scholarly journals Risk factors for wound-related reoperations in patients with metastatic spine tumor

2018 ◽  
Vol 28 (6) ◽  
pp. 663-668 ◽  
Author(s):  
Hannah M. Carl ◽  
A. Karim Ahmed ◽  
Nancy Abu-Bonsrah ◽  
Rafael De la Garza Ramos ◽  
Eric W. Sankey ◽  
...  
Keyword(s):  
Risk Factors ◽  
Univariate Analysis ◽  
Tumor Resection ◽  
Multivariate Model ◽  
Wound Complications ◽  
Karnofsky Performance Scale ◽  
Thromboembolic Events ◽  
Spine Tumor ◽  
Wound Breakdown ◽  
Metastatic Spine Tumor

OBJECTIVEResection of metastatic spine tumors can improve patients’ quality of life by addressing pain or neurological compromise. However, resections are often complicated by wound dehiscence, infection, instrumentation failures, and the need for reoperation. Moreover, when reoperations are needed, the most common indication is surgical site infection and wound breakdown. In turn, wound reoperations increase morbidity as well as the length and cost of hospitalization. The aim of this study was to examine perioperative risk factors associated with increased rate of wound reoperations after metastatic spine tumor resection.METHODSA retrospective study of patients at a single institution who underwent metastatic spine tumor resection between 2003 and 2013 was conducted. Factors with a p value < 0.200 in a univariate analysis were included in the multivariate model.RESULTSA total of 159 patients were included in this study. Karnofsky Performance Scale score > 70, smoking status, hypertension, thromboembolic events, hyperlipidemia, increasing number of vertebral levels, and posterior approach were included in the multivariate analysis. Thromboembolic events (95% CI 1.19–48.5, p = 0.032) and number of levels involved were independently associated with increased wound reoperation rates in the multivariate model. For each additional spinal level involved, the risk for wound reoperations increased by 21% (95% CI 1.03–1.43, p = 0.018).CONCLUSIONSAlthough wound complications and subsequent reoperations are potential risks for all patients with metastatic spine tumor, due to adjuvant radiotherapy and other medical comorbidities, this study identified patients with thromboembolic events or those requiring a larger incision as being at the highest risk. Measures intended to decrease the occurrence of perioperative venous thromboembolism and to improve wound care, especially for long incisions, may decrease wound-related revision surgeries in this vulnerable group of patients.

scholarly journals Which Factors Increase the Risk of Re-Operation after Meniscus Surgery in the Skeletally Immature?

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0006
Author(s):  
Neeraj M. Patel ◽  
Surya Mundluru ◽  
Nicholas Beck ◽  
Theodore J. Ganley
Keyword(s):  
Risk Factors ◽  
Cruciate Ligament ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Multivariate Model ◽  
Skeletally Immature ◽  
Initial Surgery ◽  
Repeat Operation ◽  
Operation Rate ◽  
Meniscus Surgery

Objectives: The purpose of this study is to determine which factors heighten the risk for subsequent operations in skeletally immature patients undergoing meniscus surgery. Methods: A retrospective institutional database of 1,063 meniscus surgeries performed between 2000 and 2015 was reviewed. All procedures were performed in skeletally immature patients. Demographic and intra-operative information was recorded, as were concurrent injuries or operations and subsequent surgeries. Univariate analysis consisted of chi-square and independent-samples t-tests. Multivariate logistic regression was then performed to control for confounding factors. Results: The mean age at initial surgery was 13.4 years (standard deviation, SD, 2.2 years) and the average follow-up duration was 47 months (SD 54 months). Overall, 314 patients (29.5%) required repeat surgical intervention. 36% of all females required subsequent surgery compared to 26% of males (p<0.01). Discoid menisci underwent repeat operation more frequently than non-discoid menisci (35% vs. 27%, p=0.01). After accounting for confounders in a multivariate model, females had 2.2 times the odds of repeat surgery than males (95% CI 1.4-3.3, p<0.01) and each year of increasing age resulted in 1.3 times higher odds (95% CI 1.1 -1.4, p<0.01). The odds of subsequent surgeries were 4.2 times higher in those with flap tears (95% CI 1.8-9.7, p<0.01) and 2.9 times higher for discoid menisci (95% CI 1.4-6.0, p<0.01). Concomitant anterior cruciate ligament rupture or tibial spine fracture decreased the risk of needing additional surgeries in univariate analysis, but lost statistical significance in the multivariate model. Conclusion: Even when accounting for other factors in a multivariate model, female sex, increasing age, flap tears, and discoid meniscus were risk factors for subsequent procedures after meniscus surgery in skeletally immature patients. The re-operation rate in this population may be higher than previously reported. This study describes, for the first time, risk factors for repeat operations in skeletally immature patients undergoing meniscus surgery. These results can be used to counsel and monitor patients accordingly.

