scholarly journals Interhospital transfer status for spinal metastasis patients in the United States is associated with more severe clinical presentations and higher rates of inpatient complications

2021 ◽  
Vol 50 (5) ◽  
pp. E4
Author(s):  
Rafael De la Garza Ramos ◽  
Christine Park ◽  
Edwin McCray ◽  
Meghan Price ◽  
Timothy Y. Wang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Patient Outcomes ◽  
Surgical Intervention ◽  
Mortality Rates ◽  
Cord Compression ◽  
Interhospital Transfer ◽  
Clinical Presentations ◽  
Transferred Patients

OBJECTIVE In patients with metastatic spinal disease (MSD), interhospital transfer can potentially impact clinical outcomes as the possible benefits of transferring a patient to a higher level of care must be weighed against the negative effects associated with potential delays in treatment. While the association of clinical outcomes and transfer status has been examined in other specialties, the relationship between transfer status, complications, and risk of mortality in patients with MSD has yet to be explored. The purpose of this study was to examine the impact of transfer status on in-hospital mortality and clinical outcomes in patients diagnosed with MSD. METHODS The National (Nationwide) Inpatient Sample (NIS) database was retrospectively queried for adult patients diagnosed with vertebral pathological fracture and/or spinal cord compression in the setting of metastatic disease between 2012 and 2014. Demographics, baseline characteristics (e.g., metastatic spinal cord compression [MSCC] and paralysis), comorbidities, type of intervention, and relevant patient outcomes were controlled in a multivariable logistic regression model to analyze the association of transfer status with patient outcomes. RESULTS Within the 10,360 patients meeting the inclusion and exclusion criteria, higher rates of MSCC (50.2% vs 35.9%, p < 0.001) and paralysis (17.3% vs 8.4%, p < 0.001) were observed in patients transferred between hospitals compared to those directly admitted. In univariable analysis, a higher percentage of transferred patients underwent surgical intervention (p < 0.001) when compared with directly admitted patients. After controlling for significant covariates and surgical intervention, transferred patients were more likely to develop in-hospital complications (OR 1.34, 95% CI 1.18–1.52, p < 0.001), experience prolonged length of stay (OR 1.33, 95% CI 1.16–1.52, p < 0.001), and have a discharge disposition other than home (OR 1.70, 95% CI 1.46–1.98, p < 0.001), with no significant difference in inpatient mortality rates. CONCLUSIONS Patients with MSD who were transferred between hospitals demonstrated more severe clinical presentations and higher rates of inpatient complications compared to directly admitted patients, despite demonstrating no difference in in-hospital mortality rates.

Motor network recovery in patients with chronic spinal cord compression: a longitudinal study following decompression surgery

2018 ◽  
Vol 28 (4) ◽  
pp. 379-388 ◽  
Author(s):  
Kayla Ryan ◽  
Sandy Goncalves ◽  
Robert Bartha ◽  
Neil Duggal
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Surgical Intervention ◽  
Blood Oxygen Level Dependent ◽  
Cord Compression ◽  
Decompression Surgery ◽  
Blood Oxygen Level ◽  
Motor Network ◽  
Dependent Signal

OBJECTIVEThe authors used functional MRI to assess cortical reorganization of the motor network after chronic spinal cord compression and to characterize the plasticity that occurs following surgical intervention.METHODSA 3-T MRI scanner was used to acquire functional images of the brain in 22 patients with reversible cervical spinal cord compression and 10 control subjects. Controls performed a finger-tapping task on 3 different occasions (baseline, 6-week follow-up, and 6-month follow-up), whereas patients performed the identical task before surgery and again 6 weeks and 6 months after spinal decompression surgery.RESULTSAfter surgical intervention, an increased percentage blood oxygen level–dependent signal and volume of activation was observed within the contralateral and ipsilateral motor network. The volume of activation of the contralateral primary motor cortex was associated with functional measures both at baseline (r = 0.55, p < 0.01) and 6 months after surgery (r = 0.55, p < 0.01). The percentage blood oxygen level–dependent signal of the ipsilateral supplementary motor area 6 months after surgery was associated with increased function 6 months after surgery (r = 0.48, p < 0.01).CONCLUSIONSPlasticity of the contralateral and ipsilateral motor network plays complementary roles in maintaining neurological function in patients with spinal cord compression and may be critical in the recovery phase following surgery.

scholarly journals Clinical outcomes of late decompression surgery following cervical spinal cord injury with pre-existing cord compression

Spinal Cord ◽  
2017 ◽  
Vol 56 (4) ◽  
pp. 366-371
Author(s):  
Tsunehiko Konomi ◽  
Akimasa Yasuda ◽  
Kanehiro Fujiyoshi ◽  
Junichi Yamane ◽  
Shinjiro Kaneko ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Outcomes ◽  
Cervical Spinal Cord ◽  
Cord Compression ◽  
Cervical Spinal Cord Injury ◽  
Decompression Surgery ◽  
Cord Injury

Clinical outcomes of a Dutch prospective observational registry of metastatic castration resistant prostate cancer (mCRPC) patients treated with radium-223 (Ra-223).

