Postoperative facial palsy after pediatric posterior fossa tumor resection

OBJECTIVE Facial palsy can be caused by masses within the posterior fossa and is a known risk of surgery for tumor resection. Although well documented in the adult literature, postoperative facial weakness after posterior fossa tumor resection in pediatric patients has not been well studied. The objective of this work was to determine the incidence of postoperative facial palsy after tumor surgery, and to investigate clinical and radiographic risk factors. METHODS A retrospective analysis was conducted at a single large pediatric hospital. Clinical, radiographic, and histological data were examined in children who were surgically treated for posterior fossa tumors between May 1, 1994, and June 1, 2011. The incidence of postoperative facial weakness was documented. A multivariate logistic regression model was used to analyze the predictive ability of clinicoradiological variables for facial weakness. RESULTS A total of 163 patients were included in this study. The average age at surgery was 7.4 ± 4.7 years, and tumor pathologies included astrocytoma (44%), medulloblastoma (36%), and ependymoma (20%). The lesions of 27 patients (17%) were considered high grade in nature. Thirteen patients (8%) exhibited preoperative symptoms of facial palsy. The overall incidence of postoperative facial palsy was 26% (43 patients), and the incidence of new postoperative facial palsy in patients without preoperative facial weakness was 20% (30 patients). The presence of a preoperative facial palsy had a large and significant effect in univariate analysis (OR 11.82, 95% CI 3.07–45.44, p < 0.01). Multivariate logistic regression identified recurrent operation (OR 4.45, 95% CI 1.49–13.30, p = 0.01) and other preoperative cranial nerve palsy (CNP; OR 3.01, 95% CI 1.24–7.29, p = 0.02) as significant risk factors for postoperative facial weakness. CONCLUSIONS Facial palsy is a risk during surgical resection of posterior fossa brain tumors in the pediatric population. The study results suggest that the incidence of new postoperative facial palsy can be as high as 20%. The presence of preoperative facial palsy, an operation for recurrent tumor, and the presence of other preoperative CNPs were found to be significant risk factors for postoperative facial weakness.

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Risk factors associated with stillbirth of piglets born from oxytocin-assisted parturitions

Veterinary World ◽

10.14202/vetworld.2020.2172-2177 ◽

2020 ◽

Vol 13 (10) ◽

pp. 2172-2177

Author(s):

Nguyen Hoai Nam ◽

Peerapol Sukon

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Models ◽

Significant Risk ◽

Gestation Length ◽

Stillbirth Rate ◽

Multivariate Logistic Regression ◽

Crown Rump Length ◽

Logistic Regression Models ◽

Factors Associated

Aim: The present study aimed to investigate the effects of different risk factors on stillbirth of piglets born from oxytocin-assisted parturitions. Materials and Methods: Data were collected from a total of 1121 piglets born from 74 Landrace x Yorkshire crossbred sows from a herd. Logistic regression models were used to determine the associations between stillbirth and different risk factors including parity (1, 2, 3-5, and 6-10), gestation length (GL) (112-113, 114-116, and 117-119 days), litter size, birth order (BO), sex, birth interval (BI), cumulative farrowing duration, birth weight (BW), crown rump length, BW deviation, body mass index, ponderal index (PI), and the use of oxytocin during expulsive stage of farrowing. Results: The incidence of stillbirth at litter level and stillbirth rate was 59.5% (44/74) and 8.1% (89/1094), respectively. The final multivariate logistic regression selected BO, BI, PI, GL, and parity as the five most significant risk factors for stillbirth. Increased BO and BI, GL <114 and >116 days, parity 6-10, and low PI increased the stillbirth rate in piglets. Conclusion: Several factors previously determined as risks for stillbirth in exogenous oxytocin-free parturitions also existed in exogenous oxytocin-assisted parturitions. One dose of oxytocin at fairly high BO did not increase stillbirth, whereas two doses of oxytocin were potentially associated with increased values.

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Graft dural closure is associated with a reduction in CSF leak and hydrocephalus in pediatric patients undergoing posterior fossa brain tumor resection

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.9.peds1939 ◽

2020 ◽

Vol 25 (3) ◽

pp. 228-234

Author(s):

Andrew T. Hale ◽

Stephen R. Gannon ◽

Shilin Zhao ◽

Michael C. Dewan ◽

Ritwik Bhatia ◽

...

