scholarly journals Complications and Risk Factors Using Structural Allograft Versus Synthetic Cage: Analysis 17 783 Anterior Cervical Discectomy and Fusions Using a National Registry

2018 ◽  
Vol 9 (4) ◽  
pp. 388-392 ◽  
Author(s):  
Vadim Goz ◽  
Zorica Buser ◽  
Anthony D’Oro ◽  
Christopher Wang ◽  
S. Tim Yoon ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
National Registry ◽  
Anterior Cervical Discectomy ◽  
Cervical Discectomy ◽  
Structural Allograft ◽  
Classification Of Diseases ◽  
Health Care Database ◽  
International Statistical Classification ◽  
Cage Group

Study Design: Retrospective cohort study. Objective: To determine the rates of perioperative complications in patients undergoing anterior cervical discectomy and fusion (ACDF) with allograft versus synthetic cage. Methods: A large national administrative health care database was queried for ACDF procedures performed between 2007 and 2014 using ICD-9 (International Statistical Classification of Diseases, 9th revision) and CPT (Current Procedural Terminology) codes. Cases that utilized structural allograft and synthetic cages were identified via CPT codes. Gender, age, frequency of obesity, cigarette use, diabetes, and number of levels fused were compared between the 2 cohorts using χ2 test. Complications within 90 days were identified via ICD-9 codes and compared between the 2 cohorts. Revision rates within 2 years were noted. Results: A total of 10 648 ACDF cases using synthetic cages and 7135 ACDFs using structural allograft were identified. The demographics between the 2 cohorts were similar. Overall complication rate was 8.71% in the synthetic cage group compared with 7.76% in the structural allograft group ( P < .01). Use of synthetic cage was associated with higher rate of respiratory complications, 0.57% compared with 0.31% in the structural allograft cohort ( P = .03), while use of structural allograft was associated with a higher rate of dysphagia, 0.64% compared with 0.33% ( P < .01). Revision rate at 2 years was 0.50% and 0.56% in the synthetic cage and allograft groups, respectively ( P = .03). Conclusions: This data suggests that synthetic cages are associated with a marginally higher overall rate of complications with similar revision rates.

scholarly journals Structural Allograft Versus Synthetic Interbody Cage for Anterior Cervical Discectomy and Fusion: A Comparison of 1-Year Outcomes From a National Database

2020 ◽  
pp. 219256822094221 ◽  
Author(s):  
Nandakumar Menon ◽  
Justin Turcotte ◽  
Chad Patton
Keyword(s):  
Propensity Score ◽  
Revision Surgery ◽  
Perioperative Complications ◽  
Anterior Cervical Discectomy ◽  
Research Network ◽  
National Database ◽  
Cervical Discectomy ◽  
Single Level ◽  
Structural Allograft ◽  
Implant Selection

Study Design: Observational cohort study. Objective: To compare 1-year perioperative complications between structural allograft (SA) and synthetic cage (SC) for anterior cervical discectomy and fusion (ACDF) using a national database. Methods: The TriNetX Research Network was retrospectively queried. Patients undergoing initial single or multilevel ACDF surgery between October 1, 2015 and April 30, 2019 were propensity score matched based on age and comorbidities. The rates of 1-year revision ACDF surgery and reported diagnoses of pseudoarthrosis, surgical site infection (SSI), and dysphagia were compared between structural allograft and synthetic cage techniques. Results: A comparison of 1-year outcomes between propensity score matched cohorts was conducted on 3056 patients undergoing single-level ACDF and 3510 patients undergoing multilevel ACDF. In single-level ACDF patients, there was no difference in 1-year revision ACDF surgery ( P = .573), reported diagnoses of pseudoarthrosis ( P = .413), SSI ( P = .620), or dysphagia ( P = .529) between SA and SC groups. In multilevel ACDF patients, there was a higher rate of revision surgery (SA 3.8% vs SC 7.3%, odds ratio = 1.982, P < .001) in the SC group, and a higher rate of dysphagia in the SA group (SA 15.9% vs SC 12.9%). Conclusion: While the overall revision and complication rate for single-level ACDF remains low despite interbody graft selection, SC implant selection may result in higher rates of revision surgery in multilevel procedures despite yielding lower rates of dysphagia. Further prospective study is warranted.