scholarly journals Hospital-acquired conditions: predictors and implications for outcomes following spine tumor resection

2017 ◽  
Vol 27 (6) ◽  
pp. 717-722 ◽  
Author(s):  
Nikita Lakomkin ◽  
Constantinos G. Hadjipanayis
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Adverse Events ◽  
Multivariable Analysis ◽  
Tumor Resection ◽  
Improvement Program ◽  
Spine Tumor ◽  
Prolonged Length ◽  
Hospital Acquired Conditions ◽  
Hospital Acquired

OBJECTIVEHospital-acquired conditions (HACs) significantly compromise patient safety, and have been identified by the Centers for Medicare and Medicaid Services as events that will be associated with penalties for surgeons. The mitigation of HACs must be an important consideration during the postoperative management of patients undergoing spine tumor resection. The purpose of this study was to identify the risk factors for HACs and to characterize the relationship between HACs and other postoperative adverse events following spine tumor resection.METHODSThe 2008–2014 American College of Surgeons’ National Surgical Quality Improvement Program database was used to identify adult patients undergoing the resection of intramedullary, intradural extramedullary, and extradural spine lesions via current procedural terminology and ICD-9 codes. Demographic, comorbidity, and operative variables were evaluated via bivariate statistics before being incorporated into a multivariable logistic regression model to identify the independent risk factors for HACs. Associations between HACs and other postoperative events, including death, readmission, prolonged length of stay, and various complications were determined through multivariable analysis while controlling for other significant variables. The c-statistic was computed to evaluate the predictive capacity of the regression models.RESULTSOf the 2170 patients included in the study, 195 (9.0%) developed an HAC. Only 2 perioperative variables, functional dependency and high body mass index, were risk factors for developing HACs (area under the curve = 0.654). Hospital-acquired conditions were independent predictors of all examined outcomes and complications, including death (OR 2.26, 95% CI 1.24–4.11, p = 0.007), prolonged length of stay (OR 2.74, 95% CI 1.98–3.80, p < 0.001), and readmission (OR 9.16, 95% CI 6.27–13.37, p < 0.001). The areas under the curve for these models ranged from 0.750 to 0.917.CONCLUSIONSThe comorbidities assessed in this study were not strongly predictive of HACs. Other variables, including hospital-associated factors, may play a role in the development of these conditions. The presence of an HAC was found to be an independent risk factor for a variety of adverse events. These findings highlight the need for continued development of evidence-based protocols designed to reduce the incidence and severity of HACs.

Risk Factors for Thirty-Day Morbidity and Mortality in Extradural Lumbar Spine Tumor Resection

2018 ◽  
Vol 114 ◽  
pp. e1101-e1106 ◽  
Author(s):  
Christopher A. Sarkiss ◽  
Eliza H. Hersh ◽  
Travis R. Ladner ◽  
Nathan Lee ◽  
Parth Kothari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lumbar Spine ◽  
Tumor Resection ◽  
Morbidity And Mortality ◽  
Spine Tumor

scholarly journals Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy - results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Maciej Walędziak ◽  
Anna Lasek ◽  
Michał Wysocki ◽  
Michael Su ◽  
Maciej Bobowicz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Events ◽  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Hospital Readmission ◽  
Univariate Analysis ◽  
Complicated Appendicitis ◽  
Multivariate Model ◽  
Adverse Outcomes ◽  
Primary Procedure