Keyword(s):

Logistic Regression ◽

Wound Infection ◽

Posterior Fossa ◽

Pediatric Patients ◽

Tumor Resection ◽

Csf Leak ◽

Multivariate Logistic Regression ◽

Dural Closure ◽

Csf Diversion ◽

Persistent Hydrocephalus

OBJECTIVEThe authors aimed to evaluate clinical, radiological, and surgical factors associated with posterior fossa tumor resection (PFTR)–related outcomes, including postoperative complications related to dural augmentation (CSF leak and wound infection), persistent hydrocephalus ultimately requiring permanent CSF diversion after PFTR, and 90-day readmission rate.METHODSPediatric patients (0–17 years old) undergoing PFTR between 2000 and 2016 at Monroe Carell Jr. Children’s Hospital of Vanderbilt University were retrospectively reviewed. Descriptive statistics included the Wilcoxon signed-rank test to compare means that were nonnormally distributed and the chi-square test for categorical variables. Variables that were nominally associated (p < 0.05) with each outcome by univariate analysis were included as covariates in multivariate linear regression models. Statistical significance was set a priori at p < 0.05.RESULTSThe cohort consisted of 186 patients with a median age at surgery of 6.62 years (range 3.37–11.78 years), 55% male, 83% Caucasian, and average length of follow-up of 3.87 ± 0.25 years. By multivariate logistic regression, the variables primary dural closure (PDC; odds ratio [OR] 8.33, 95% confidence interval [CI] 1.07–100, p = 0.04), pseudomeningocele (OR 7.43, 95% CI 2.23–23.76, p = 0.0007), and hydrocephalus ultimately requiring permanent CSF diversion within 90 days of PFTR (OR 9.25, 95% CI 2.74–31.2, p = 0.0003) were independently associated with CSF leak. PDC versus graft dural closure (GDC; 35% vs 7%, OR 5.88, 95% CI 2.94–50.0, p = 0.03) and hydrocephalus ultimately requiring permanent CSF diversion (OR 3.30, 95% CI 1.07–10.19, p = 0.0007) were associated with wound infection requiring surgical debridement. By multivariate logistic regression, GDC versus PDC (23% vs 37%, OR 0.13, 95% CI 0.02–0.87, p = 0.04) was associated with persistent hydrocephalus ultimately requiring permanent CSF diversion, whereas pre- or post-PFTR ventricular size, placement of peri- or intraoperative extraventricular drain (EVD), and radiation therapy were not. Furthermore, the addition of perioperative EVD placement and dural closure method to a previously validated predictive model of post-PFTR hydrocephalus improved its performance from area under the receiver operating characteristic curve of 0.69 to 0.74. Lastly, the authors found that autologous (vs synthetic) grafts may be protective against persistent hydrocephalus (p = 0.02), but not CSF leak, pseudomeningocele, or wound infection.CONCLUSIONSThese results suggest that GDC, independent of potential confounding factors, may be protective against CSF leak, wound infection, and hydrocephalus in patients undergoing PFTR. Additional studies are warranted to further evaluate clinical and surgical factors impacting PFTR-associated complications.

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Incidence and Risk Factors of Delayed Facial Palsy After Vestibular Schwannoma Resection

Neurosurgery ◽

10.1227/neu.0000000000001015 ◽

2015 ◽

Vol 78 (2) ◽

pp. 251-255 ◽

Cited By ~ 10

Author(s):

Lucas P. Carlstrom ◽

William R. Copeland ◽

Brian A. Neff ◽

Marina L. Castner ◽

Colin L.W. Driscoll ◽

...

Keyword(s):