Die Wirksamkeit eines Frühinterventionsprogramms für Jugendliche mit Computerspiel- und Internetabhängigkeit: Mittelfristige Effekte der PROTECT+ Studie

2020 ◽  
Vol 48 (1) ◽  
pp. 3-14 ◽  
Author(s):  
Carolin Szász-Janocha ◽  
Eva Vonderlin ◽  
Katajun Lindenberg
Keyword(s):  
Internet Use ◽  
Health Problems ◽  
Reliable Change Index ◽  
Gaming Disorder ◽  
Statistical Classification ◽  
Reliable Change ◽  
Classification Of Diseases ◽  
International Statistical Classification

Zusammenfassung. Fragestellung: Das junge Störungsbild der Computerspiel- und Internetabhängigkeit hat in den vergangenen Jahren in der Forschung zunehmend an Aufmerksamkeit gewonnen. Durch die Aufnahme der „Gaming Disorder“ in die ICD-11 (International Statistical Classification of Diseases and Related Health Problems) wurde die Notwendigkeit von evidenzbasierten und wirksamen Interventionen avanciert. PROTECT+ ist ein kognitiv-verhaltenstherapeutisches Gruppentherapieprogramm für Jugendliche mit Symptomen der Computerspiel- und Internetabhängigkeit. Die vorliegende Studie zielt auf die Evaluation der mittelfristigen Effekte nach 4 Monaten ab. Methodik: N = 54 Patientinnen und Patienten im Alter von 9 bis 19 Jahren (M = 13.48; SD = 1.72) nahmen an der Frühinterventionsstudie zwischen April 2016 und Dezember 2017 in Heidelberg teil. Die Symptomschwere wurde zu Beginn, zum Abschluss der Gruppentherapie sowie nach 4 Monaten anhand von standardisierten Diagnostikinstrumenten erfasst. Ergebnisse: Mehrebenenanalysen zeigten eine signifikante Reduktion der Symptomschwere anhand der Computerspielabhängigkeitsskala (CSAS) nach 4 Monaten. Im Selbstbeurteilungsbogen zeigte sich ein kleiner Effekt (d = 0.35), im Elternurteil ein mittlerer Effekt (d = 0.77). Der Reliable Change Index, der anhand der Compulsive Internet Use Scale (CIUS) berechnet wurde, deutete auf eine starke Heterogenität im individuellen Symptomverlauf hin. Die Patientinnen und Patienten bewerteten das Programm zu beiden Follow-Up-Messzeitpunkten mit einer hohen Zufriedenheit. Schlussfolgerungen: Die vorliegende Arbeit stellt international eine der wenigen Studien dar, die eine Reduktion der Symptome von Computerspiel- und Internetabhängigkeit im Jugendalter über 4 Monate belegen konnte.

Nonunion Rates After Anterior Cervical Discectomy and Fusion: Comparison of Polyetheretherketone vs Structural Allograft Implants

Neurosurgery ◽  
2021 ◽  
Author(s):  
Won Hyung A Ryu ◽  
Dominick Richards ◽  
Mena G Kerolus ◽  
Adewale A Bakare ◽  
Ryan Khanna ◽  
...  
Keyword(s):  
Smoking Status ◽  
Posterior Instrumentation ◽  
Patient Reported Outcome ◽  
Anterior Cervical Discectomy ◽  
Successful Outcome ◽  
Cervical Discectomy ◽  
Structural Allograft ◽  
Modifiable Factors ◽  
Patient Reported ◽  
The Impact

