽

Dementia Risk ◽

Incident Dementia ◽

Nonspecific Effects ◽

Reduce Risk

Abstract Background Adult vaccinations may reduce risk for dementia. However it has not been established whether tetanus, diphtheria, pertussis (Tdap) vaccination is associated with incident dementia. Methods Hypotheses were tested in a Veterans Health Affairs (VHA) cohort and replicated in a MarketScan medical claims cohort. Patients were ≥65 years of age and free of dementia for 2 years prior to index date. Patients either had or did not have a Tdap vaccination by the start of either of two index periods (2011 or 2012). Follow-up continued through 2018. Controls had no Tdap vaccination for the duration of follow-up. Confounding was controlled using entropy balancing. Competing risk (VHA) and Cox proportional hazard (MarketScan) models estimated the association between Tdap vaccination and incident dementia in all patients and in age sub-groups (65-69, 70-74, ≥75 years of age). Results VHA patients were, on average, 75.6 (SD±7.5) years of age, 4% female, and 91.2% were white race. MarketScan patients were 69.8 (SD±5.6) years of age, on average and 65.4% were female. After controlling for confounding, patients with, compared to without Tdap vaccination, had a significantly lower risk for dementia in both cohorts (VHA: HR=0.58; 95%CI:0.54 - 0.63 and MarketScan: HR=0.58; 95%CI:0.48 - 0.70). Conclusions Tdap vaccination was associated with a 42% lower dementia risk in two cohorts with different clinical and sociodemographic characteristics. Several vaccine types are linked to decreased dementia risk, suggesting that these associations are due to nonspecific effects on inflammation rather than vaccine-induced pathogen-specific protective effects.

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Microalbuminuria After Kidney Transplantation Predicts Cardiovascular Morbidity

Frontiers in Medicine ◽

10.3389/fmed.2021.635847 ◽

2021 ◽

Vol 8 ◽

Author(s):

Dana Bielopolski ◽

Ruth Rahamimov ◽

Boris Zingerman ◽

Avry Chagnac ◽

Limor Azulay-Gitter ◽

...

Keyword(s):

Hazard Analysis ◽

Cardiovascular Morbidity ◽

Urine Collection ◽

Proportional Hazard ◽

Cvd Risk ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Cardiovascular Morbidity And Mortality ◽

Independent Association

Background: Microalbuminuria is a well-characterized marker of kidney malfunction, both in diabetic and non-diabetic populations, and is used as a prognostic marker for cardiovascular morbidity and mortality. A few studies implied that it has the same value in kidney transplanted patients, but the information relies on spot or dipstick urine protein evaluations, rather than the gold standard of timed urine collection.Methods: We revisited a cohort of 286 kidney transplanted patients, several years after completing a meticulously timed urine collection and assessed the prevalence of major cardiovascular adverse events (MACE) in relation to albuminuria.Results: During a median follow up of 8.3 years (IQR 6.4–9.1) 144 outcome events occurred in 101 patients. By Kaplan-Meier analysis microalbuminuria was associated with increased rate of CV outcome or death (p = 0.03), and this was still significant after stratification according to propensity score quartiles (p = 0.048). Time dependent Cox proportional hazard analysis showed independent association between microalbuminuria and CV outcomes 2 years following microalbuminuria detection (HR 1.83, 95% CI 1.07–2.96).Conclusions: Two years after documenting microalbuminuria in kidney transplanted patients, their CVD risk was increased. There is need for primary prevention strategies in this population and future studies should address the topic.

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Molecular Response After 3 Months of 1st Line Imatinib Therapy Is Predictive for Treatment Failure and Disease Progression In Patients with Chronic Phase Chronic Myeloid Leukemia - a Follow-up Analysis of the German CML Study IV

Blood ◽

10.1182/blood.v116.21.360.360 ◽

2010 ◽

Vol 116 (21) ◽

pp. 360-360 ◽

Cited By ~ 2

Author(s):

Benjamin Hanfstein ◽

Martin C. Müller ◽

Philipp Erben ◽

Susanne Schnittger ◽

Susanne Saussele ◽

...