Risk Factors ◽

Vestibular Schwannoma ◽

Facial Palsy ◽

Tumor Resection ◽

Normal Function ◽

Early Postoperative Period ◽

Facial Nerve Function ◽

Facial Weakness ◽

Facial Function ◽

Study Inclusion

ABSTRACT BACKGROUND: Preservation of facial nerve function following vestibular schwannoma surgery is a high priority. Even those patients with normal to near-normal function in the early postoperative period remain at risk for delayed facial palsy (DFP). OBJECTIVE: To evaluate the incidence and prognosis of DFP and to identify risk factors for its occurrence. METHODS: A retrospective cohort study of 489 patients who underwent vestibular schwannoma resection at our institution between 2000 and 2014. Delayed facial palsy was defined as deterioration in facial function of at least 2 House-Brackmann (HB) grades between postoperative days 5 to 30. Only patients with a HB grade of I to III by postoperative day 5 were eligible for study inclusion. RESULTS: One hundred twenty-one patients with HB grade IV to VI facial weakness at postoperative day 5 were excluded from analysis. Of the remaining 368, 60 (16%) patients developed DFP (mean 12 days postoperatively, range: 5-25 days). All patients recovered function to HB grade I to II by a mean of 33 days (range: 7-86 days). Patients that developed DFP had higher rates of gross total resections (83% vs 71%, P = .05) and retrosigmoid approaches (72% vs 52%, P < .01). There was no difference in recovery time between patients who received treatment with steroids, steroids with antivirals, or no treatment at all (P = .530). CONCLUSION: Patients with a gross total tumor resection or undergoing a retrosigmoid approach may be at higher risk of DFP. The prognosis is favorable, with patients likely recovering to normal or near-normal facial function within 1 month of onset.

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Incidence and Risk Factors for Severe Thrombocytopenia in Lymphoma Patients Receiving Chemotherapy.

Blood ◽

10.1182/blood.v108.11.3994.3994 ◽

2006 ◽

Vol 108 (11) ◽

pp. 3994-3994

Author(s):

Auris Huen ◽

Xiao Zhou ◽

Shyam Teegala ◽

Yuan Ji ◽

Luis Fayad ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Medical Records ◽

Cell Lymphoma ◽

Significant Risk ◽

Severe Thrombocytopenia ◽

Multivariate Logistic Regression ◽

Prior Therapy ◽

Burkitts Lymphoma ◽

Grade 3

Abstract Background: Severe thrombocytopenia (TCP) can be a serious complication of chemotherapy (CT) in lymphoma patients (pts), however the exact incidence with the current regimens and risk factors for TCP are not well known. Methods: A retrospective cohort study was conducted to determine the incidence of TCP, and logistic regression analysis were performed to identify the clinical and laboratory features correlated with severe TCP in lymphoma. Medical records of 538 consecutive pts out of the 1050 lymphoma pts, who were newly referred to MDACC in 2003, were reviewed. Results: 202 pts who received > 1 cycle of treatment were included in the analysis. The total number of CT cycles (with PLT counts) for the 202 pts was 985 (median 6, range, 1–20). Grade (gr) 4 TCP (PLT nadir < 25x103/μL) was observed in 39% (79/202) of pts and 20% (196/985) of cycles. The median cycle in which gr 4 TCP occurred was 2 (range, 1 to 11), and median PLT nadir count for gr 4 TCP was 12x103/μL (3 to 24x103/μL). The regimens most commonly associated with gr 4 TCP were Hyper-CVAD/ Ara-c/Mtx (31/35=89%), ESHAP (6/7=86%), ASHAP (3/4=75%), and ICE (5/7=71%) + rituxan, and the most common histological subtypes were MCL (15/19=79%), Burkitts lymphoma (7/9=78%), T cell lymphoma (10/17=58%), and LCL (31/64=48%). Thirty two of 79 (41%) gr 4 TCP pts had bleeding as compared to 8 of 123 (7%) pts with higher PLT counts (p=0.0001). Overall, the incidence of bleeding was 20% (40/202) by pts and 6% (60/985) by cycles; however, the most incidents [95% (57/60)] were minor. 80% (63/79) of Grade 4 TCP pts received PLT transfusions, as compared to only 2% (2/123) of the rest (p<0.0001). Using multivariate logistic regression, histological gr, (highly aggressive or aggressive vs indolent: OR=10.402, 95% CI, 3.991 to 27.107, p<0.0001), baseline PLT count (≤150 vs >150x103/μL: OR=4.610, 95% CI, 1.366 to 15.560, p=0.0138), prior therapy (yes vs. no: OR=2.575, 95% CI, 1.337 to 4.961, p=0.0047), Beta2 Microglobulin (B2M) (≥2 vs <2mg/L: OR=2.846, 95% CI, 1.401 to 5.783, p=0.0038), age (>60 vs. ≤60 yrs: OR=0.479, 95% CI, 0.241 to 0.952, p=0.0356) were the most important risk factors for grade 3 or 4 TCP. Conclusions: The incidence of severe TCP in this population is high. Baseline pt characteristics including histological gr, PLT counts, prior therapy, age and serum B2M were found to be significant risk factors predictive for chemotherapy-induced TCP (CIT). These findings could be useful to identify high risk pts for consideration of treatment approaches for prevention and treatment of CIT.

