Carotid plaques and detection of atrial fibrillation in embolic stroke of undetermined source

Neurology ◽  
2019 ◽  
Vol 92 (23) ◽  
pp. e2644-e2652 ◽  
Author(s):  
George Ntaios ◽  
Kalliopi Perlepe ◽  
Gaia Sirimarco ◽  
Davide Strambo ◽  
Ashraf Eskandari ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Rank Test ◽  
Lower Probability ◽  
Cumulative Probability ◽  
Carotid Plaques ◽  
Pooled Data ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Product Limit

ObjectiveTo investigate the association between the presence of ipsilateral nonstenotic carotid plaques and the rate of detection of atrial fibrillation (AF) during follow-up in patients with embolic strokes of undetermined source (ESUS).MethodsWe pooled data of all consecutive ESUS patients from 3 prospective stroke registries. Multivariate stepwise regression assessed the association between the presence of nonstenotic carotid plaques and AF detection. The 10-year cumulative probabilities of AF detection were estimated by the Kaplan-Meier product limit method.ResultsAmong 777 patients followed for 2,642 patient-years, 341 (38.6%) patients had an ipsilateral nonstenotic carotid plaque. AF was detected in 112 (14.4%) patients in the overall population during follow-up. The overall rate of AF detection was 8.5% in patients with nonstenotic carotid plaques (2.9% per 100 patient-years) and 19.0% in patients without (5.0% per 100 patient-years) (unadjusted hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.37–0.84). The presence of ipsilateral nonstenotic carotid plaques was associated with lower probability for AF detection (adjusted HR 0.57, 95% CI 0.34–0.96, p = 0.03). The 10-year cumulative probability of AF detection was lower in patients with ipsilateral nonstenotic carotid plaques compared to those without (34.5%, 95% CI 21.8–47.2 vs 49.0%, 95% CI 40.4–57.6 respectively, log-rank-test: 11.8, p = 0.001).ConclusionsAF is less frequently detected in ESUS patients with nonstenotic carotid plaques compared to those without.Clinicaltrials.gov identifierNCT02766205.

scholarly journals Impact of monitoring on detection of arrhythmia recurrences in the ESC-EHRA EORP atrial fibrillation ablation long-term registry

EP Europace ◽  
2019 ◽  
Vol 21 (12) ◽  
pp. 1802-1808
Author(s):  
Tosho Balabanski ◽  
Josep Brugada ◽  
Elena Arbelo ◽  
Cécile Laroche ◽  
Aldo Maggioni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Atrial Fibrillation Ablation ◽  
Rank Test ◽  
Lower Probability ◽  
Monitoring Methods ◽  
Holter Ecg ◽  
Af Ablation ◽  
Log Rank Test

Abstract Aims Monitoring of patients after ablation had wide variations in the ESC-EHRA atrial fibrillation ablation long-term (AFA-LT) registry. We aimed to compare four different monitoring strategies after catheter AF ablation. Methods and results The ESC-EHRA AFA-LT registry included 3593 patients who underwent ablation. Arrhythmia monitoring during follow-up was performed by 12-lead electrocardiogram (ECG), Holter ECG, trans-telephonic ECG monitoring (TTMON), or an implanted cardiac monitoring (ICM) system. Patients were selected to a given monitoring group according to the most extensive ECG tool used in each of them. Comparison of the probability of freedom from recurrences was performed by censored log-rank test and presented by Kaplan–Meier curves. The rhythm monitoring methods were used among 2658 patients: ECG (N = 578), Holter ECG (N = 1874), TTMON (N = 101), and ICM (N = 105). A total of 767 of 2658 patients (28.9%) had AF recurrences during follow-up. Censored log-rank test discovered a lower probability of freedom from relapses, which was detected with ICM compared to TTMON, ECG, and Holter ECG (P < 0.001). The rate of freedom from AF recurrences was 50.5% among patients using the ICM while it was 65.4%, 70.6%, and 72.8% using the TTMON, ECG, and Holter ECG, respectively. Conclusion Comparing all main electrocardiographic monitoring methods in a large patient sample, our results suggest that post-ablation recurrences of AF are significantly underreported by TTMON, ECG, and Holter ECG. The ICM estimates AF ablation recurrences most reliably and should be a preferred mode of monitoring for trials evaluating novel AF ablation techniques.