Abstract BACKGROUND Although advances in implant materials, such as polyetheretherketone (PEEK), have been developed aimed to improve outcome after anterior cervical discectomy and fusion (ACDF), it is essential to confirm whether these changes translate into clinically important sustained benefits. OBJECTIVE To compare the radiographic and clinical outcomes of patients undergoing up to 3-level ACDF with PEEK vs structural allograft implants. METHODS In this cohort study, radiographic and symptomatic nonunion rates were compared in consecutive patients who underwent 1 to 3 level ACDF with allograft or PEEK implant. Prospectively collected clinical data and patient-reported outcome (PRO) scores were compared between the allograft and PEEK groups. Regression analysis was performed to determine the predictors of nonunion. RESULTS In total, 194 of 404 patients met the inclusion criteria (79% allograft vs 21% PEEK). Preoperative demographic variables were comparable between the 2 groups except for age. The rate of radiographic nonunion was higher with PEEK implants (39% vs 27%, P = .0035). However, a higher proportion of nonunion in the allograft cohort required posterior instrumentation (14% vs 3%, P = .039). Patients with multilevel procedures and PEEK implants had up to 5.8 times the risk of radiographic nonunion, whereas younger patients, active smokers, and multilevel procedures were at higher risk of symptomatic nonunion. CONCLUSION Along with implant material, factors such as younger age, active smoking status, and the number of operated levels were independent predictors of fusion failure. Given the impact of nonunion on PRO, perioperative optimization of modifiable factors and surgical planning are essential to ensure a successful outcome.

scholarly journals Application of MRI for the Diagnosis of Neoplasms

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Ewa Bejer-Oleńska ◽  
Michael Thoene ◽  
Andrzej Włodarczyk ◽  
Joanna Wojtkiewicz
Keyword(s):  
Benign Neoplasms ◽  
Young Males ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
Mri Scans ◽  
International Statistical Classification ◽  
The Central Nervous System ◽  
Spss Software ◽  
The Brain

Aim. The aim of the study was to determine the most commonly diagnosed neoplasms in the MRI scanned patient population and indicate correlations based on the descriptive variables. Methods. The SPSS software was used to determine the incidence of neoplasms within the specific diagnoses based on the descriptive variables of the studied population. Over a five year period, 791 patients and 839 MRI scans were identified in neoplasm category (C00-D48 according to the International Statistical Classification of Diseases and Related Health Problems ICD-10). Results. More women (56%) than men (44%) represented C00-D48. Three categories of neoplasms were recorded. Furthermore, benign neoplasms were the most numerous, diagnosed mainly in patients in the fifth decade of life, and included benign neoplasms of the brain and other parts of the central nervous system. Conclusions. Males ≤ 30 years of age with neoplasms had three times higher MRI scans rate than females of the same age group; even though females had much higher scans rate in every other category. The young males are more often selected for these scans if a neoplasm is suspected. Finally, the number of MRI-diagnosed neoplasms showed a linear annual increase.

scholarly journals Anterior cervical discectomy and fusion performed using structural allograft or polyetheretherketone: pseudarthrosis and revision surgery rates with minimum 2-year follow-up

2020 ◽  
Vol 32 (4) ◽  
pp. 562-569
Author(s):  
Minghao Wang ◽  
Dean Chou ◽  
Chih-Chang Chang ◽  
Ankit Hirpara ◽  
Yilin Liu ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Plate Fixation ◽  
Anterior Cervical Discectomy ◽  
Anterior Plate ◽  
Cervical Discectomy ◽  
Posterior Surgery ◽  
Structural Allograft ◽  
Significant Difference ◽  
Surgery Rates

