Survival after surgery for spinal metastatic disease: a nationwide multiregistry cohort study

ObjectivesTo evaluate survival after surgery and indications for surgery due to spinal metastatic disease.DesignA retrospective longitudinal multiregistry nationwide cohort study.Setting19 public hospitals in Sweden with spine surgery service, where 6 university hospitals account for over 90% of the cases.Participants1820 patients 18 years or older undergoing surgery due to spinal metastatic disease 2006–2018 and registered in Swespine, the Swedish national spine surgery registry.InterventionsDecompressive and/or stabilising spine surgery due to spinal metastatic disease.Primary outcomeSurvival (median and mean) after surgery.Secondary outcomesIndications for surgery, types of surgery and causes of death.ResultsThe median estimated survival after surgery was 6.2 months (95% CI: 5.6 to 6.8) and the mean estimated survival time was 12.2 months (95% CI: 11.4 to 13.1). Neurologic deficit was the most common indication for surgery and posterior stabilisation was performed in 70.5% of the cases. A neoplasm was stated as the main cause of death for 97% of the patients.ConclusionBoth median and mean survival times were well above the generally accepted thresholds for surgical treatment for spinal metastases, suggesting that patient selection for surgical treatment on a national level is adequate. Further research on quality of life after surgery and prognostication is needed.

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Metastatic Spine Disease: Should Patients With Short Life Expectancy Be Denied Surgical Care? An International Retrospective Cohort Study

Neurosurgery ◽

10.1093/neuros/nyz472 ◽

2019 ◽

Vol 87 (2) ◽

pp. 303-311 ◽

Cited By ~ 4

Author(s):

Nicolas Dea ◽

Anne L Versteeg ◽

Arjun Sahgal ◽

Jorrit-Jan Verlaan ◽

Raphaële Charest-Morin ◽

...

Keyword(s):

Quality Of Life ◽

Cohort Study ◽

Surgical Treatment ◽

Life Expectancy ◽

Performance Status ◽

Spinal Metastases ◽

Post Treatment ◽

Baseline Performance ◽

Significant Difference

Abstract BACKGROUND Despite our inability to accurately predict survival in many cancer patients, a life expectancy of at least 3 mo is historically necessary to be considered for surgical treatment of spinal metastases. OBJECTIVE To compare health-related quality of life (HRQOL) in patients surviving <3 mo after surgical treatment to patients surviving >3 mo to assess the validity of this inclusion criteria. METHODS Patients who underwent surgery for spinal metastases between August 2013 and May 2017 were retrospectively identified from an international cohort study. HRQOL was evaluated using generic and disease-specific outcome tools at baseline and at 6 and 12 wk postsurgery. The primary outcome was the HRQOL at 6 wk post-treatment measured by the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ). RESULTS A total of 253 patients were included: 40 patients died within the first 3 mo after surgery and 213 patients survived more than 3 mo. Patients surviving <3 mo after surgery presented with lower baseline performance status. Adjusted analyses for baseline performance status did not reveal a significant difference in HRQOL between both groups at 6 wk post-treatment. No significant difference in patient satisfaction at 6 wk with regard to their treatment could be detected between both groups. CONCLUSION When controlled for baseline performance status, quality of life 6 wk after surgery for spinal metastasis is independent of survival. To optimize improvement in HRQOL for this patient population, baseline performance status should take priority over expected survival in the surgical decision-making process.

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Gender Disparities in Surgical Treatment of Axis Fractures in Older Adults

Global Spine Journal ◽

10.1177/2192568219890573 ◽

2019 ◽

Vol 11 (1) ◽

pp. 71-75

Author(s):

Michael P. Catalino ◽

Brice A. Kessler ◽

Virginia Pate ◽

Drew Cutshaw ◽

Til Stürmer ◽

...