Characteristics and outcomes of Embolic Stroke of Undetermined Source according to stroke severity

2020 ◽  
Vol 15 (8) ◽  
pp. 866-871
Author(s):  
Ioannis Leventis ◽  
Kalliopi Perlepe ◽  
Dimitrios Sagris ◽  
Gaia Sirimarco ◽  
Davide Strambo ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Rank Test ◽  
Stroke Recurrence ◽  
Cumulative Probability ◽  
Stroke Severity ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Product Limit

Background and aims Patients with embolic strokes of undetermined source (ESUS) usually present with mild symptoms. We aimed to compare the baseline characteristics between mild and severe ESUS, identify predictors for severe ESUS, and assess outcomes of patients with severe ESUS. Methods In the AF-ESUS (AF-ESUS) dataset, we stratified ESUS severity using the median National Institutes of Health Stroke Scale (NIHSS) score on admission as cut-off. We performed multivariable stepwise regression analyses to identify independent predictors of severe ESUS and to assess the association between ESUS severity and stroke recurrence, death, and new incident atrial fibrillation (AF) on follow-up. The 10-year cumulative probabilities of outcome incidence were estimated by the Kaplan–Meier product limit method. Results In 772 patients (median NIHSS: 6 (interquartile range: 3–12)), 414 (53.6%) patients had severe ESUS (i.e. NIHSS ≥6). Female sex was the only independent predictor for severe ESUS (odds ratio: 1.72 (1.27–2.33)). The rates of recurrence (3.3%/year vs. 3.4%/year, adjusted-hazard ratio: 1.09 (0.73–1.62)) and new incident AF (13.5% vs. 17.0%, adjusted odds ratio: 0.67 (0.44–1.03)) were similar between severe and mild ESUS, but mortality was higher (5.4%/year vs. 3.7%/year, adjusted-hazard ratio: 1.51 (1.05–2.16)) in severe ESUS. The 10-year cumulative probability for stroke recurrence was similar between severe and mild ESUS (38.1% (29.2–48.6) vs. 36.6% (27.8–47.0), log-rank test: 0.01, p = 0.920). The 10-year cumulative probability of death was higher in patients with severe ESUS compared with mild ESUS (40.5% (32.5–50.0) vs. 34.0% (26.0–43.6) respectively; log-rank test: 4.54, p = 0.033). Conclusions Women have more severe ESUS compared with men. Patients with severe ESUS have similar rates of stroke recurrence and new incident AF, but higher mortality compared with mild ESUS.

Abstract 2451: Chronic Kidney Disease as an Independent Risk Factor for New-Onset Atrial Fibrillation in Patients with Essential Hypertension

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Takeshi Horio ◽  
Yoshio Iwashima ◽  
Kei Kamide ◽  
Takeshi Tokudome ◽  
Hiroto Nakata ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Rank Test ◽  
Hypertensive Patients ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Lv Mass ◽  
New Onset

Atrial fibrillation (AF) is frequently observed in hypertensive heart disease. Older age, increased left ventricular (LV) mass, and left atrial (LA) dilatation are known to be risk factors for the occurrence of AF in hypertensive patients. Chronic kidney disease (CKD) has recently been recognized to be a powerful risk for cardiovascular events. However, no study has revealed the association between CKD and the onset of AF. Thus, the present study assessed the hypothesis that CKD may influence the onset of AF in hypertensives. A total of 1,118 essential hypertensive patients (mean age, 63 years) without previous paroxysmal AF, heart failure, myocardial infarction, valvular disease, or LV asynergy were enrolled. In echocardiographic examinations, LA dimension and LV mass index (LVMI) were determined. Estimated glomerular filtration rate (eGFR) was calculated by the modified MDRD formula. During follow-up periods (mean, 4.7 years), fifty-seven cases of new onset AF (including paroxysmal AF) were found (1.1% /year). Cumulative event-free rates by the Kaplan-Meier method were decreased according to the decrease in basal eGFR (≥60, 30 – 60, 15–30, and <15 mL/min) and the increase in proteinuria (−/±, 1+/2+, and ≥3+) (log-rank test P<0.001, respectively). When CKD was defined as decreased eGFR (<60 mL/min) and/or the presence of proteinuria, the prevalence of new-onset AF was significantly higher in subjects with CKD (n=420) than without CKD (n=698) (7.9% vs 3.4%, P=0.001). Kaplan-Meier curves also revealed the increase in event rates in the CKD group (log-rank test P<0.001). By univariate Cox regression analysis, age, smoking, LA dimension, LVMI, and the presence of CKD were significantly associated with the occurrence of AF during follow-up. Among these possible predictors, older age (HR 1.63 /10 years, P<0.001) and the presence of CKD (HR 2.25, P=0.004) were independent determinants for the onset of AF in multivariate analysis. The present study demonstrated that the complication of CKD in hypertensive patients was a powerful predictor of new-onset AF, independently of LV hypertrophy and LA dilatation. Our findings may provide a new aspect in considering the cardiorenal association in hypertensive diseases.