Keyword(s):

Treatment Failure ◽

Disease Progression ◽

Research Funding ◽

Standard Dose ◽

Imatinib Therapy ◽

Molecular Response ◽

Imatinib Treatment ◽

Early Assessment ◽

Risk Of Treatment

Abstract Abstract 360 Introduction: The lack of a sufficient response to first line imatinib treatment has been observed in a substantial proportion of CML patients and has been associated with an inferior survival. Therefore, response criteria have been defined to identify patients with treatment failure. A change of drug therapy to 2nd generation tyrosine kinase inhibitors or allogeneic stem cell transplantation is recommended for this group of patients (European LeukemiaNet, ELN, Baccarani et al., JCO 2009). We sought to evaluate the predictive value of early molecular response landmarks for treatment failure and disease progression to identify patients at risk and to provide a guidance for the interpretation of BCR-ABL levels. Patients and methods: 949 patients included into the randomized German CML Study IV and treated with an imatinib based therapy consisting of standard dose imatinib (400 mg/d), high dose imatinib (800 mg/d) and combinations of standard dose imatinib with low dose cytarabine or interferon alpha were evaluable for molecular and cytogenetic analysis. BCR-ABL (IS) was determined by quantitative RT-PCR. The type of BCR-ABL transcript (b2a2, n=424; b3a2, n=464; b2a2 and b3a2, n=148) was defined by multiplex PCR. Patients with atypical BCR-ABL transcripts were excluded from the analysis. Cytogenetic response (CyR) was determined by G-banding metaphase analyses. Treatment failure has been defined according to ELN criteria as a lack of major CyR after 12 months and a lack of complete CyR after 18 months of imatinib treatment, respectively. CyR data were available for 479 pts between 12 and 18 months with a subset of 289 pts evaluable for 3 month molecular response (CyR data after 18 months, n=532; 3 month molecular subset, n=289). Disease progression comprises the incidence of accelerated phase, blast phase and death. Median follow-up for disease progression was 35 months (range 2–85). Fisher's exact test has been performed to evaluate the prognostic significance of 3 month BCR-ABL landmarks for 12 month and 18 month treatment failure. A landmark analysis has been performed for disease progression (logrank test). Results: In 20 of 289 evaluable pts treatment failure has been observed after 12 months, and in 29 of 289 pts after 18 months. 24 of 570 evaluable pts showed a disease progression after a median of 18 months (range 5–71). A stratification into three groups at 3 months reveals a significant difference concerning treatment failure between pts with BCR-ABL levels between 1% and 10% and those with BCR-ABL levels >10%. With regard to disease progression there is a statistical trend. Comparing two groups the 10% BCR-ABL cut-off is highly significant for both, treatment failure and disease progression. Missing the 10% BCR-ABL landmark after 3 months of imatinib treatment defines a poor risk group with a 20.7% risk of treatment failure after 18 months and a 8.1% risk of disease progression (Table). Conclusion: Early assessment of molecular response after 3 months of imatinib therapy allows the identification of a patient cohort with an increased risk of treatment failure and disease progression. Disclosure: Müller: Novartis Corporation: Honoraria, Research Funding. Schnittger:MLL Munich Leukemia Laboratory: Employment, Equity Ownership. Hochhaus:Novartis Corporation: Honoraria, Research Funding.

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Prognosis of hemodialysis patients with progressive aortic stenosis: a prospective cohort study

Renal Replacement Therapy ◽

10.1186/s41100-021-00367-3 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yoriko Horiguchi ◽

Kaoru Uemura ◽

Naoyoshi Aoyama ◽

Shinichi Nakajima ◽

Tomoki Asai ◽

...

Keyword(s):

