scholarly journals Comparison between microendoscopic laminectomy and open posterior decompression surgery for single-level lumbar spinal stenosis: a multicenter retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Nozomu Ohtomo ◽  
Hideki Nakamoto ◽  
Junya Miyahara ◽  
Yuichi Yoshida ◽  
Hiroyuki Nakarai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Operating Time ◽  
Open Group ◽  
Intraoperative Blood Loss ◽  
Satisfaction Rate ◽  
Lumbar Spinal

Abstract Background Microendoscopic laminectomy (MEL), in which a 16-mm tubular retractor with an internal scope is used, has shown excellent surgical results for patients with lumbar spinal canal stenosis. However, no reports have directly compared MEL with open laminectomy. This study aimed to elucidate patient-reported outcomes (PROs) and perioperative complications in patients undergoing MEL versus open laminectomy. Methods This is a multicenter retrospective cohort study of prospectively registered patients who underwent lumbar spinal surgery at one of the six high-volume spine centers between April 2017 and September 2018. A total of 258 patients who underwent single posterior lumbar decompression at L4/L5 were enrolled in the study. With regard to demographic data, we prospectively used chart sheets to evaluate the diagnosis, operative procedure, operation time, estimated blood loss, and complications. The follow-up period was 1-year. PROs included a numerical rating scale (NRS) for lower back pain and leg pain, the Oswestry Disability Index (ODI), EuroQol 5 Dimension (EQ-5D), and patient satisfaction with the treatment. Results Of the 258 patients enrolled, 252 (97%) completed the 1-year follow-up. Of the 252, 130 underwent MEL (MEL group) and 122 underwent open decompression (open group). The MEL group required a significantly shorter operating time and sustained lesser intraoperative blood loss compared with the open group. The MEL group showed shorter length of postoperative hospitalization than the open group. The overall complication rate was similar (8.2% in the MEL group versus 7.7% in the open group), and the revision rate did not significantly differ. As for PROs, both preoperative and postoperative values did not significantly differ between the two groups. However, the satisfaction rate was higher in the MEL group (74%) than in the open group (53%) (p = 0.02). Conclusions MEL required a significantly shorter operating time and resulted in lesser intraoperative blood loss compared with laminectomy. Postoperative PROs and complication rates were not significantly different between the procedures, although MEL demonstrated a better satisfaction rate.

scholarly journals Comparison Between Microendoscopic Laminectomy and Open Posterior Decompression Surgery for Single-Level Lumbar Spinal Stenosis: A Multicenter Retrospective Cohort Study

2021 ◽  
Author(s):  
Nozomu Ohtomo ◽  
Hideki Nakamoto ◽  
Junya Miyahara ◽  
Yuichi Yoshida ◽  
Hiroyuki Nakarai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Operating Time ◽  
Open Group ◽  
Complication Rates ◽  
Intraoperative Blood Loss ◽  
Satisfaction Rate ◽  
Lumbar Spinal

Abstract BackgroundMicroendoscopic laminectomy (MEL), in which a 16-mm tubular retractor with an internal scope is used, has shown excellent surgical results for patients with lumbar spinal canal stenosis. However, no reports have directly compared MEL with open laminectomy. This study aimed to elucidate patient-reported outcomes (PROs) and perioperative complications in patients undergoing MEL versus open laminectomy.MethodsThis is a multicenter retrospective cohort study of prospectively registered patients who underwent lumbar spinal surgery at one of the six high-volume spine centers between April 2017 and September 2018. A total of 258 patients who underwent single posterior lumbar decompression at L4/L5 were enrolled in the study. With regard to demographic data, we prospectively used chart sheets to evaluate the diagnosis, operative procedure, operation time, estimated blood loss, and complications. PROs included a numerical rating scale (NRS) for lower back pain and leg pain, the Oswestry Disability Index (ODI), EuroQol 5 Dimension (EQ-5D), and patient satisfaction with the treatment. ResultsOf the 258 patients enrolled, 252 (97%) completed the 1-year follow-up. Of the 252, 130 underwent MEL (MEL group) and 122 underwent open decompression (open group). The MEL group required a significantly shorter operating time and sustained lesser intraoperative blood loss compared with the open group. The overall complication rate was similar (8.2% in the MEL group versus 7.7% in the open group), and the revision rate did not significantly differ. As for PROs, both preoperative and postoperative values did not significantly differ between the two groups. However, the satisfaction rate was higher in the MEL group (74%) than in the open group (53%) (p = 0.02). ConclusionsMEL required a significantly shorter operating time and resulted in lesser intraoperative blood loss compared with laminectomy. Postoperative PROs and complication rates were not significantly different between the procedures, although MEL demonstrated a better satisfaction rate.