Colorectal Liver Metastases - Does the Number of Lesions Determine the Sensibility of Resection?

Swiss Surgery ◽  
2000 ◽  
Vol 6 (1) ◽  
pp. 6-10
Author(s):  
Knoefel ◽  
Brunken ◽  
Neumann ◽  
Gundlach ◽  
Rogiers ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Rank Test ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Chirurgische Entfernung

Die komplette chirurgische Entfernung von Lebermetastasen bietet Patienten nach kolorektalem Karzinom die einzige kurative Chance. Es gibt jedoch eine, anscheinend unbegrenzte, Anzahl an Parametern, die die Prognose dieser Patienten bestimmen und damit den Sinn dieser Therapie vorhersagen können. Zu den am häufigsten diskutierten und am einfachsten zu bestimmenden Parametern gehört die Anzahl der Metastasen. Ziel dieser Studie war es daher die Wertigkeit dieses Parameters in der Literatur zu reflektieren und unsere eigenen Patientendaten zu evaluieren. Insgesamt konnte von 302 Patienten ein komplettes Follow-up erhoben werden. Die gebildeten Patientengruppen wurden mit Hilfe einer Kaplan Meier Analyse und konsekutivem log rank Test untersucht. Die Literatur wurde bis Dezember 1998 revidiert. Die Anzahl der Metastasen bestätigte sich als ein prognostisches Kriterium. Lagen drei oder mehr Metastasen vor, so war nicht nur die Wahrscheinlichkeit einer R0 Resektion deutlich geringer (17.8% versus 67.2%) sondern auch das Überleben der Patienten nach einer R0 Resektion tendenziell unwahrscheinlicher. Das 5-Jahres Überleben betrug bei > 2 Metastasen 9% bei > 2 Metastasen 36%. Das 10-Jahres Überleben beträgt bislang bei > 2 Metastasen 0% bei > 2 Metastasen 18% (p < 0.07). Die Anzahl der Metastasen spielt in der Prognose der Patienten mit kolorektalen Lebermetastasen eine Rolle. Selbst bei mehr als vier Metastasen ist jedoch gelegentlich eine R0 Resektion möglich. In diesen Fällen kann der Patient auch langfristig von einer Operation profitieren. Das wichtigere Kriterium einer onkologisch sinnvollen Resektabilität ist die Frage ob technisch und funktionell eine R0 Resektion durchführbar ist. Ist das der Fall, so sollte auch einem Patienten mit mehreren Metastasen die einzige kurative Chance einer Resektion nicht vorenthalten bleiben.

Effects of electrical stimulation in the treatment of osteonecrosis of the femoral head

2017 ◽  
Vol 28 (4) ◽  
pp. 434-441
Author(s):  
Salvador Fornell ◽  
Juan Ribera ◽  
Mario Mella ◽  
Andrés Carranza ◽  
David Serrano-Toledano ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Retrospective Study ◽  
Femoral Head ◽  
Core Decompression ◽  
Rank Test ◽  
Time To Recurrence ◽  
Log Rank Test ◽  
Kaplan Meier

Introduction: The aim of this study was to examine whether the use of an internal electrostimulator could improve the results obtained with core decompression alone in the treatment of osteonecrosis of the femoral head. Methods: We performed a retrospective study of 41 patients (55 hips) treated for osteonecrosis of the femoral head between 2005 and 2014. Mean follow-up time was 56 (12-108) months. We recorded 3 parameters: time to recurrence of pain, time to conversion to arthroplasty and time to radiographic failure. Survival was estimated using the Kaplan-Meier method. The equality of the survival distributions was determined by the Log rank test. Results: Implanted electrostimulator was a factor that increased the survival of hips in a pre-op Steinberg stage of II or below, while it remained unchanged if the stage was III or higher. Conclusions: The addition of an internal electrostimulator provides increased survival compared to core decompression alone at stages below III.