Aortic Stenosis ◽

Cardiac Death ◽

Hazard Analysis ◽

Hemodialysis Patients ◽

Proportional Hazard ◽

Cardiac Events ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

All Cause Mortality

Abstract Background Whether progressive mild to moderate aortic stenosis in hemodialysis patients influences their prognosis has not been elucidated. This prospective cohort study explored whether progressive aortic stenosis predicted the rate of cardiac events and mortality in those patients. Methods A total of 283 consecutive hemodialysis patients (no aortic stenosis, 248; progressive aortic stenosis, 35) underwent echocardiography for assessment of aortic stenosis, with a median follow-up period of 4.1 years. Study endpoints were cardiac events, all-cause mortality, and cardiac death. Kaplan–Meier analysis and multivariate Cox proportional hazard analysis were performed to estimate cardiac events, all-cause mortality, and cardiac death. Results Cumulative cardiac event rate, all-cause mortality rate, and the rate of cardiac death at 3-year follow-up were 44.9%, 40.5%, and 26.4% in patients with progressive aortic stenosis and 22.1%, 19.0%, and 7.5% in those without aortic stenosis, respectively. Kaplan–Meier analysis demonstrated the cumulative rates of cardiac events and all-cause mortality. And cardiac death was significantly higher in patients with progressive aortic stenosis than in those without aortic stenosis. Multivariate Cox proportional hazard analysis revealed that progressive aortic stenosis was predictive of cardiac events (adjusted hazard ratio 2.47; 95% confidence interval 1.38–4.39) and cardiac death (adjusted hazard ratio 4.21; 95% confidence interval 2.10–8.46). Age, physical activity, C-reactive protein, and serum albumin levels—but not progressive aortic stenosis—predicted all-cause mortality. Conclusions The rates of cardiac events and cardiac death were higher in hemodialysis patients with progressive aortic stenosis than in those without aortic stenosis. Furthermore, progressive aortic stenosis predicted cardiac events and cardiac death. Compared with those without aortic stenosis, patients with progressive aortic stenosis had higher all-cause mortality, which was related to their comorbidities. Trial registration This study was retrospectively registered with University Hospital Medical Information Network Clinical Trials Registry (registration number, UMIN 000024023) at September 12th, 2016.

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Relationship between social support status and mortality in a community-based population: a prospective observational study (Yamagata study)

10.21203/rs.3.rs-32367/v4 ◽

2020 ◽

Author(s):

Tsutomu Uzuki ◽

Tsuneo Konta ◽

Ritsuko Saito ◽

Ri Sho ◽

Tsukasa Osaki ◽

...

Keyword(s):

Social Support ◽

Social Relationships ◽

Cardiovascular Mortality ◽

Prospective Observational Study ◽

Hazard Analysis ◽

Vital Role ◽

Proportional Hazard ◽

Community Based ◽

Cox Proportional Hazard

Abstract Background: Social support, defined as the exchange of support in social relationships, plays a vital role in maintaining healthy behavior and mitigating the effects of stressors. This study investigated whether functional aspect of social support is related to 5-year mortality in health checkup participants.Methods: This study recruited 16,651 subjects (6,797 males, 9,854 females). Social support was evaluated using five-component questions: Do you have someone 1) whom you can consult when you are in trouble? 2) whom you can consult when your physical condition is not good? 3) who can help you with daily homework? 4) who can take you to hospital when you don't feel well? and 5) who can take care of you when you are ill in bed? The association between the component of social support and all-cause and cardiovascular mortality was examined using Cox proportional hazard analysis.Results: The percentage of subjects without social support components was 7.7%-15.0%. They were more likely to be male, non-elderly, and living alone. During the follow-up period, there were 166 all-cause and 38 cardiovascular deaths. Cox proportional analysis adjusted for confounders showed that only the lack of support for transportation to hospital was significantly associated with all-cause (hazard ratio [HR] 2.01, 95% confidence interval [CI] 1.26-3.05) and cardiovascular mortality (HR 3.30, 95% CI 1.41-6.87). These associations were stronger in males than females.Conclusion: This study showed that the lack of social support for transportation to the hospital was independently associated with all-cause and cardiovascular mortality in a community-based population.

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Relationship between social support status and mortality in a community-based population: a prospective observational study (Yamagata study)

10.21203/rs.3.rs-32367/v3 ◽

2020 ◽

Author(s):

Tsutomu Uzuki ◽

Tsuneo Konta ◽

Ritsuko Saito ◽

Ri Sho ◽

Tsukasa Osaki ◽

...

Keyword(s):