Abstract Laparoscopic appendectomy (LA) for treatment of acute appendicitis has gained acceptance with its considerable benefits over open appendectomy. LA, however, can involve some adverse outcomes: morbidity, prolonged length of hospital stay (LOS) and hospital readmission. Identification of predictive factors may help to identify and tailor treatment for patients with higher risk of these adverse events. Our aim was to identify risk factors for serious morbidity, prolonged LOS and hospital readmission after LA. A database compiled information of patients admitted for acute appendicitis from eighteen Polish and German surgical centers. It included factors related to the patient characteristics, peri- and postoperative period. Univariate and multivariate logistic regression models were used to identify risk factors for serious perioperative complications, prolonged LOS, and hospital readmissions in acute appendicitis cases. 4618 laparoscopic appendectomy patients were included. First, although several risk factors for serious perioperative complications (C-D III-V) were found in the univariate analysis, in the multivariate model only the presence of intraoperative adverse events (OR 4.09, 95% CI 1.32–12.65, p = 0.014) and complicated appendicitis (OR 3.63, 95% CI 1.74–7.61, p = 0.001) was statistically significant. Second, prolonged LOS was associated with the presence of complicated appendicitis (OR 2.8, 95% CI: 1.53–5.12, p = 0.001), postoperative morbidity (OR 5.01, 95% CI: 2.33–10.75, p < 0.001), conversions (OR 6.48, 95% CI: 3.48–12.08, p < 0.001) and reinterventions after primary procedure (OR 8.79, 95% CI: 3.2–24.14, p < 0.001) in the multivariate model. Third, although several risk factors for hospital readmissions were found in univariate analysis, in the multivariate model only the presence of postoperative complications (OR 10.33, 95% CI: 4.27–25.00), reintervention after primary procedure (OR 5.62, 95% CI: 2.17–14.54), and LA performed by resident (OR 1.96, 95% CI: 1.03–3.70) remained significant. Laparoscopic appendectomy is a safe procedure associated with low rates of complications, prolonged LOS, and readmissions. Risk factors for these adverse events include complicated appendicitis, postoperative morbidity, conversion, and re-intervention after the primary procedure. Any occurrence of these factors during treatment should alert the healthcare team to identify the patients that require more customized treatment to minimize the risk for adverse outcomes.

Incidence and impact of thromboembolic events in lung cancer patients treated with nivolumab.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20624-e20624
Author(s):  
Aparna Madhukeshwar Hegde ◽  
Chipman Robert Geoffrey Stroud ◽  
Cynthia R. Cherry ◽  
Meera Yogarajah ◽  
Sulochana Devi Cherukuri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Univariate Analysis ◽  
High Risk Population ◽  
Thromboembolic Events ◽  
Lung Cancer Patients ◽  
Established Risk Factor

e20624 Background: Lung cancer has one of the highest incidences of thromboembolic events (TEE) ranging from 8.4 to13.2%. Cisplatin-based chemotherapy in lung cancer is a well-established risk factor for TEE (11.8%). The incidence of TEE in lung cancer patients (pts) treated with nivolumab (nivo) is unclear. The objective of this study was to evaluate the incidence of TEE, risk factors and its impact on overall survival in lung cancer pts treated with nivo. Methods: This was a retrospective cohort study that included all lung cancer pts treated with nivo from April 2015 to October 2016 at our institution. Medical records were reviewed for incidence, timing, CTCAE grade, type and site of TEE, risk factors and patient demographics. Cox proportional hazard model was used to identify independent predictive factors for TEE. Risk factors with p <0.15 in univariate analysis were included in multivariate model using a stepwise approach. Kaplan-Meier method was used to estimate overall survival (OS). Results: The cumulative incidence (CI) of TEE over a median follow up of 10.8 months after starting nivo was 18.4% (14/76 pts). Of the 14 pts who had TEE, 8 had deep vein thrombosis (DVT), 7 had pulmonary embolism (PE), 1 had concurrent DVT/PE and 2 had arterial thrombosis (AT). 28.6% (4/14) of pts experienced recurrent TEE resulting in 18 total episodes. Median time to TEE after starting nivo was 2.9 months (95% CI 1.9 - 8.4). Gender was the only covariate included in multivariate analysis that showed a significant association with TEE (Female vs Male HR 3.1, 95% CI 1.02 – 9.5, p= 0.045). At a median follow up of 31.8 months since diagnosis of lung cancer, pts who had TEE before receiving nivo had worse OS. TEE occurring after nivo had no impact on OS. Conclusions: The CI of TEE is significantly high at 18.4% in lung cancer pts treated with nivo. However, it had no impact on OS. Further studies are needed to determine the role of prophylactic anticoagulation in this high-risk population. [Table: see text]

scholarly journals Total Ankle Arthroplasty: Risk Factors For Subsequent Flap Coverage