Keyword(s):

Cohort Study ◽

Surgical Treatment ◽

Spine Surgery ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

International Classification Of Diseases ◽

Population Based ◽

Gender Disparity ◽

Gender Disparities ◽

Secondary Outcome

Study Design: Retrospective cohort study. Objectives: Gender appears to play in important role in surgical outcomes following acute cervical spine trauma, with current literature suggesting males have a significantly higher mortality following spine surgery. However, no well-adjusted population-based studies of gender disparities in incidence and outcomes of spine surgery following acute traumatic axis injuries exist to our knowledge. We hypothesized that females would receive surgery less often than males, but males would have a higher 1-year mortality following isolated traumatic axis fractures. Methods: We performed a retrospective cohort study using Medicare claims data that identified US citizens aged 65 and older with ICD-9 (International Classification of Diseases, Ninth Revision) code diagnosis corresponding to isolated acute traumatic axis fracture between 2007 and 2014. Our primary outcome was defined as cumulative incidence of surgical treatment, and our secondary outcome was 1-year mortality. Propensity weighted analysis was performed to balance covariates between genders. Our institutional review board approved the study (IRB #16-0533). Results: There was no difference in incidence of surgery between males and females following acute isolated traumatic axis fractures (7.4 and 7.5 per 100 fractures, respectively). Males had significantly higher 1-year weighted mortality overall (41.7 and 28.9 per 100 fractures, respectively, P < .001). Conclusion: Our well-adjusted data suggest there was no significant gender disparity in incidence of surgical treatment over the study period. The data also support previous observations that males have worse outcomes in comparison to females in the setting of axis fractures and spinal trauma regardless of surgical intervention.

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Quality of life and cost-utility of surgical treatment for patients with spinal metastases: prospective cohort study

International Orthopaedics ◽

10.1007/s00264-017-3463-9 ◽

2017 ◽

Vol 41 (6) ◽

pp. 1265-1271 ◽

Cited By ~ 3

Author(s):

Shingo Miyazaki ◽

Kenichiro Kakutani ◽

Yoshitada Sakai ◽

Yasuo Ejima ◽

Koichiro Maeno ◽

...

Keyword(s):

Quality Of Life ◽

Cohort Study ◽

Surgical Treatment ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Spinal Metastases ◽

Cost Utility

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4-year follow-up of ultrasound-based diagnosis and non-surgical treatment of developmental dysplasia of the hip in mongolia: a prospective cohort study

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/s-0036-1587724 ◽

2016 ◽

Vol 37 (S 01) ◽

Cited By ~ 1

Author(s):

T Baumann ◽

B Munkhuu ◽

B Chuluunbaatar ◽

R Schmid ◽

S Essig

Keyword(s):

Cohort Study ◽

Surgical Treatment ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Developmental Dysplasia ◽

Dysplasia Of The Hip ◽

Non Surgical Treatment

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Influenza Vaccine Effectiveness in Preventing Severe Outcomes in Patients Hospitalized with Laboratory-Confirmed Influenza during the 2017–2018 Season. A Retrospective Cohort Study in Catalonia (Spain)

Viruses ◽

10.3390/v13081465 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1465

Author(s):

Lesly Acosta ◽

Nuria Soldevila ◽

Nuria Torner ◽

Ana Martínez ◽

Xavier Ayneto ◽

...

Keyword(s):

Cohort Study ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Vaccine Effectiveness ◽

Public Hospitals ◽

Categorical Variables ◽

Type B ◽

Icu Admission

Seasonal influenza is a common cause of hospital admission, especially in older people and those with comorbidities. The objective of this study was to determine influenza vaccine effectiveness (VE) in preventing intensive care admissions and shortening the length of stay (LOS) in hospitalized laboratory-confirmed influenza cases (HLCI) in Catalonia (Spain). A retrospective cohort study was carried out during the 2017–2018 season in HLCI aged ≥18 years from 14 public hospitals. Differences in means and proportions were assessed using a t-test or a chi-square test as necessary and the differences were quantified using standardized effect measures: Cohen’s d for quantitative and Cohen’s w for categorical variables. Adjusted influenza vaccine effectiveness in preventing severity was estimated by multivariate logistic regression where the adjusted VE = (1 − adjusted odds ratio) · 100%; adjustment was also made using the propensity score. We analyzed 1414 HLCI aged ≥18 years; 465 (33%) were vaccinated, of whom 437 (94%) were aged ≥60 years, 269 (57.8%) were male and 295 (63.4%) were positive for influenza type B. ICU admission was required in 214 (15.1%) cases. There were 141/1118 (12.6%) ICU admissions in patients aged ≥60 years and 73/296 (24.7%) in those aged <60 years (p < 0.001). The mean LOS and ICU LOS did not differ significantly between vaccinated and unvaccinated patients. There were 52/465 (11.2%) ICU admissions in vaccinated cases vs. 162/949 (17.1%) in unvaccinated cases. Patients admitted to the ICU had a longer hospital LOS (mean: 22.4 [SD 20.3] days) than those who were not (mean: 11.1 [SD 14.4] days); p < 0.001. Overall, vaccination was associated with a lower risk of ICU admission. Taking virus types A and B together, the estimated adjusted VE in preventing ICU admission was 31% (95% CI 1–52; p = 0.04). When stratified by viral type, the aVE was 40% for type A (95% CI -11–68; p = 0.09) and 25% for type B (95% CI -18–52; p = 0.21). Annual influenza vaccination may prevent ICU admission in cases of HLCI. A non-significantly shorter mean hospital stay was observed in vaccinated cases. Our results support the need to increase vaccination uptake and public perception of the benefits of influenza vaccination in groups at a higher risk of hospitalization and severe outcomes.