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 323-323
Author(s):  
Rebecca Louhanepessy ◽  
Sushil Badrising ◽  
Vincent van der Noort ◽  
Jules L. L. M. Coenen ◽  
Paul Hamberg ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Clinical Outcomes ◽  
Spinal Cord Compression ◽  
Survival Data ◽  
Cord Compression ◽  
Subsequent Treatment ◽  
Castration Resistant Prostate Cancer ◽  
Bone Surgery ◽  
Radium 223 ◽  
Pathologic Fractures

323 Background: In 2012 the ALSYMPCA study established a 3.6 month Overall Survival (OS) benefit of mCRPC patients treated with Ra-223 over placebo. To date clinical outcomes of Ra-223 treatment in a non-study population have not been prospectively evaluated. Methods: The ROTOR registry aimed to include 300 patients in 20 Dutch hospitals prior to Ra-223 treatment at the physician’s discretion. Clinical parameters collected included: positioning of Ra-223, Adverse Events (AE’s; CTCAE v4.03), Skeletal Related Events (SRE) and survival data. SRE was defined as radiotherapy to a bone metastasis, a new pathological fracture, spinal cord compression and/or bone surgery. Progression-Free Survival (PFS) was defined as survival until radiological or clinical progression, subsequent treatment or death. Results: Between April 2014 and September 2017, 305 patients were included of whom 300 were evaluable. The mean age of patients was 72.6 (range 46.3-91.5) years, 255 (85%) had ≥ 6 bone metastases and 197 (65.5%) were pretreated with taxanes and/or abiraterone or enzalutamide (214 (71.3%)). Two-hundred and ninety (96.7%) patients were treated with Ra-223. Twenty-nine (9.7%), 104 (34.7%), 96 (32%) and 66 (22%) patients received Ra-223 as a first, second, third, ≥ fourth mCRPC treatment line, respectively. Patients received an average of 4.6 (SD 1.8) cycles of Ra-223, while 140 (46.7%) completed all six cycles. After a median follow-up of 13.2 months, PFS was 5.1 (CI 4.5-5.8) months and OS 15.2 (CI 12.8-17.6) months. Eighty-two (27.3%) patients were hospitalized during Ra-223 treatment (Serious AE). Grade ≥ 3 anemia, neutropenia and thrombocytopenia was found in 54 (18.0%), 8 (2.7%) and 11 (3.7%) patients, respectively. Other frequent AE’s (all grades) were nausea (90 (30%)), diarrhea (83 (27.7%)) and fatigue (178 (59.3%)). SREs were observed in 46 (15.3%) patients; 22 (7.3%) received radiotherapy, 6 (2%) developed pathologic fractures, 17 (5.6%) spinal cord compression and 1 (0.3%) received bone surgery during Ra-223 therapy. Conclusions: The non-study ROTOR population had characteristics, all grade AEs and OS comparable with the treatment arm of ALSYMPCA. Clinical trial information: NCT03223597.

Spinal neurocysticercosis

2002 ◽  
Vol 12 (6) ◽  
pp. 1-7 ◽  
Author(s):  
George A. Alsina ◽  
J. Patrick Johnson ◽  
Duncan Q. McBride ◽  
Patrick R. L. Rhoten ◽  
C. Mark Mehringer ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Medical Therapy ◽  
Subarachnoid Space ◽  
Surgical Intervention ◽  
Parasitic Infection ◽  
Mass Effect ◽  
Cord Compression ◽  
Limited Size ◽  
Improved Outcomes ◽  
The Central Nervous System

Worldwide, cysticercosis is the most common parasitic infection of the central nervous system. In endemic regions, the incidence of neurocysticercosis (NCC) approaches 4% of the general population. The disease is predominantly intracranial, the authors of most series generally report the incidence of spinal NCC as only 1.5 to 3% of all cases. Although spinal NCC is relatively rare, it represents a distinct clinical entity that can have devastating consequences for the patient. Because of the limited size of the spinal canal, the mass effect of these lesions is poorly tolerated. Most spinal NCC occurs in the subarachnoid space where mass effect can cause spinal cord compression, although obstruction of cerebrospinal fluid pathways due to scarring of the subarachnoid space can also cause symptoms. The authors treated six patients with spinal NCC. In five cases the lesions were located in the subarachnoid space, and in one the lesion was intramedullary. All patients with subarachnoid spinal NCC required excision of the symptomatic lesions; in two cases initial medical therapy had failed. The patient with intramedullary spinal NCC experienced mild symptoms and underwent steroid therapy. All patients experienced variably improved outcomes and were eventually ambulatory. Medical therapy should be carefully considered in selected patients in whom symptoms are stable and nonprogressive. Surgical intervention is required when severe or progressive deficits occur to prevent permanent injury. In some patients recovery may be limited as a result of inflammatory injury to the spinal cord or arachnoidal adhesions.

