scholarly journals Analysis of overlapping surgery in patients undergoing microsurgical aneurysm clipping: acute and long-term outcomes from the Barrow Ruptured Aneurysm Trial

2018 ◽  
Vol 129 (3) ◽  
pp. 711-717 ◽  
Author(s):  
Michael A. Mooney ◽  
Scott Brigeman ◽  
Michael A. Bohl ◽  
Elias D. Simon ◽  
John P. Sheehy ◽  
...  
Keyword(s):  
Smoking Status ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Ruptured Aneurysm ◽  
Long Term Outcomes ◽  
Microsurgical Clipping ◽  
Fisher Grade ◽  
Medicine Today ◽  
Saccular Aneurysms

OBJECTIVEOverlapping surgery is a controversial subject in medicine today; however, few studies have examined the outcomes of this practice. The authors analyzed outcomes of patients with acutely ruptured saccular aneurysms who were treated with microsurgical clipping in a prospectively collected database from the Barrow Ruptured Aneurysm Trial. Acute and long-term outcomes for overlapping versus nonoverlapping cases were compared.METHODSDuring the study period, 241 patients with ruptured saccular aneurysms underwent microsurgical clipping. Patients were separated into overlapping (n = 123) and nonoverlapping (n = 118) groups based on surgical start/stop times. Outcomes at discharge and at 6 months, 1 year, 3 years, and 6 years after surgery were analyzed.RESULTSPatient variables (e.g., age, smoking status, cardiovascular history, Hunt and Hess grade, Fisher grade, and aneurysm size) were similar between the 2 groups. Aneurysm locations were similar, with the exception of the overlapping group having more posterior circulation aneurysms (18/123 [15%]) than the nonoverlapping group (8/118 [7%]) (p = 0.0495). Confirmed aneurysm obliteration at discharge was significantly higher for the overlapping group (109/119 [91.6%]) than for the nonoverlapping group (95/116 [81.9%]) (p = 0.03). Hospital length of stay, discharge location, and proportions of patients with a modified Rankin Scale (mRS) score > 2 at discharge and up to 6 years postoperatively were similar. The mean and median mRS, Glasgow Outcome Scale, Mini–Mental State Examination, National Institutes of Health Stroke Scale, and Barthel Index scores at all time points were not statistically different between the groups.CONCLUSIONSCompared with nonoverlapping surgery, overlapping surgery was not associated with worse outcomes for any variable at any time point, despite the complexity of the surgical management in this patient population. These findings should be considered during the discussion of future guidelines on the practice of overlapping surgery.

Saccular aneurysms in the post–Barrow Ruptured Aneurysm Trial era

2021 ◽  
pp. 1-8
Author(s):  
Joshua S. Catapano ◽  
Mohamed A. Labib ◽  
Visish M. Srinivasan ◽  
Candice L. Nguyen ◽  
Kavelin Rumalla ◽  
...  
Keyword(s):  
Aneurysmal Subarachnoid Hemorrhage ◽  
Endovascular Embolization ◽  
Endovascular Intervention ◽  
Ruptured Aneurysm ◽  
Endovascular Coiling ◽  
Neurological Outcomes ◽  
Microsurgical Clipping ◽  
Poor Neurological Outcome ◽  
Technical Advances ◽  
Saccular Aneurysms

OBJECTIVE The Barrow Ruptured Aneurysm Trial (BRAT) was a single-center trial that compared endovascular coiling to microsurgical clipping in patients treated for aneurysmal subarachnoid hemorrhage (aSAH). However, because patients in the BRAT were treated more than 15 years ago, and because there have been advances since then—particularly in endovascular techniques—the relevance of the BRAT today remains controversial. Some hypothesize that these technical advances may reduce retreatment rates for endovascular intervention. In this study, the authors analyzed data for the post-BRAT (PBRAT) era to compare microsurgical clipping with endovascular embolization (coiling and flow diverters) in the two time periods and to examine how the results of the original BRAT have influenced the practice of neurosurgeons at the study institution. METHODS In this retrospective cohort study, the authors evaluated patients with saccular aSAHs who were treated at a single quaternary center from August 1, 2007, to July 31, 2019. The saccular aSAH diagnoses were confirmed by cerebrovascular experts. Patients were separated into two cohorts for comparison on the basis of having undergone microsurgery or endovascular intervention. The primary outcome analyzed for comparison was poor neurological outcome, defined as a modified Rankin Scale (mRS) score > 2. The secondary outcomes that were compared included retreatment rates for both therapies. RESULTS Of the 1014 patients with aSAH during the study period, 798 (79%) were confirmed to have saccular aneurysms. Neurological outcomes at ≥ 1-year follow-up did not differ between patients treated with microsurgery (n = 451) and those who received endovascular (n = 347) treatment (p = 0.51). The number of retreatments was significantly higher among patients treated endovascularly (32/347, 9%) than among patients treated microsurgically (6/451, 1%) (p < 0.001). The retreatment rate after endovascular treatment was lower in the PBRAT era (9%) than in the BRAT (18%). CONCLUSIONS Similar to results from the BRAT, results from the PBRAT era showed equivalent neurological outcomes and increased rates of retreatment among patients undergoing endovascular embolization compared with those undergoing microsurgery. However, the rate of retreatment after endovascular intervention was much lower in the PBRAT era than in the BRAT.