Clinical presentation and outcomes of 2,924 early breast cancer patients (br.ca. pts) treated in a single institution in a 10-year period with a long follow up

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10669-10669
Author(s):  
E. Galligioni ◽  
R. Triolo ◽  
A. Lucenti ◽  
A. Ferro ◽  
M. Frisinghelli ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Rank Test ◽  
Consecutive Series ◽  
Breast Cancer Patients ◽  
Log Rank Test ◽  
Product Limit ◽  
Probability Of Death ◽  
Clinical Records ◽  
Hormonal Receptor Status

10669 Background: A consecutive series of br.ca. pts, treated between Jan 1st 1990 to Dec 31st 1999 in our Department, is the basis of our retrospective study, aimed to create a data base on routinary clinical management of early br.ca. pts, to which compare similar series and literature data. Methods: All Clinical Records were reviewed and computerized. Disease free and overall survival were estimated using the product-limit method of Kaplan and Meier. The log-rank test was used to compare prognosis between different subgroups. Results: Among 2924 consecutive br.ca. pts, 836 were younger than 50 years (med. age 44) and 2088 older (med. age 63). Regional nodes were negative (N−) in 1754, positive (N+) in 1027 and unknown in the remaining pts. So, 2593 pts were stage I-II and 301 stage IIIA-B. Hormonal Receptor status (available on 2560 pts) was positive for Estrogen (ER+) in 2021 pts and for Progesterone (PgR+) in 1649 pts. Moreover, 1571 pts were ER+Pgr+, 539 ER-PgR−, 78 ER-PgR+ and 461 ER+PgR−. HER2 was overexpressed in 262/1426 (18%) pts. Tumor grading (available on 2176 cases) was G1–2 in 1411 and G3–4 in 765 cases. After surgery, 731 pts received adjuvant Tamoxifen, 507 pts CMF ± Antracyclines chemotherapy, 434 pts both chemotherapy and Tamoxifen and 958 pts none. (no therapy data are available for the remaining 334 pts). At a median f.up of 9.8 years, 993/2924 pts (33.9%) have recurred, (med. DFS 137 mos) with a 5, 10 and 15 y probability of recurrence of 26, 44 and 63% respectively. Corresponding figures of recurrence for N− pts were 14, 30 and 50% (med. DFS 168 mos), while for N+ pts were 41, 61 and 77% (med DFS 81 mos). For younger N+ pts treated with chemotherapy, the 5 years probability of recurrence was 34% while it was 24% for older ER+ pts treated with hormonal therapy. So far, 794/2924 (27.5%) pts have died, with a 5, 10 and 15 y probability of death of 13, 27 and 41%. This was 5, 16 and 28% for N- pts and 22, 41 and 56% for N+ pts. For younger N+ pts treated with chemotherapy, the 5 y probability of death was 14%, as it was for older ER+ pts treated with Tamoxifen. Conclusions: Although this data are not yet conclusive, it appears that large part of the clinical improvements reported in clinical trials may be achieved in the routine management of breast cancer pts. No significant financial relationships to disclose.

Prognostic value of immunohistochemical phenotypes (IP) of 141 operable breast cancer patients (pts) included in phase III trials of adjuvant therapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 21040-21040
Author(s):  
R. Trujillo ◽  
E. Gallego ◽  
A. Márquez ◽  
N. Ribelles ◽  
J. Trigo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cox Regression ◽  
Phase Iii ◽  
Rank Test ◽  
Prognostic Effect ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Phase Iii Trials ◽  
Her 2