scholarly journals Quantitative comparison of clinical outcomes and decompression parameters between extreme lateral lumbar interbody fusion and transforaminal lumbar interbody fusion in treating lumbar spinal stenosis: a 3-year retrospective cohort study

2020 ◽  
Author(s):  
Junchao Xing ◽  
Peng Cheng ◽  
Jianzhong Xu ◽  
Hongwei Lu ◽  
Qingyi He
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Interbody Fusion ◽  
Operative Time ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Lumbar Interbody Fusion ◽  
Lumbar Spinal

Abstract Background This retrospective cohort study was conducted to compare the clinical efficacy and decompression parameters of extreme lateral lumbar interbody fusion (XLIF) with transforaminal lumbar interbody fusion (TLIF) in treating lumbar spinal stenosis (LSS). Methods From January 2012 to June 2016, 1455 patients with LSS who underwent surgery were reviewed and 83 cases were included (40 cases for XLIF and 43 cases for TLIF). The operative time, blood loss, accumulated fluoroscopy time, visual analogue scale (VAS), Oswestry Disability Index (ODI), fusion rate and complications were evaluated. Moreover, decompression parameters were compared, including the sagittal disc height (DH), the foraminal height (FH) and area (FA), the lumbar lordosis (LL), the transverse area of the dural sac (DS), as well as the rate of change loss of these parameters. Results The baseline was consistent between two groups. The mean follow-up time was 36.9 months. Both of XLIF and TLIF yielded clinical improvements. XLIF had advantages over TLIF in blood loss, operative time, hospital stay and complication. The fusion rate, postoperative VAS and ODI scores were comparable. Particularly, XLIF showed analogous, or even better, capacity of ameliorating decompression parameters to TLIF, especially regarding DH, LL and the maintenance of decompression. Conclusions Compared with TLIF, XLIF is advantageous to avoid blood loss, shorten the operative time, hospital stay and maintain the decompressive effect in treating LSS.

scholarly journals Anaesthetic challenges for pelvic reconstruction with custom three-dimensional-printed titanium implants: A retrospective cohort study

2019 ◽  
Vol 47 (4) ◽  
pp. 368-377
Author(s):  
Alfred WY Chua ◽  
Matthew J Chua ◽  
Peter CA Kam ◽  
Demien Broekhuis ◽  
Sascha Karunaratne ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Reconstructive Surgery ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Titanium Implants ◽  
Pelvic Reconstructive Surgery ◽  
Intraoperative Blood Loss ◽  
3D Printed ◽  
Prolonged Surgery

Custom 3D printed titanium implant pelvic reconstructive surgery was implemented as a novel technique at our institutions in the last five years. It provided an option for pelvic bone malignancy patients who were previously deemed unsuitable for re-implantation of irradiated resected bone segments, as well as in revision total hip arthroplasty associated with excessive acetabular bone loss. A retrospective cohort study of the anaesthetic management of patients who underwent pelvic reconstructive surgery using custom 3D printed titanium implants from August 2013 to July 2018 was conducted. Twenty-seven patients were included in the study; 23 patients completed single-stage procedures with a mean (standard deviation) duration of surgery of 7.5 (3.3) hours (median 6.8, range 3.0–15.8 hours), and mean intraoperative blood loss of 5400 (3100) mL (median 6000, range 1400–10,000 mL). Surgery involving the sacrum ( n = 7) was associated with longer intensive care stay, longer total length of hospital stay and, in three cases, unplanned two-stage procedures. The twenty procedures not involving the sacrum were successfully completed in a single stage. The major anaesthetic challenges included massive blood loss, prolonged surgery, interventions to prevent calf compartment syndrome, and perioperative thromboembolism. Preoperative pelvic radiotherapy, malignant tumours, and procedures involving the sacrum were associated with massive intraoperative blood loss and more prolonged surgery.