A cost-utility analysis of surgical intervention in metastatic spinal cord compression (MSCC)

2016 ◽  
Vol 16 (4) ◽  
pp. S62
Author(s):  
Bilal A.S. Chaudhry ◽  
Naveed Yasin ◽  
Saeed Mohammad ◽  
Rajat Verma ◽  
Irfan Siddique
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Surgical Intervention ◽  
Cord Compression ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Metastatic Spinal Cord Compression ◽  
Utility Analysis

Retrospective Database Analysis of the Effect of Zoledronic Acid (ZOL) On Skeletal-Related Events (SREs) in Patients (Patients) with Multiple Myeloma (MM).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3881-3881
Author(s):  
Henry J Henk ◽  
Satyin Kaura ◽  
Jose Ricardo Perez ◽  
Laura Becker
Keyword(s):  
Spinal Cord ◽  
Health Plan ◽  
Spinal Cord Compression ◽  
Lower Risk ◽  
Pathologic Fracture ◽  
Mortality Rates ◽  
Cord Compression ◽  
P Value ◽  
Employment Equity ◽  
Equity Ownership

Abstract Abstract 3881 Poster Board III-817 Background For MM patients with malignant bone lesions (BM), SREs including pathologic fracture, spinal cord compression, hypercalcemia of malignancy, and radiotherapy and/or surgery to bone are associated with significant morbidity and mortality and reduced quality of life. ZOL is an IV bisphosphonate (BP) proven to reduce and delay incidence of SREs in several tumor types. This study was designed to assess the benefit of long-term ZOL use in a real-life setting. Methods Claims-based analysis of commercial and Medicare data from a large US managed care plan and a 45 health-plan database was used to evaluate SRE rates, time from BM to 1st SRE, and mortality in patients treated with ZOL or no IV BP therapy. Patients older than 18 years with MM and BM diagnosed between Jan 2001 and Dec 2006 were included. Treatment Persistency was defined as the absence of a >45 day gap between ZOL administrations. Continuous enrollment in the health plan for 6 months before and no prior evidence of BM or IV BP use were required. When assessing mortality, patients with a date of death less than 30 days following index date were excluded. Patients were followed until they disenrolled from the plan or to the end of the study's follow-up period. In this study, SREs were defined as evidence of pathologic fracture, spinal cord compression, and radiotherapy and/or surgery to bone. Results The study sample included 1,655 Patients with a mean age of 61.7 ± 11.9 years; approx. 64% were treated with ZOL and 36% with no IV BP. Incidences of SREs and mortality rates were both greater in the no IV BP group (incidence rate ratio [IRR] = 1.58; p-value<0.001 and mortality rate = 1.71; p-value=0.0234) vs. the ZOL groups. Longer persistency with ZOL was associated with a lower risks of first SRE compared with no IV BP (trend test p-value=0.0025) [TABLE 1]. Conclusions This study showed that in MM Patients with BM, ZOL use was associated with a lower risk of SREs, including fractures, and lower mortality rates. In addition, longer persistence was found to be associated with lower risk of SRE. Disclosures: Kaura: Novartis: Employment, Equity Ownership. Perez:Novartis: Employment, Equity Ownership.

scholarly journals The association between hallway boarding in internal wards, readmission and mortality rates: a comparative, retrospective analysis, following a policy change

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Assaf Ben Shoham ◽  
Gabriel Munter
Keyword(s):  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Policy Change ◽  
Medical Center ◽  
Linear Regression Analysis ◽  
Length Of Hospital Stay ◽  
Mortality Rates ◽  
Before And After ◽  
Full Capacity ◽  
Bed Capacity

Abstract Background Emergency department overcrowding is associated with adverse clinical outcomes and poor patients and staff experience. Full capacity protocols enabling hallway boarding in internal wards are instituted to relieve emergency room overcrowding. The effect of hallway boarding on the clinical outcomes of all inpatients in the internal wards has not been studied. Early in 2016, a decision to enable hallway boarding in the internal wing in our medical center came into effect, comprising an abrupt change to the medical center’s policy. The objective of this study is to examine the effect of hallway boarding on patients who were hospitalized in the internal wards. Methods General linear regression analysis, based on administrative data about admissions of patients, from January 2013 through September 2019, is used to compare in-hospital mortality, 30-day readmission and 30-day mortality rates, of inpatients hospitalized in two internal departments in our medical center, before and after the policy change. Results Eight thousand five hundred eighty-three patients and 11,962 patients were admitted to internal departments A and B, before and after the policy change, respectively. Adjusted in-hospital mortality was lower after the policy change (OR 0.76, [CI, 0.65 to 0.90]), 30-day readmission was mildly higher (OR, 1.18 [CI, 1.00 to 1.40]) and no change in 30-day mortality was observed (OR 1.16 [CI, 0.88 to 1.53]). The results emanate from corresponding changes in department A. No apparent change was observed in the length of hospital stay in department A, while a shorter length of stay was observed in department B. Conclusion Enabling inpatient boarding in our medical center, effectively, had increased bed capacity and generated an increase in the volume of patients. It was associated with lower in-hospital mortality and an increased 30-day readmission, without increasing 30-day mortality. Since this is an observational study, conducted in a single center, further research is necessary to confirm and qualify these observations.

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