Social Support ◽

Social Relationships ◽

Cardiovascular Mortality ◽

Prospective Observational Study ◽

Hazard Analysis ◽

Vital Role ◽

Proportional Hazard ◽

Community Based ◽

Cox Proportional Hazard

Abstract Background: Social support, defined as the exchange of support in social relationships, plays a vital role in maintaining healthy behavior and mitigating the effects of stressors. This study investigated whether functional aspect of social support is related to 5-year mortality in health checkup participants. Methods: This study recruited 16,651 subjects (6,797 males, 9,854 females). Social support was evaluated using five-component questions: Do you have someone 1) whom you can consult when you are in trouble? 2) whom you can consult when your physical condition is not good? 3) who can help you with daily homework? 4) who can take you to hospital when you don’t feel well? and 5) who can take care of you when you are ill in bed? The association between the component of social support and all-cause and cardiovascular mortality was examined using Cox proportional hazard analysis. Results: The percentage of subjects without social support components was 7.7%-15.0%. They were more likely to be male, non-elderly, and living alone. During the follow-up period, there were 166 all-cause and 38 cardiovascular deaths. Cox proportional analysis adjusted for confounders showed that only the lack of support for transportation to hospital was significantly associated with all-cause (hazard ratio [HR] 2.01, 95% confidence interval [CI] 1.26-3.05) and cardiovascular mortality (HR 3.30, 95% CI 1.41-6.87). These associations were stronger in males than females. Conclusion: This study showed that the lack of social support for transportation to the hospital was independently associated with all-cause and cardiovascular mortality in a community-based population.

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P908 The novel predictor for mortality in patients with functional mitral regurgitation: the modified MIDA-Score

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.545 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

C Ozturk ◽

U M Becher ◽

A Kalkan ◽

...

Keyword(s):

Left Ventricle ◽

Mitral Regurgitation ◽

Hazard Analysis ◽

Strong Predictor ◽

Cox Proportional Hazard ◽

Sts Score ◽

Long Term Prognosis ◽

Grade 3

Abstract EuroSCORE and STS-Score are used to assess surgical risk in patients with valvular heart diseases. The MIDA- Score has been recently published as a representative predictor for short- and long-term prognosis in patients with degenerative mitral regurgitation (DMR). The adequate assessment of long-term prognosis in patients with functional MR is scarce. We aim to adapt this classical score system for patients with FMR. We retrospectively included 105 patients with FMR who underwent transcatheter mitral regurgitation therapy (TMVR) between January 2014 and August 2016 in our center. Due to the different underlying pathomechanisms of FMR, annular dilatation and impaired left ventricle function, and more elderly patient population we adapted some cut-off values to FMR patients (Age > 65 to Age > 75; LV-EF ≤ 60% to LV-EF ≤ 45%; sPAP≥50mmHg to sPAP≥45mmHg). Moreover, according to Cox proportional hazard analysis of our patient collective we re-calculated the weights of the risk factors: Age 2 points, Symptoms 1 point, atrial fibrillation 2 points, left atrial diameter 1 point, right ventricle systolic pressure 2 points, left ventricle end-systolic diameter 2 points, left ventricle ejection fraction 2 points. We defined three risk groups according to total points from the risk factors; Grade 1 (0-4 points): low risk, Grade 2 (5-9 points): moderate risk, Grade 3 (10-12 points): high risk. We retrospectively included 105 patients (76.7 ± 8.8 years, 50,6% female) with symptomatic (functional NYHA class > II ) moderate-to-severe FMR (PISA: 0.7 ± 0.4cm, VC width: 0.8 ± 0.3cm, EROA: 0.22cm2, RegVol: 38.1 ± 19.2ml) at surgical high risk (EuroSCORE II: 5.4 ± 3.8%, STS-Score: 4.7 ± 2.8%). We found all-cause mortality 7% at one-year follow-up. 34.1% of our collective were hospitalized. The classical MIDA Score was not significantly correlated with mortality and rehospitalization in patients with FMR at follow-up (p = 0.5); however, the modified MIDA score was found to be a strong predictor for mortality and rehospitalization in patients with FMR (AUC: 0.89). According to multivariate analysis, the modified MIDA score was found to be superior compared to the other conventional score systems (The modified MIDA-Score HR: 4.1, p = 0.021; EuroSCORE II; HR: 1.2, p = 0.004, STS-Score; HR: 1.7, p = 0.005). We performed Cox proportional hazard analysis to assess the weighting factor of the predictors. As a result of this, we found age (HR: 2,95, p = 0.03) as the most reliable parameter to predict the combined outcome. The 12,5% of grade 1, 27% grade 2, 57% grade 3 patients showed combined endpoint. According to regression analysis, the modified score >9 points found to be a strong predictor for high mortality and rehospitalization (OR: 3.35, p = 0.011). We found the modified MIDA Score sufficient and extensive to assess outcomes in patients with FMR. The modified MIDA Score offers a sufficient promising tool to predict individual prognosis in patients with FMR.