Rib Fracture Stabilization in Patients Sustaining Blunt Chest Injury

2006 ◽  
Vol 72 (4) ◽  
pp. 307-309 ◽  
Author(s):  
Ram Nirula ◽  
Brian Allen ◽  
Ralph Layman ◽  
Mark E. Falimirski ◽  
Lewis B. Somberg
Keyword(s):  
Hospital Length ◽  
Rib Fracture ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Chest Injuries ◽  
Fracture Stabilization ◽  
Matched Case ◽  
The Impact ◽  
Control Study

Conservative management for the majority of patients with severe chest injuries has produced a reduction in mortality, complications, and hospital length of stay. More recently, operative stabilization of rib fractures has been used with the implication of improved outcome. We assessed the impact of operative rib fracture stabilization on outcome among trauma patients. A matched case-control study of patients undergoing operative rib fracture stabilization was performed. Thirty patients undergoing rib stabilization were matched with 30 controls. Length of intensive care unit (controls, 14.1 ± 2.7 vs cases, 12.1 ± 1.2, P = 0.51) and total hospital (controls, 21.1 ± 3.9 vs cases, 18.8 ± 1.8, P = 0.59) stay were similar for both groups. There was a trend toward fewer total ventilator days for operative patients (6.5 ± 1.3 days vs 11.2 ± 2.6 days, P = 0.12). Ventilator days for operative patients from the time of stabilization was 2.9 ± 0.6 days compared with 9.4 ± 2.7 days in controls (P = 0.02). Rib fracture fixation may reduce ventilator requirements in trauma patients with severe thoracic injuries. Long-term functional outcomes need to be assessed to ascertain the impact of this procedure.

scholarly journals Long-term results of middle cerebral artery aneurysm clipping in the Barrow Ruptured Aneurysm Trial

2019 ◽  
Vol 130 (3) ◽  
pp. 895-901 ◽  
Author(s):  
Michael A. Mooney ◽  
Elias D. Simon ◽  
Scott Brigeman ◽  
Peter Nakaji ◽  
Joseph M. Zabramski ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Clinical Outcomes ◽  
Cerebral Artery ◽  
Long Term Results ◽  
Ruptured Aneurysm ◽  
Microsurgical Clipping ◽  
Mca Aneurysm

OBJECTIVEA direct comparison of endovascular versus microsurgical treatment of ruptured middle cerebral artery (MCA) aneurysms in randomized trials is lacking. As endovascular treatment strategies continue to evolve, the number of reports of endovascular treatment of these lesions is increasing. Herein, the authors report a detailed post hoc analysis of ruptured MCA aneurysms treated by microsurgical clipping from the Barrow Ruptured Aneurysm Trial (BRAT).METHODSThe cases of patients enrolled in the BRAT who underwent microsurgical clipping for a ruptured MCA aneurysm were reviewed. Characteristics of patients and their clinical outcomes and long-term angiographic results were analyzed.RESULTSFifty patients underwent microsurgical clipping of a ruptured MCA aneurysm in the BRAT, including 21 who crossed over from the endovascular treatment arm. Four patients with nonsaccular (e.g., dissecting, fusiform, or blister) aneurysms were excluded, leaving 46 patients for analysis. Most (n = 32; 70%) patients presented with a Hunt and Hess grade II or III subarachnoid hemorrhage, with a high prevalence of intraparenchymal blood (n = 23; 50%), intraventricular blood (n = 21; 46%), or both. At the last follow-up (up to 6 years after treatment), clinical outcomes were good (modified Rankin Scale score 0–2) in 70% (n = 19) of 27 Hunt and Hess grades I–III patients and in 36% (n = 4) of 11 Hunt and Hess grade IV or V patients. There were no instances of rebleeding after the surgical clipping of aneurysms in this series at the time of last clinical follow-up.CONCLUSIONSMicrosurgical clipping of ruptured MCA aneurysms has several advantages over endovascular treatment, including durability over time. The authors report detailed outcome data of patients with ruptured MCA aneurysms who underwent microsurgical clipping as part of a prospective, randomized trial. These results should be used for comparison with future endovascular and surgical series to ensure that the best results are being achieved for patients with ruptured MCA aneurysms.