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0003
Author(s):  
Daniel J. Cunningham ◽  
Sean Ryan ◽  
Samuel B. Adams
Keyword(s):  
Risk Factors ◽  
Total Ankle Arthroplasty ◽  
Patient Specific ◽  
Wound Complications ◽  
Diabetes Diagnosis ◽  
Ankle Arthroplasty ◽  
Medical Comorbidities ◽  
Flap Coverage ◽  
Wound Breakdown ◽  
The Impact

Category: Ankle Arthritis; Ankle; Diabetes Introduction/Purpose: Total ankle arthroplasty (TAA) results in improved patient outcomes and preserved range of motion for patients with end-stage arthritis. Wound complications following these procedures, while rare, can have a significant impact on patient morbidity, particularly when they require return to the operating room and flap coverage. We sought to determine the risk factors associated with the need for flap coverage over TAA, and hypothesized that intraoperative variables such as additional procedures to provide angular correction would play a more important role than patient-specific variables. Methods: We performed a single center retrospective review of primary total ankle arthroplasties from April 2007 - February 2019. Patients demographics and medical comorbidities were collected in addition to concomitant procedures performed at the time of TAA such as tibial osteotomies, removal of hardware, and subtalar fusion. Multivariable, main effects logistic regression models were performed to evaluate the impact of specific concomitant procedures during primary TAA on the rate of subsequent flap coverage with adjustment for age, sex, and medical comorbidities. Results: 2,124 TAA resulted in 29 flaps after an average of 1.1 (range 0-5) surgeries and 89.7 (range 18-591) days after the index arthroplasty. The most common flap was a radial forearm free flap performed in 15 (51.7%) patients. Patients requiring flap coverage were significantly older (p=0.044), were more likely to be diabetic (p=0.029), and were more likely to present to the ED and be readmitted within 90-days of their surgery (p<0.001). In a multivariable model controlling for age, gender, and diabetes diagnosis, patients with flaps were more likely to have a concomitant osteotomy (OR 3.720, 95% CI 1.693-8.177; p=0.001) at the time of there TAA. Other concomitant procedures did not show a significant association with subsequent need for flap coverage. Conclusion: Simultaneous procedures during TAA may place patients at higher risk of wound breakdown, specifically requiring flap coverage. In particular, osteotomies, namely tibial osteotomies for realignment, carry a special risk for wound healing difficulty. This should be considered as the indications for TAA continue to expand. [Table: see text]

Evaluation of cost and survival in intracranial gliomas using the Value Driven Outcomes database: a retrospective cohort analysis

2020 ◽  
Vol 132 (4) ◽  
pp. 1006-1016
Author(s):  
Herschel Wilde ◽  
Mohammed A. Azab ◽  
Abdullah M. Abunimer ◽  
Hussam Abou-Al-Shaar ◽  
Michael Karsy ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Univariate Analysis ◽  
Tumor Resection ◽  
Healthcare Delivery ◽  
Cost Driver ◽  
Karnofsky Performance Scale ◽  
Who Grade ◽  
Variable Nature ◽  
Grade Iii

OBJECTIVEGliomas occur in 3–4 individuals per 100,000 individuals and are one of the most common primary brain tumors. Treatment options are limited for gliomas despite the progressive nature of the disease. The authors used the Value Driven Outcomes (VDO) database to identify cost drivers and subgroups that are involved in the surgical treatment of gliomas.METHODSA retrospective cohort of patients with gliomas treated at the authors’ institution from August 2011 to February 2018 was evaluated using medical records and the VDO database.RESULTSA total of 263 patients with intracranial gliomas met the authors’ inclusion criteria and were included in the analysis (WHO grade I: 2.0%; grade II: 18.5%; grade III: 18.1%; and grade IV: 61.4%). Facility costs were the major (64.4%) cost driver followed by supplies (16.2%), pharmacy (10.1%), imaging (4.5%), and laboratory (4.7%). Univariate analysis of cost contributors demonstrated that American Society of Anesthesiologists physical status (p = 0.002), tumor recurrence (p = 0.06), Karnofsky Performance Scale score (p = 0.002), length of stay (LOS) (p = 0.0001), and maximal tumor size (p = 0.03) contributed significantly to the total costs. However, on multivariate analysis, only LOS (p = 0.0001) contributed significantly to total costs. More extensive tumor resection in WHO grade III and IV tumors was associated with significant improvement in survival (p = 0.004 and p = 0.02, respectively).CONCLUSIONSUnderstanding care costs is challenging because of the highly complex, fragmented, and variable nature of healthcare delivery. Adopting effective strategies that would reduce facility costs and limit LOS is likely the most important aspect in reducing intracranial glioma treatment costs.