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Development and Validation of a Novel Nomogram to Predict Lymph Node Involvement in T1 Stage Lung Adenocarcinoma.

10.21203/rs.3.rs-40792/v1 ◽

2020 ◽

Author(s):

Jianjun Wang ◽

Li Wei ◽

Jiwei Li ◽

Quan Zhang ◽

Zeheng Ma

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Lymph Node ◽

Lung Adenocarcinoma ◽

Bootstrap Method ◽

Significant Risk ◽

Lymph Node Involvement ◽

Tumor Diameter ◽

Multivariate Logistic Regression ◽

Lymph Node Swelling

Abstract A total of 326 patients with T1 lung adenocarcinoma from March 2012 to April 2016 in our center were included. The relationship between LNI and different risk factors were accessed by univariate and multivariate logistic regression analyses. Four significant risk factors identified by multivariate logistic regression were tumor diameter (OR = 2.175, 95%CI:1.277–3.072, p = 0.0045), lymph node swelling exist preoperative (OR = 6.144, 95%CI:6.947–14.059, p = 0.003), platelet to lymphocyte ratio (OR = 3.149, 95%CI:1.546–6.673, p = 0.003), CEA (OR = 4.375, 95%CI: 2.613–7.537, p = 0.00694). A nomogram was constructed by combing risk factors and validated with an internal set. The C-index of this nomogram was 0.875, which was validated by bootstrap method. At last we concluded that the novel nomogram showed the potential value of LNI prediction for lung adenocarcinoma.

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Risk factors for neutropenic fever in lymphoma patients receiving chemotherapy

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.19616 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 19616-19616 ◽

Cited By ~ 1

Author(s):

S. R. Teegala ◽

X. Zhou ◽

A. Huen ◽

Y. Ji ◽

L. E. Fayad ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

High Risk ◽

Medical Records ◽

Significant Risk ◽

Neutropenic Fever ◽

Baseline Risk ◽

Multivariate Logistic Regression ◽

Number Of Cycles

19616 Background: Neutropenic fever (NF) can be a serious complication of chemotherapy (CT) in lymphoma patients (pts), however the exact incidence with the current regimens and risk factors for NF are not well known. Methods: A retrospective cohort study was conducted to determine the incidence of NF, and logistic regression analysis were performed to identify the clinical and laboratory features correlated with NF in lymphoma. Medical records of all newly referred lymphoma pts (n=1046) in 2003 were reviewed. Results: 425 pts who received ≥ 1 cycle of treatment at MDACC were included in the analysis. Median age was 57 (range 17–87) with 262 (62%) newly diagnosed. Most common first regimens were (± rituxan) CHOP (29%), Hyper-CVAD ± Ara-c-MTX (23%), and ABVD (8%), with the total number of cycles were 1638 (median 3, range, 1–10). NF was observed in 23 % (97/425) of pts and 8 % (123/1638) of cycles, with the highest number in cycle 1 (49/123). The NF incidence among most common regimens were (± rituxan) Hyper-CVAD/ Ara-c/MTX 53% (31/58), Hyper-CVAD 24% (9/37), CHOP 22% (27/125), and ABVD 6% (2/34), and most common subtypes were MCL (33%), LCL (23%), HD (16%), and FL (13%). In the univariate regression analysis, CT, Hb, Ca, LDH, lymphocyte (ALC) and neutrophil (ANC) counts, were significantly associated with the NF. Using multivariate logistic regression, baseline ALC count (=1000 vs. >1000/μL: OR=2.251, 95% CI, 1.194 to 4.244, p=0.0121), Hb (<12 g/dL vs. ≥ 12g/dL: OR=2.117, 95% CI, 1.122 to 3.996, p=0.0207), age (>60 vs. ≤60: OR=2.035, 95% CI, 1.066 to 3.884, p=0.0312), CT (high vs. low risk: OR=2.913, 95% CI, 1.520 to 5.583, p=0.0013) were the most important baseline risk factors for NF in cycle-1. Conclusions: The incidence of NF in this population is high in cycle 1. Baseline pt characteristics including old age, high risk CT, low ALC and Hb were found to be significant risk factors predictive for NF in cycle-1. These findings could be useful to identify high risk pts for consideration of treatment approaches for prevention of NF. No significant financial relationships to disclose.