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Abstract 3737: The Association Between Therapy With Insulin Glargine Versus Nph And The Risk Of Myocardial Infarction In Patients With Type 2 Diabetes

Circulation ◽

10.1161/circ.116.suppl_16.ii_849-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Mikhail Kosiborod ◽

Quanwu Zhang ◽

JoAnne Foody

Keyword(s):

Myocardial Infarction ◽

Type 2 Diabetes ◽

Insulin Glargine ◽

Lower Risk ◽

Administrative Database ◽

Medical Claim ◽

Cox Proportional Hazard ◽

Cox Proportional Hazard Models

Background: Prior studies have demonstrated that insulin glargine produces less hypoglycemia, as compared with NPH. Whether these results translate into better long-term cardiovascular outcomes in patients with Type 2 diabetes is unknown. Methods: Using a national managed care administrative database, we evaluated patients with Type 2 diabetes who were on oral antiglycemic agents within 6 months prior to initiating either insulin glargine (n=15,039) or NPH (n=5,666) and had at least 12 months of subsequent continuous plan enrollment during 03/2001–03/2005. Cox proportional hazard models were used to compare the rate of subsequent myocardial infarction (MI) events (defined by ICD-9 codes) following initiation of glargine vs NPH, after adjusting for demographic characteristics, comorbidities, other medications, insulin adherence and baseline Hemoglobin A1C (A1C). Results: Mean age was 56 years, 49% were women; mean duration of follow up was 24 months. Among patients who had available A1C (n=2514), those in glargine group had higher A1C at baseline vs. NPH (9.3 vs 8.9 respectively, p<0.0001). During the 1 st year following insulin initiation, 8.7% patients in NPH vs. 7.5% in glargine group had at least one medical claim for hypoglycemia (OR=1.17, 95% CI: 1.05–1.31). In unadjusted analysis, the rate of MI events was 4.4% in glargine group vs. 7.7% in the NPH group (p<0.0001). After multivariable adjustment, risk of MI events remained lower in glargine group (HR: 0.78, 95% CI: 0.64–0.95). Although hypoglycemic events were associated with higher MI risk (HR 1.3, 95% CI 1.18–1.44 for each quarter with a medical claim for hypoglycemia during 1 st year of follow up), the association between glargine use and lower risk of MI events remained significant even after adjusting for hypoglycemia (HR: 0.79, 95% CI 0.65–0.96). Conclusion: Initiation of insulin glargine in patients with Type 2 diabetes is associated with lower risk of subsequent MI events, as compared with NPH. Lower rate of hypoglycemia associated with glargine use does not completely account for this difference in outcomes. Further studies are needed to validate these results and provide insights into potential physiologic mechanisms.

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Long-Term Outcomes of Cervical Laminoplasty in the Elderly

BioMed Research International ◽

10.1155/2015/713952 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7 ◽

Cited By ~ 8

Author(s):

Yasushi Oshima ◽

Kota Miyoshi ◽

Yoji Mikami ◽

Hideki Nakamoto ◽

Sakae Tanaka

Keyword(s):

Hazard Analysis ◽

The Elderly ◽

Neurological Status ◽

Cervical Laminoplasty ◽

Long Term Outcomes ◽

Cox Proportional Hazard ◽

Age Related ◽

Upper And Lower Extremities

Incidences of cervical laminoplasty in the elderly are increasing; the influence of other age-related complications and neurological status must be considered for justifying surgery. This study identified the aforementioned influence on long-term outcomes of cervical laminoplasty in patients aged ≥75 years. Thirty-seven of 38 consecutive patients aged ≥75 years who underwent cervical laminoplasty were retrospectively evaluated. Minimum 5-year follow-up was acceptable if patients were complication-free. Follow-up was terminated when neurological evaluation was not possible, owing to death or other serious complications affecting activities of daily living (ADL). Postoperative neurological changes and newly developed severe complications were investigated. Postoperatively, one patient died of acute pneumonia, one remained nonambulatory owing to cerebral infarction, and 35 were ambulatory and were discharged. At a mean follow-up of 78 months, three patients died and nine developed serious complications severely affecting ADL. Of the 25 remaining patients, 23 remained ambulatory at mean follow-up of 105 months. Cox proportional hazard analysis revealed that postoperative motor upper and lower extremities JOA scores of ≤2 and ≤1, respectively, were risk factors for mortality or other severe complications. Postoperative neurological status can be maintained in the elderly if they remain complication-free. Poorer neurological status significantly affected their ADL and mortality.

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