Status and Determinants of Treatment Outcomes Among New Tuberculosis Patients in South Korea: A Retrospective Cohort Study

2021 ◽  
pp. 101053952110005
Author(s):  
Hyunjin Son ◽  
Jeongha Mok ◽  
Miyoung Lee ◽  
Wonseo Park ◽  
Seungjin Kim ◽  
...  
Keyword(s):  
Cohort Study ◽  
South Korea ◽  
Success Rate ◽  
Treatment Outcomes ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Care Facilities ◽  
Tuberculosis Patients ◽  
Lost To Follow Up

This is a retrospective cohort study using notification data in South Korea. We evaluated the nationwide status, regional differences, and the determinants of treatment outcomes among tuberculosis patients. Treatment success rate improved from 77.0% in 2012 to 86.0% in 2015. The lost to follow-up rate was higher among older people, males, and foreign nationals. Health care facilities designated for the Public-Private Mix (PPM) project showed higher success rate and lower rate of lost to follow-up. Moreover, municipalities with low regional deprivation index had higher PPM project coverage. Since there is a large regional difference in the coverage of the PPM project, an additional community-based support program should be implemented, especially for tuberculosis patients residing in region with low PPM project coverage.

scholarly journals Antithrombotic drugs have a minimal effect on intraoperative blood loss during emergency surgery for generalized peritonitis: a nationwide retrospective cohort study in Japan

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tadashi Matsuoka ◽  
Nao Ichihara ◽  
Hiroharu Shinozaki ◽  
Kenji Kobayashi ◽  
Alan Kawarai Lefor ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Blood Loss ◽  
Emergency Surgery ◽  
Retrospective Cohort ◽  
Confounding Factors ◽  
Intraoperative Blood Loss ◽  
Antithrombotic Drugs ◽  
Generalized Peritonitis ◽  
Blood Loss Volume

Abstract Background The effect of antithrombotic drugs on intraoperative operative blood loss volume in patients undergoing emergency surgery for generalized peritonitis is not well defined. The purpose of this study was to investigate the effect of antithrombotic drugs on intraoperative blood loss in patients with generalized peritonitis using a nationwide surgical registry in Japan. Method This retrospective cohort study used a nationwide surgical registry data from 2011 to 2017 in Japan. Propensity score matching for the use of antithrombotic drugs was used for the adjustment of age, gender, comorbidities, frailty, preoperative state, types of surgery, surgical approach, laboratory data, and others. The main outcome was intraoperative blood loss: comparison of intraoperative blood loss, ratio of intraoperative blood loss after adjusted for confounding factors, and variable importance of all covariates. Results A total of 70,105 of the eligible 75,666 patients were included in this study, and 2947 patients were taking antithrombotic drugs. Propensity score matching yielded 2864 well-balanced pairs. The blood loss volume was slightly higher in the antithrombotic drug group (100 [10–349] vs 70 [10–299] ml). After adjustment for confounding factors, the use of antithrombotic drugs was related to a 1.30-fold increase in intraoperative blood loss compared to non-use of antithrombotic drugs (95% CI, 1.16–1.45). The variable importance revealed that the effect of the use of antithrombotic drugs was minimal compared with surgical approach or type of surgery. Conclusion This study shows that while taking antithrombotic drugs is associated with a slight increase in intraoperative blood loss in patients undergoing emergency surgery for generalized peritonitis, the effect is likely of minimal clinical significance.

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