OBJECTIVEBoth structural allograft and PEEK have been used for anterior cervical discectomy and fusion (ACDF). There are reports that PEEK has a higher pseudarthrosis rate than structural allograft. The authors compared pseudarthrosis, revision, subsidence, and loss of lordosis rates in patients with PEEK and structural allograft.METHODSThe authors performed a retrospective review of patients who were treated with ACDF at their hospital between 2005 and 2017. Inclusion criteria were adult patients with either PEEK or structural allograft, anterior plate fixation, and a minimum 2-year follow-up. Exclusion criteria were hybrid PEEK and allograft cases, additional posterior surgery, adjacent corpectomies, infection, tumor, stand-alone or integrated screw and cage devices, bone morphogenetic protein use, or lack of a minimum 2-year follow-up. Demographic variables, number of treated levels, interbody type (PEEK cage vs structural allograft), graft packing material, pseudarthrosis rates, revision surgery rates, subsidence, and cervical lordosis changes were collected. These data were analyzed by Pearson’s chi-square test (or Fisher’s exact test, according to the sample size and expected value) and Student t-test.RESULTSA total of 168 patients (264 levels total, mean follow-up time 39.5 ± 24.0 months) were analyzed. Sixty-one patients had PEEK, and 107 patients had structural allograft. Pseudarthrosis rates for 1-level fusions were 5.4% (PEEK) and 3.4% (allograft) (p > 0.05); 2-level fusions were 7.1% (PEEK) and 8.1% (allograft) (p > 0.05); and ≥ 3-level fusions were 10% (PEEK) and 11.1% (allograft) (p > 0.05). There was no statistical difference in the subsidence magnitude between PEEK and allograft in 1-, 2-, and ≥ 3-level ACDF (p > 0.05). Postoperative lordosis loss was not different between cohorts for 1- and 2-level surgeries.CONCLUSIONSIn 1- and 2-level ACDF with plating involving the same number of fusion levels, there was no statistically significant difference in the pseudarthrosis rate, revision surgery rate, subsidence, and lordosis loss between PEEK cages and structural allograft.

scholarly journals Zmiany kryteriów w diagnozowaniu zaburzeń związanych z hazardem oraz uzależnień chemicznych i czynnościowych

2017 ◽  
Vol 12 ◽  
pp. 91
Author(s):  
Iwona Niewiadomska ◽  
Agnieszka Palacz-Chrisidis
Keyword(s):  
Mental Disorders ◽  
Health Problems ◽  
Statistical Classification ◽  
Addictive Disorders ◽  
Statistical Manual ◽  
Dsm V ◽  
Classification Of Diseases ◽  
Icd 10 ◽  
International Statistical Classification

Autorki poruszają kwestię zmian w kryteriach diagnostycznych dotyczących zaburzeń związanych z hazardem oraz uzależnień chemicznych i czynnościowych w literaturze przedmiotu. Prezentują też krótki przegląd kolejnych edycji podręczników międzynarodowych klasyfikacji, zarówno Diagnostics and Statistical Manual of Mental Disorders – DSM, jak i The International Statistical Classification of Diseases and Related Health Problems – ICD. W artykule przedstawiona jest również dyskusja badaczy na temat umiejscowienia zaburzeń związanych z hazardem w klasyfikacjach diagnostycznych. DSM-V umiejscawia zaburzenie hazardowe w kategorii „zaburzenia używania substancji i nałogów” (ang. Substance-Related and Addictive Disorders, DSM-V), w podkategorii „zaburzenia niezwiązane z substancjami” (ang. Non-Substace Related Disorders, DSM-V). Natomiast według nadal obowiązującego ICD-10, zaburzenie hazardowe pozostaje w obszarze zaburzeń kontroli i impulsów, pod nazwą „hazard patologiczny”.