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Characteristics, Natural Evolution and Surgical Treatment Outcomes of Unilateral Laryngeal Paralysis versus Ankylosis: a Longitudinal Cohort Study

Clinical Otolaryngology ◽

10.1111/coa.13792 ◽

2021 ◽

Author(s):

Quentin Lisan ◽

Florent Couineau ◽

Ollivier Laccourreye

Keyword(s):

Cohort Study ◽

Surgical Treatment ◽

Treatment Outcomes ◽

Longitudinal Cohort Study ◽

Natural Evolution ◽

Longitudinal Cohort ◽

Laryngeal Paralysis

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Prospective cohort study of surgical outcome for spinal metastases in patients aged 70 years or older

The Bone & Joint Journal ◽

10.1302/0301-620x.102b12.bjj-2020-0566.r1 ◽

2020 ◽

Vol 102-B (12) ◽

pp. 1709-1716

Author(s):

Yutaro Kanda ◽

Kenichiro Kakutani ◽

Yoshitada Sakai ◽

Takashi Yurube ◽

Shingo Miyazaki ◽

...

Keyword(s):

Quality Of Life ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Spinal Metastases ◽

Palliative Surgery ◽

Advanced Age ◽

Health State ◽

Survival Times ◽

The Mean

Aims With recent progress in cancer treatment, the number of advanced-age patients with spinal metastases has been increasing. It is important to clarify the influence of advanced age on outcomes following surgery for spinal metastases, especially with a focus on subjective health state values. Methods We prospectively analyzed 101 patients with spinal metastases who underwent palliative surgery from 2013 to 2016. These patients were divided into two groups based on age (< 70 years and ≥ 70 years). The Eastern Cooperative Oncology Group (ECOG) performance status (PS), Barthel index (BI), and EuroQol-5 dimension (EQ-5D) score were assessed at study enrolment and at one, three, and six months after surgery. The survival times and complications were also collected. Results In total, 65 patients were aged < 70 years (mean 59.6 years; 32 to 69) and 36 patients were aged ≥ 70 years (mean 75.9 years; 70 to 90). In both groups, the PS improved from PS3 to PS1 by spine surgery, the mean BI improved from < 60 to > 80 points, and the mean EQ-5D score improved from 0.0 to > 0.7 points. However, no significant differences were found in the improvement rates and values of the PS, BI, and EQ-5D score at any time points between the two groups. The PS, BI, and EQ-5D score improved throughout the follow-up period in approximately 90% of patients in each group. However, the improved PS, BI, and EQ-5D scores subsequently deteriorated in some patients, and the redeterioration rate of the EQ-5D was significantly higher in patients aged ≥ 70 than < 70 years (p = 0.027). Conclusion Palliative surgery for spinal metastases improved the PS, activities of daily living, and quality of life, regardless of age. However, clinicians should be aware of the higher risk of redeterioration of the quality of life in advanced-age patients. Cite this article: Bone Joint J 2020;102-B(12):1709–1716.