Endoscopic thoracic microdiscectomy

2005 ◽  
Vol 3 (6) ◽  
pp. 459-464 ◽  
Author(s):  
Rod J. Oskouian ◽  
J. Patrick Johnson
Keyword(s):  
Hospital Length ◽  
Outcome Data ◽  
Hospital Length Of Stay ◽  
Content Type ◽  
Neurological Outcomes ◽  
Long Term Follow Up ◽  
Thoracic Disc ◽  
Fine Print

Object. The purpose of this clinical study was to evaluate prospectively surgical and neurological outcomes after endoscopic thoracic disc surgery. Methods. The authors assessed the following quantifiable outcome data in 46 patients: operative time, blood loss, duration of chest tube insertion, narcotic use, hospital length of stay (LOS), and long-term follow-up neurological function and pain-related symptoms. In patients who presented with myelopathy there was a postoperative improvement of two Frankel grades. Pain related to radiculopathy was improved by 75% and in one patient it worsened postoperatively. The authors also present operative data, surgical outcomes, and complications. Conclusions. Thoracoscopic discectomy can be used to achieve acceptable results. It has several distinct advantages such as reduced postoperative pain, morbidity, and LOS compared with traditional open procedures.

scholarly journals Smoking status at diagnosis and histology type as determinants of long-term outcomes of lung cancer patients

2012 ◽  
Vol 43 (5) ◽  
pp. 919-924 ◽  
Author(s):  
Michael Poullis ◽  
James McShane ◽  
Mathew Shaw ◽  
Michael Shackcloth ◽  
Richard Page ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Smoking Status ◽  
Long Term Outcomes ◽  
Lung Cancer Patients

scholarly journals Anticarbamylated protein antibodies are associated with long-term disability and increased disease activity in patients with early inflammatory arthritis: results from the Norfolk Arthritis Register

2015 ◽  
Vol 75 (6) ◽  
pp. 1139-1144 ◽  
Author(s):  
Jennifer H Humphreys ◽  
Marije K Verheul ◽  
Anne Barton ◽  
Alexander J MacGregor ◽  
Mark Lunt ◽  
...  
Keyword(s):  
Disease Activity ◽  
Random Effects ◽  
Inflammatory Arthritis ◽  
Smoking Status ◽  
Health Assessment ◽  
Joint Disease ◽  
Random Effects Model ◽  
Long Term Outcomes ◽  
Acpa Status

ObjectivesAnticarbamylated protein (anti-CarP) antibodies are a novel family of autoantibodies recently identified in patients with inflammatory arthritis. The aim of this study was to investigate their association with long-term outcomes of disability and disease activity over 20 years’ follow-up in a cohort of patients with inflammatory polyarthritis (IP).MethodsNorfolk Arthritis Register recruited adults with recent-onset swelling of ≥2 joints for ≥4 weeks from 1990 to 2009. At baseline, Health Assessment Questionnaire (HAQ) and 28 joint disease activity scores (DAS28) were obtained, and C reactive protein, rheumatoid factor (RF), anticitrullinated protein antibodies (ACPA) and anti-CarP antibodies were measured. Further HAQ scores and DAS28 were obtained at regular intervals over 20 years. Generalised estimating equations were used to test the association between anti-CarP antibody status and longitudinal HAQ and DAS28 scores; adjusting for age, gender, smoking status, year of inclusion and ACPA status. Analyses were repeated in subgroups stratified by ACPA status. The relative association of RF, ACPA and anti-CarP antibodies with HAQ and DAS28 scores was investigated using a random effects model.Results1995 patients were included; 1310 (66%) were female. Anti-CarP antibodies were significantly associated with more disability and higher disease activity, HAQ multivariate β-coefficient (95% CI) 0.12 (0.02 to 0.21), and these associations remained significant in the ACPA-negative subgroups. The associations of RF, ACPA and anti-CarP antibodies were found to be additive in the random effects model.ConclusionsAnti-CarP antibodies are associated with increased disability and higher disease activity in patients with IP. Our results suggest that measurement of anti-CarP antibodies may be useful in identifying ACPA-negative patients with worse long-term outcomes. Further, anti-CarP antibody status provided additional information about RF and ACPA.