PUBLIC HEALTH, NURSING, AND MEDICAL SOCIAL WORK

PEDIATRICS ◽  
1959 ◽  
Vol 23 (4) ◽  
pp. 761-765
Author(s):  
Myron E. Wegman
Keyword(s):  
Causes Of Death ◽  
Geographic Area ◽  
Final Diagnosis ◽  
International Classification Of Diseases ◽  
Limiting Factor ◽  
Standard Nomenclature ◽  
Classification Of Diseases ◽  
International Statistical Classification ◽  
Health Nursing

Every physician who has been through an internship is familiar with the Standard Nomenclature of Diseases and Operations. Far fewer know the International Statistical Classification of Diseases, Injuries and Causes of Death or appreciate the relationship between the two. Official inauguration of the use of the Seventh Revision of the International Classification of Diseases on January 1, 1958 offers occasion for reviewing some of the considerations affecting the proper naming and classification of diseases and causes of death. It is necessary to clarify the distinction between a "nomenclature" and a "classification." A nomenclature is a list of all terms considered satisfactory in medical usage at the time the nomenclature was prepared. Its primary purpose is to promote use of the same name for the same disease, a necessity for comparability of reports and effective study of a disease. To achieve such uniformity there must be some background of usage and custom, as well as a systematic reference work to help the physician arrive at and use the standard term as a final diagnosis for his case. The Standard Nomenclature of Diseases and Operations of the American Medical Association is in practically universal use in the major institutions of the U. S. A. The Nomenclature itself, while detailed and inevitably complicated by extent of coverage and inclusiveness, follows such a logical pattern that under the pressure of institutional rules and routines it is not difficult to use the system efficiently. Individual physicians, however, are not so disposed to spend the time necessary to follow the Nomenclature and tend rather to use the terminology popular in the geographic area where they are working. Development of local terminologies and usages is perhaps the greatest limiting factor militating against a really general nomenclature.

scholarly journals Towards a national perioperative clinical quality registry: The diagnostic accuracy of administrative data in identifying major postoperative complications

2020 ◽  
Vol 48 (3) ◽  
pp. 203-212 ◽  
Author(s):  
Jennifer R Reilly ◽  
Mark A Shulman ◽  
Annie M Gilbert ◽  
Bismi Jomon ◽  
Robin J Thompson ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Administrative Data ◽  
Clinical Audit ◽  
Hospital Performance ◽  
Clinical Quality ◽  
Quality Registry ◽  
Alfred Hospital ◽  
Classification Of Diseases ◽  
International Statistical Classification

Accurately measuring the incidence of major postoperative complications is essential for funding and reimbursement of healthcare providers, for internal and external benchmarking of hospital performance and for valid and reliable public reporting of outcomes. Actual or surrogate outcomes data are typically obtained by one of three methods: clinical quality registries, clinical audit, or administrative data. In 2017 a perioperative registry was developed at the Alfred Hospital and mapped to administrative and clinical data. This study investigated the statistical agreement between administrative data (International Statistical Classification of Diseases and Related Health Problems (10th edition) Australian Modification codes) and clinical audit by anaesthetists in identifying major postoperative complications. The study population included 482 high-risk surgical patients referred to the Alfred Hospital anaesthesia postoperative service over two years. Clinical audit was conducted to determine the presence of major complications and these data were compared to administrative data. The main outcome was statistical agreement between the two methods, as defined by Cohen’s kappa statistic. Substantial agreement was observed for five major complications, moderate agreement for three, fair agreement for six and poor agreement for two. Sensitivity and positive predictive value ranged from 0 to 100%. Specificity was above 90% for all complications. There was important variation in inter-rater agreement. For four of the five complications with substantial agreement between administrative data and clinical audit, sensitivity was only moderate (61.5%–75%). Using International Statistical Classification of Diseases and Related Health Problems (10th edition) Australian Modification codes to identify postoperative complications at our hospital has high specificity but is likely to underestimate the incidence compared to clinical audit. Further, retrospective clinical audit itself is not a highly reliable method of identifying complications. We believe a perioperative clinical quality registry is necessary to validly and reliably measure major postoperative complications in Australia for benchmarking of hospital performance and before public reporting of outcomes should be considered.

Sign in / Sign up

Export Citation Format

Share Document