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Switching antifibrotics in patients with idiopathic pulmonary fibrosis: a multi-center retrospective cohort study

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01587-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yuzo Suzuki ◽

Kazutaka Mori ◽

Yuya Aono ◽

Masato Kono ◽

Hirotsugu Hasegawa ◽

...

Keyword(s):

Cohort Study ◽

Propensity Score ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Disease Progression ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Survival Times ◽

Antifibrotic Therapy ◽

Median Period

Abstract Background Currently, there are two antifibrotics used to treat idiopathic pulmonary fibrosis (IPF): pirfenidone and nintedanib. Antifibrotics slow disease progression by reducing the annual decline of forced vital capacity (FVC), which possibly improves outcomes in IPF patients. During treatment, patients occasionally switch antifibrotic treatments. However, prognostic implication of changing antifibrotics has not yet been evaluated. Methods This multi-center retrospective cohort study examined 262 consecutive IPF patients who received antifibrotic therapy. Antifibrotic agents were switched in 37 patients (14.1%). The prognoses were compared between the patient cohort that switched antifibrotics (Switch-IPF) and those without (Non-Switch-IPF) using propensity-score matched analyses. Results The median period between the initiation of antifibrotic therapy and the drug switch was 25.8 (12.7–35.3) months. The most common reasons for the switch were disease progression (n = 17) followed by gastrointestinal disorders (n = 12). Of the 37 patients that switched antifibrotics, only eight patients disrupted switched antifibrotics by their adverse reactions. The overall prognosis of the Switch-IPF cohort was significantly better than the Non-Switch-IPF cohort (median periods: 67.2 vs. 27.1 months, p < 0.0001). In propensity-score matched analyses that were adjusted to age, sex, FVC (%), history of acute exacerbation, and usage of long-term oxygen therapy, the Switch-IPF cohort had significantly longer survival times than the Non-Switch-IPF group (median 67.2 vs. 41.3 months, p = 0.0219). The second-line antifibrotic therapy showed similar survival probabilities than those in first-line antifibrotic therapy in multistate model analyses. Conclusion Switching antifibrotics is feasible and may improve prognosis in patients with IPF. A further prospective study will be required to confirm clinical implication of switching the antifibrotics.

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Regular Use of VKA Prior to COVID-19 Associated with Lower 7-Day Survival in Hospitalized Frail Elderly COVID-19 Patients: The GERIA-COVID Cohort Study

Nutrients ◽

10.3390/nu13010039 ◽

2020 ◽

Vol 13 (1) ◽

pp. 39

Author(s):

Pierre Ménager ◽

Olivier Brière ◽

Jennifer Gautier ◽

Jérémie Riou ◽

Guillaume Sacco ◽

...

Keyword(s):

Cohort Study ◽

Vitamin K ◽

Frail Elderly ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Clinical Severity ◽

Survival Times ◽

Short Term Mortality

Background. Vitamin K concentrations are inversely associated with the clinical severity of COVID-19. The objective of this cohort study was to determine whether the regular use of vitamin K antagonist (VKA) prior to COVID-19 was associated with short-term mortality in frail older adults hospitalized for COVID-19. Methods. Eighty-two patients consecutively hospitalized for COVID-19 in a geriatric acute care unit were included. The association of the regular use of VKA prior to COVID-19 with survival after 7 days of COVID-19 was examined using a propensity-score-weighted Cox proportional-hazards model accounting for age, sex, severe undernutrition, diabetes mellitus, hypertension, prior myocardial infarction, congestive heart failure, prior stroke and/or transient ischemic attack, CHA2DS2-VASc score, HAS-BLED score, and eGFR. Results. Among 82 patients (mean ± SD age 88.8 ± 4.5 years; 48% women), 73 survived COVID-19 at day 7 while 9 died. There was no between-group difference at baseline, despite a trend for more frequent use of VKA in those who did not survive on day 7 (33.3% versus 8.2%, p = 0.056). While considering “using no VKA” as the reference (hazard ratio (HR) = 1), the HR for 7-day mortality in those regularly using VKA was 5.68 [95% CI: 1.17; 27.53]. Consistently, COVID-19 patients using VKA on a regular basis had shorter survival times than the others (p = 0.031). Conclusions. Regular use of VKA was associated with increased mortality at day 7 in hospitalized frail elderly patients with COVID-19.

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