scholarly journals Hospital outreach service: Helping to prevent nursing home placement

1998 ◽  
Vol 21 (4) ◽  
pp. 192 ◽  
Author(s):  
Phillip Bairstow ◽  
Sarah Ashe ◽  
Mary Bairstow
Keyword(s):  
Nursing Home ◽  
Length Of Stay ◽  
Health Service ◽  
Hospital Length ◽  
Nursing Home Placement ◽  
Hospital Length Of Stay ◽  
Advantages And Disadvantages ◽  
Outreach Service ◽  
Home Placement

An outreach service from a post-acute metropolitan teaching hospital delivered anintensive, multidisciplinary and coordinated allied health service, and achieved bothearly hospital discharge and the prevention or delay of nursing home placement. Thisarticle reports on three types of cases which illustrate how the service assisted wardteams, families and patients to determine whether nursing home placement wasessential. For a group of 20 cases, the total reduction in hospital length of stay was556 days, and home accommodation as an alternative to nursing homeaccommodation was achieved for a total of 7505 days. The article outlines a matrixof advantages and disadvantages, both tangible and intangible, of home versusnursing home accommodation. It is suggested that a full costing of this matrix wouldinform debate on the comparative merits of long-term home and nursing homeaccommodation.

Efficacy and Safety of Recurrent Paraesophageal Hernia Repair with Roux-en-Y Gastric Bypass

2020 ◽  
Vol 86 (3) ◽  
pp. 250-255 ◽  
Author(s):  
Matthew D. Spann ◽  
Noah J. Harrison ◽  
Wayne J. English ◽  
Aaron R. Bolduc ◽  
Chetan V. Aher ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Paraesophageal Hernia ◽  
Medication Use ◽  
Hospital Length ◽  
Acid Suppression ◽  
Hospital Length Of Stay ◽  
Sustained Weight Loss ◽  
Effective Option ◽  
One Year

Roux-en-Y gastric bypass (RYGB) has been explored as a revisional option to failed paraesophageal hernia (PEH) repair with fundoplication, particularly in patients suffering from obesity. However, few studies have assessed long-term outcomes of RYGB with revisional PEH repairin regard to acid-suppressing medication use. We retrospectively identified 19 patients who underwent revisional PEH repair with RYGB between 2011 and 2018. The median operative time was 232 minutes with a median hospital length of stay of two days. The median length of follow-up was 24 months. Two patients (10.5%) had complications in the first 30 days, and five patients (26.3%) had complications within one year. Of the 12 patients on preoperative acid suppression, 6 (50%) were either off medication or on reduced dose at 12 months. The median BMI decrease was 14.4 kg/m2 at 12 months and did not change significantly afterward. Although rates of acid-suppression medication use did not change overall after revisional PEH repair with RYGB, patients experienced successful long-term management of morbid obesity and sustained weight loss. Revisional PEH repair with RYGB is a safe and effective option, with a complication rate comparable with the reported rates after revisional foregut procedures such as revisional Nissen fundoplication.

scholarly journals Pain is vital in resuscitation in trauma

SICOT-J ◽  
2019 ◽  
Vol 5 ◽  
pp. 28
Author(s):  
Theodosios Saranteas ◽  
Andreas Kostroglou ◽  
Dimitrios Anagnostopoulos ◽  
Dimitrios Giannoulis ◽  
Pantelis Vasiliou ◽  
...  
Keyword(s):  
Vital Sign ◽  
Pain Treatment ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Emergency Setting ◽  
Short And Long Term ◽  
Early Healing

Implementation of the ATLS algorithm has remarkably improved the resuscitation of trauma patients and has significantly contributed to the systematic management of multi-trauma patients. However, pain remains the most prevalent complaint in trauma patients, and can induce severe complications, further deterioration of health, and death of the patient. Providing appropriate and timely pain management to these patients prompts early healing, reduces stress response, shortens hospital Length of Stay (LOS), diminishes chronic pain, and ultimately reduces morbidity and mortality. Pain has been proposed to be evaluated as the fifth vital sign and be recorded in the vital sign charts in order to emphasize the importance of pain on short- and long-term outcomes of the patients. However, although the quality of pain treatment seems to be improving we believe that pain has been underestimated in trauma. This article aims to provide evidence for the importance of pain in trauma, to support its management in the emergency setting and the acute phase of patients’ resuscitation, and to emphasize on the necessity to introduce the letter P (pain) in the ATLS alphabet.

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