21040 Background: Gene expression arrays and IP studies classified breast cancer in three distinct subtypes: basal, HER2/neu and luminal that are associated with different clinical outcomes. Methods: In 141 pts with operable breast cancer, included in phase III trials of adjuvant therapy in our center, immunohistochemical staining was performed on 3μm sections of paraffin blocks, containing tissue-arrays of tumour tissue.A basal phenotype (BP) was defined by negative estrogen receptor (ER) and progesterone receptor (PR) and positive cytokeratin (CK) 5/6 or EGFR immunoreactivity. HER2/neu phenotype as positive c-erb B2 by HercepTest™ and luminal phenotype (LP) by positive ER, PR and CK 7/8 and negative HER-2. Survival curves were calculated by the Kaplan-Meier method. The differences between survivals were estimated using the log rank test. Multivariate Cox regression analysis was used to evaluate any independent prognostic effect of the variables on disease-free survival (DFS). Results: Complete clinical follow-up information was available for 141 pts. The median follow-up period was 52 months (range 1–103 months). During this period, 13.8% pts died from breast cancer and 27.7% pts relapsed. At the time of the primary diagnosis 10.4% of the pts had lymph node negative disease and 89.6% had positive lymph nodes. 50.8% pts received taxane chemotherapy, 7.7% Trastuzumab, 62.3% radiotherapy and 61% pts received hormonotherapy. Positivity for LP was 65.2%, BP 9.9% and Her-2 phenotype 8.5%. 16.3% didn't fit for any of the three subtypes. Median DFS for BP: 24 moths, for LP and Her-2 phenotypes median DFS was not reached. 5 years DFS were; BP: 19%, LP: 63% and Her-2: 56%. Kaplan-Meier survival analyses demonstrated that the presence of a detectable BP was highly significantly associated with a worse DFS compared with the presence of a LP, log rank test (p= 0.0001). Multivariate Cox regression analyses estimated that the prognostic effect of BP in relation to DFS was independent of lymph node, stage and tumor size, HR: 0.12 95% CI (0.05–0.2). Conclusions: We found that expression of BP was associated with poor prognostic in the context of randomized phase III trials. No significant financial relationships to disclose.

Oral (O) versus intravenous (IV) etoposide and platinum in the treatment of extensive-stage small cell lung cancer (SCLC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 7597-7597 ◽  
Author(s):  
Scott Alan Dorroh ◽  
Eric R Siegel ◽  
Rangaswamy Govindarajan
Keyword(s):  
Poor Performance ◽  
Rank Test ◽  
Test Results ◽  
Extensive Disease ◽  
Tumor Registry ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Extensive Stage ◽  
Pharmacy Data

7597 Background: Platinum and etoposide chemotherapy is the treatment for patients with SCLC. O etoposide is substituted for IV by many clinicians at twice the dose for bioavailability but the outcome of these subjects has not been studied. To compare the efficacy of O vs. IV etoposide in extensive stage SCLC, a retrospective analysis of subjects treated in the VISN 16 network of 10VA hospitals was undertaken. Methods: Subjects with SCLC diagnosed between 10/1/1996 and 9/30/2010 were identified from the VISN-16 tumor registry. Study was limited to extensive disease by excluding those treated with radiation therapy. Chemotherapy details were obtained from the pharmacy data in the VISN 16 database. Overall survival (OS) was computed as the time in months from the first etoposide issue date to the date of death or last contact. Kaplan-Meier methods were used to compute median OS, and etoposide groups were compared via log-rank test. Results: 300 subjects were eligible for analysis, with median age 67 yrs (range 45-84). 295 deaths were observed during 2,419 total months of follow-up. The median OS of all subjects was 6.3 months (interquartile range (IQR) 2.0-11 months). In addition to platinum, 153 subjects received only O etoposide, 147 received some form of IV etoposide. The median duration (IQR) of therapy for all subjects was 29 (1-110) days; 23 days for those who received any IV etoposide and 43 days for those who received only oral etoposide. The median OS was 7.6 months for those who received only O etoposide vs. 5.4 months for any IV etoposide (P<0.0001). In the latter group, those receiving purely IV etoposide had only 1.5 months’ median OS vs. 8.8 months for those receiving both O and IV etoposide (P<0.0001). Conclusions: Survival of subjects with SCLC treated with O etoposide is comparable to those who received a combination of O and IV therapy. Poor OS for those with only IV therapy may be due to selection bias of poor-performance subjects. [Table: see text]

The Distribution of Yin-Deficient Symptoms and Their Relationship on Survival Rate in Cancer Patients with Yin-Deficiency

2008 ◽  
Vol 36 (04) ◽  
pp. 655-663 ◽  
Author(s):  
Shu-Chuan Lin ◽  
Ming-Feng Chen ◽  
Tsai-Chung Li ◽  
Yu-Ho Hsieh ◽  
Shwu-Jiuan Liu
Keyword(s):  
Survival Rate ◽  
Cancer Patients ◽  
Survival Rates ◽  
Rank Test ◽  
Yin Deficiency ◽  
Rate Analysis ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Product Limit ◽  
Cumulative Probabilities