scholarly journals Impact of preoperative Karnofsky Performance Scale (KPS) and American Society of Anesthesiologists (ASA) scores on perioperative complications in patients with recurrent glioma undergoing repeated operation

2019 ◽  
Vol 7 (3) ◽  
pp. 143-152 ◽  
Author(s):  
Zhong Deng ◽  
Hai Yu ◽  
Ning Wang ◽  
Wahap Alafate ◽  
Jia Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Perioperative Complications ◽  
Tumor Resection ◽  
Recurrent Glioma ◽  
Cerebrospinal Fluid Leakage ◽  
Karnofsky Performance Scale ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Performance Scale

Objective:The objective of this study was to document the impact of the preoperative Karnofsky Performance Scale (KPS) and American Society of Anesthesiologists (ASA) scores on perioperative complications in patients with recurrent glioma who underwent tumor resection via craniotomy.Methods:A total of 96 patients were retrospectively reviewed. Based on KPS and ASA scores, patients were categorized into high KPS (> 70) or low KPS (≤ 70) and high ASA (3~4) or low ASA (1~2) groups. Differences in intraoperative risk factors and perioperative complications among the groups were analyzed. Multivariate analysis was performed to identify risk factors for perioperative complications.Results:The most frequent perioperative complications were cerebrospinal fluid leakage (31.8%) and intracranial infection (27.0%); 30-day mortality was 5.2%. The incidence rates of severe complications, central nervous system complications, and total complications were comparable in the low and high KPS groups and in the low and high ASA groups (all p > 0.05). Multivariate analysis showed that low KPS and high ASA scores were not the independent risk factors for perioperative complications.Conclusion:Low KPS and high ASA scores are not associated with increased postoperative complications in patients with recurrent glioma who undergo tumor resection via craniotomy.

scholarly journals Risk factors for hydrocephalus following fourth ventricle tumor surgery: A retrospective analysis of 121 patients

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241853
Author(s):  
Tengyun Chen ◽  
Yanming Ren ◽  
Chenghong Wang ◽  
Bowen Huang ◽  
Zhigang Lan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Retrospective Analysis ◽  
Fourth Ventricle ◽  
Univariate Analysis ◽  
Tumor Resection ◽  
Tumor Location ◽  
Subtotal Resection ◽  
Independent Risk Factors ◽  
Postoperative Hydrocephalus

Background and aim Most patients who present with a fourth ventricle tumor have concurrent hydrocephalus, and some demonstrate persistent hydrocephalus after tumor resection. There is still no consensus on the management of hydrocephalus in patients with fourth ventricle tumor after surgery. The purpose of this study was to identify the factors that predispose to postoperative hydrocephalus and the need for a postoperative cerebrospinal fluid (CSF) diversion procedure. Materials and methods We performed a retrospective analysis of patients who underwent surgery of the fourth ventricle tumor between January 2013 and December 2018 at the Department of Neurosurgery in West China Hospital of Sichuan University. The characteristics of patients and the tumor location, tumor size, tumor histology, and preventive external ventricular drainage (EVD) that were potentially correlated with CSF circulation were evaluated in univariate and multivariate analysis. Results A total of 121 patients were enrolled in our study; 16 (12.9%) patients underwent postoperative CSF drainage. Univariate analysis revealed that superior extension (p = 0.004), preoperative hydrocephalus (p<0.001), and subtotal resection (p<0.001) were significantly associated with postoperative hydrocephalus. Multivariate analysis revealed that superior extension (p = 0.013; OR = 44.761; 95% CI 2.235–896.310) and subtotal resection (p = 0.005; OR = 0.087; 95% CI 0.016–0.473) were independent risk factors for postoperative hydrocephalus after resection of fourth ventricle tumor. Conclusion Superior tumor extension (into the aqueduct) and failed total resection of tumor were identified as independent risk factors for postoperative hydrocephalus in patients with fourth ventricle tumor.

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