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Short-Term Outcomes Following Removal of Infected Hernia Mesh

The American Surgeon ◽

10.1177/00031348211024189 ◽

2021 ◽

pp. 000313482110241

Author(s):

Christine Tung ◽

Junko Ozao-Choy ◽

Dennis Y. Kim ◽

Christian de Virgilio ◽

Ashkan Moazzez

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Logistic Regression ◽

Body Mass ◽

Smoking History ◽

Multivariate Logistic Regression ◽

Short Term ◽

Mesh Removal ◽

Mesh Placement ◽

Infected Mesh

There are limited studies regarding outcomes of replacing an infected mesh with another mesh. We reviewed short-term outcomes following infected mesh removal and whether placement of new mesh is associated with worse outcomes. Patients who underwent hernia repair with infected mesh removal were identified from 2005 to 2018 American College of Surgeons-National Surgical Quality Improvement Program database. They were divided into new mesh (Mesh+) or no mesh (Mesh-) groups. Bivariate and multivariate logistic regression analyses were used to compare morbidity between the two groups and to identify associated risk factors. Of 1660 patients, 49.3% received new mesh, with higher morbidity in the Mesh+ (35.9% vs. 30.3%; P = .016), but without higher rates of surgical site infection (SSI) (21.3% vs. 19.7%; P = .465). Mesh+ had higher rates of acute kidney injury (1.3% vs. .4%; P = .028), UTI (3.1% vs. 1.3%, P = .014), ventilator dependence (4.9% vs. 2.4%; P = .006), and longer LOS (8.6 vs. 7 days, P < .001). Multivariate logistic regression showed new mesh placement (OR: 1.41; 95% CI: 1.07-1.85; P = .014), body mass index (OR: 1.02; 95% CI: 1.00-1.03; P = .022), and smoking (OR: 1.43; 95% CI: 1.05-1.95; P = .025) as risk factors independently associated with increased morbidity. New mesh placement at time of infected mesh removal is associated with increased morbidity but not with SSI. Body mass index and smoking history continue to contribute to postoperative morbidity during subsequent operations for complications.

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Risk factors for tissue expander infection in scar reconstruction: a retrospective cohort study of 2374 consecutive cases

Burns & Trauma ◽

10.1093/burnst/tkaa037 ◽

2020 ◽

Vol 8 ◽

Author(s):

Chen Dong ◽

Minhui Zhu ◽

Luguang Huang ◽

Wei Liu ◽

Hengxin Liu ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Treatment Failure ◽

Logistic Regression Analysis ◽

Disease Duration ◽

Multivariate Logistic Regression Analysis ◽

Tissue Expansion ◽

Multivariate Logistic Regression ◽

Hematoma Evacuation

Abstract Background Tissue expansion is used for scar reconstruction owing to its excellent clinical outcomes; however, the complications that emerge from tissue expansion hinder repair. Infection is considered a major complication of tissue expansion. This study aimed to analyze the perioperative risk factors for expander infection. Methods A large, retrospective, single-institution observational study was carried out over a 10-year period. The study enrolled consecutive patients who had undergone tissue expansion for scar reconstruction. Demographics, etiological data, expander-related characteristics and postoperative infection were assessed. Univariate and multivariate logistic regression analysis were performed to identify risk factors for expander infection. In addition, we conducted a sensitivity analysis for treatment failure caused by infection as an outcome. Results A total of 2374 expanders and 148 cases of expander infection were assessed. Treatment failure caused by infection occurred in 14 expanders. Multivariate logistic regression analysis identified that disease duration of ≤1 year (odds ratio (OR), 2.07; p < 0.001), larger volume of expander (200–400 ml vs <200 ml; OR, 1.74; p = 0.032; >400 ml vs <200 ml; OR, 1.76; p = 0.049), limb location (OR, 2.22; p = 0.023) and hematoma evacuation (OR, 2.17; p = 0.049) were associated with a high likelihood of expander infection. Disease duration of ≤1 year (OR, 3.88; p = 0.015) and hematoma evacuation (OR, 10.35; p = 0.001) were so related to high risk of treatment failure. Conclusions The rate of expander infection in patients undergoing scar reconstruction was 6.2%. Disease duration of <1 year, expander volume of >200 ml, limb location and postoperative hematoma evacuation were independent risk factors for expander infection.

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