Yin-Deficiency (YD), representing a status of the human body under lack of nutrition and fluid in traditional Chinese medicine, is commonly seen in late stage of cancer patients. It is not known whether the severity of YD related symptoms/signs can predict the survival rate of cancer patients. This study evaluated the distribution of Yin-deficiency symptoms/signs (YDS) in cancer patients with YD, and investigated whether the severity of YDS can predict the survival rate of cancer patients with YD. From 5 January 2007 to 5 May 2007, we selected 43 cancer patients with diagnosis of YD from hospitalized patients and outpatients. The severity of YD was evaluated by a questionnaire. We further estimated the cumulative probabilities of the survival rates over 4 months since the start of study by the Kaplan-Meier product-limit method, and compared the differences among groups with various severities in each symptom/sign with the use of the log-rank test. The results revealed that, the 3 most common YDS were sleeplessness with annoyance, less or non-coated tongue with or without redness and dry mouth. In the survival rate analysis, only 2 parameters, rapidly small pulse (p = 0.002) and less-or non-coated tongue with paleness (p = 0.017), were found to be related to the decrease of cancer patients with YD. This suggests that, both rapidly small pulse and less-or non-coated tongue without redness may be used as predictors for the estimation of survival rate in cancer patients with YD.

scholarly journals Reoperation rates for symptomatic nonunions in posterior cervical (subaxial) fusions with and without bone morphogenetic protein in a cohort of 1158 patients

2016 ◽  
Vol 24 (4) ◽  
pp. 556-564 ◽  
Author(s):  
Kern H. Guppy ◽  
Jessica Harris ◽  
Jason Chen ◽  
Elizabeth W. Paxton ◽  
Julie Alvarez ◽  
...  
Keyword(s):  
Bone Morphogenetic Protein ◽  
Patient Characteristics ◽  
Rank Test ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Morphogenetic Protein ◽  
Significant Difference ◽  
Spinal Fusions ◽  
Reoperation Rates

OBJECTIVE Bone morphogenetic protein (BMP) was first approved in 2002 for use in single-level anterior lumbar fusions as an alternative to iliac crest grafts. Subsequent studies have concluded that BMP provides superior fusions rates and therefore reduces reoperations for nonunions. The purpose of this study was to determine the reoperation rates for symptomatic nonunions in posterior cervical (subaxial) spinal fusions with and without the use of BMP and to determine if the nonunion rates are statistically significantly different between the two groups. METHODS Between January 2009 and September 2013, the authors identified 1158 posterior cervical spinal fusion cases in the subaxial spine (C2–7) from a large spine registry (Kaiser Permanente). Patient characteristics, diagnoses, operative times, lengths of stay, and reoperations were extracted from the registry. Reoperations for symptomatic nonunions were adjudicated via chart review. Logistic regression was conducted to produce estimates of odds ratios (OR) and 95% confidence intervals (CIs). Kaplan-Meier curves for the non-BMP and BMP groups were generated and compared using the log-rank test. RESULTS In this cohort there were 1158 patients (19.3% with BMP) with a median follow up of 1.7 years (interquartile range [IQR] 0.7–2.9 years) and median duration to operative nonunion of 0.63 years (IQR 0.44–1.57 years). Kaplan-Meier curves showed no significant difference in reoperation rates for nonunions using the log-rank test (p = 0.179). In a subset of patients with more than 1 year of follow-up, 788 patients were identified (22.5% with BMP) with a median follow-up duration of 2.5 years (IQR 1.7–3.4 years) and a median time to operative nonunion of 0.73 years (IQR 0.44–1.57 years). There was no statistically significant difference in the symptomatic operative nonunion rates for posterior cervical (subaxial) fusions with BMP compared with non-BMP (1.1% vs 0.7%; crude OR 1.73, 95% CI 0.32–9.55, p = 0.527) for more than 1 year of follow-up. CONCLUSIONS This study presents the largest series of patients using BMP in posterior cervical (subaxial) spinal fusions. Reoperation rates for symptomatic nonunions with more than 1 year of follow-up were found to be 1.1% with BMP and 0.7% without BMP. There was no significant difference in the reoperation rates for symptomatic nonunions with or without BMP.

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