Clinical Outcomes of Clipping and Coiling in Elderly Patients with Unruptured Cerebral Aneurysms: a National Cohort Study in Korea

Background: Evaluation of the overall clinical outcomes of stroke care is important for improving institutional quality of care. We performed a nationwide survey in Japan to analyze cases of unruptured cerebral aneurysms using the diagnostic procedure combination (DPC). Methods and Results: Certified neurosurgical training institutions in Japan provided data from the DPC database on patients hospitalized with neurosurgical diseases between April 1, 2012 and March 31, 2013. Patients hospitalized owing to unruptured cerebral aneurysms were identified from the DPC database based on the International Classification of Diseases (ICD)-10 diagnosis code (I671). We excluded patients with emergency admissions. We compared the mortality rates, modified Rankin Scale (mRS) scores, postoperative complications of patients who underwent clipping and coiling. With respect to postoperative complications, we evaluated the ratio of an event of complication (brain infarction, brain hemorrhage and cardiac infarction) and the number of complications (scored using patient safety indicators: PSIs and hospital-acquired conditions: HACs). We used hierarchical logistic regression models to estimate the odds ratios (ORs) for in-hospital mortality and complications. We identified 6329 patients with unruptured cerebral aneurysms (3710 clipping, 2619 coiling). Patient characteristics, mortality rates, and mRS were similar between groups. Patients who underwent coiling had a significantly lower number of complications than patients who underwent clipping (PSIs: OR = 0.40; P < 0.001, HACs: OR = 0.47; P = 0.001). Adversely, there was an increased likelihood of ischemic stroke in coiling patients compared with clipping patients (coiling: 7.2%; clipping: 4.7%; OR = 1.37; P = 0.011). 83.2% of coiling patients underwent MRI after the operation, compared with 37.3% of clipping patients. Conclusions: Our data demonstrated that coiling patients had lower number of post-operative complications and higher number of ischemic stroke than clipping patients. But the cause that higher number of coiling patients had ischemic stroke than clipping patients because higher number of coiling patients were underwent MRI after operation compared with clipping patients.

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Asthma During Pregnancy and Clinical Outcomes in Offspring: A National Cohort Study

PEDIATRICS ◽

10.1542/peds.2012-3686 ◽

2013 ◽

Vol 132 (3) ◽

pp. 483-491 ◽

Cited By ~ 26

Author(s):

M. Tegethoff ◽

J. Olsen ◽

E. Schaffner ◽

G. Meinlschmidt

Keyword(s):

Cohort Study ◽

Clinical Outcomes ◽

National Cohort

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9073 POSTER Clinical Outcomes for Bevacizumab (BV)-treated Elderly Patients With Non-small Cell Lung Cancer (NSCLC) – Results From the ARIES Observational Cohort Study (OCS)

European Journal of Cancer ◽

10.1016/s0959-8049(11)72385-1 ◽

2011 ◽

Vol 47 ◽

pp. S614

Author(s):

A. Wozniak ◽

M.R. Kosty ◽

M. Jahanzeb ◽

J. Garst ◽

D. Spigel ◽

...

Keyword(s):

Lung Cancer ◽

Cohort Study ◽

Elderly Patients ◽

Small Cell Lung Cancer ◽

Clinical Outcomes ◽

Cell Lung Cancer ◽

Small Cell ◽

Observational Cohort Study ◽

Small Cell Lung ◽

Observational Cohort

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Unruptured Cerebral Aneurysms in Elderly Patients

Neurologia medico-chirurgica ◽

10.2176/nmc.ra.2016-0286 ◽

2017 ◽

Vol 57 (6) ◽

pp. 247-252 ◽

Cited By ~ 7

Author(s):

Tomohito HISHIKAWA ◽

Isao DATE

Keyword(s):

Elderly Patients ◽

Cerebral Aneurysms ◽

Unruptured Cerebral Aneurysms

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Proton-pump inhibitors do not influence clinical outcomes in patients with Staphylococcus aureus bacteremia

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284819834273 ◽

2019 ◽

Vol 12 ◽

pp. 175628481983427 ◽

Cited By ~ 1

Author(s):

Aisling R. Caffrey ◽

Tristan T. Timbrook ◽

Syed Raza Ali ◽

Victor Nizet ◽

George Sakoulas

Keyword(s):

Staphylococcus Aureus ◽

Cohort Study ◽

Clinical Outcomes ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

De Novo ◽

Culture Collection ◽

Staphylococcus Aureus Bacteremia ◽

Increased Risk ◽

National Cohort

Background: Proton-pump inhibitors (PPIs) are commonly used in clinical practice for gastric acid suppression. However, these agents have also been associated with certain negative clinical outcomes. We evaluated the real-world effects of incident PPI use on clinical outcomes in patients with Staphylococcus aureus bacteremia. Methods: This retrospective cohort study included patients admitted to Veterans Affairs hospitals with positive S. aureus blood cultures collected between 2002 and 2013 that received appropriate antibiotics within 48 hours of culture collection. Clinical outcomes among three PPI exposure groups, each compared to nonusers, were assessed with propensity-score-matched Cox proportional-hazard regression models: pretreated PPI users initiating therapy in the 30 days prior to culture and either (a) continuing PPI therapy after culture, or (b) not continuing after culture, and (c) de novo users initiating at culture. Results: Clinical outcomes, including inpatient mortality, intensive care discharge, 30-day mortality, 30-day readmission, and 30-day Clostridium difficile infection (CDI) were similar among PPI users and nonusers. Though length of stay was longer in pretreated, continuing PPI users [time-to-discharge hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.65–0.93], 14-day mortality was significantly lower than in nonusers (HR 0.66, 95% CI 0.50–0.87). Conclusions: In our large national cohort study, PPIs were not associated with an increased risk of negative clinical outcomes, including mortality and CDI, in patients with S. aureus bacteremia.

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Locking Intramedullary Nails Versus Locking Plates in the Treatment of 2-part and 3-part Proximal Humeral Surgical Neck Fractures in Elderly Patients: A Prospective Cohort Study

10.21203/rs.3.rs-29763/v1 ◽

2020 ◽

Author(s):

Rui Geng ◽

Hao Wu ◽

Ke Ren ◽

Qing Chang ◽

Yalikun Yusufu ◽

...

Keyword(s):

Cohort Study ◽

Elderly Patients ◽

Clinical Outcomes ◽

Prospective Cohort Study ◽

Complication Rate ◽

Prospective Cohort ◽

Locking Plates ◽

Intramedullary Nails ◽

Neck Shaft Angle

Abstract Background: Locking intramedullary nails and locking plates are most widely used in the treatment of 2-part and 3-part proximal humeral surgical neck fractures, however, the clinical outcomes are controversial. This study aimed to compare the clinical outcomes of treatment with these two implants in elderly patients.Methods: In this prospective cohort study with a 24-month follow-up period, from June 2014 to November 2016, a total of 53 elderly patients with 2-part and 3-part proximal humeral surgical neck fractures treated with locking intramedullary nails and locking plates were included. We analyzed the intraoperative and radiographic parameters. The American Shoulder and Elbow Surgeons (ASES) score, Constant–Murley score and range of motion (ROM) were used to evaluate shoulder function. We also assessed the visual analog scale (VAS) score and complication rate.Results: For both 2-part and 3-part proximal humeral surgical neck fractures, the nail group showed statistically significant superiority compared with the plate group in terms of the operative duration, incision length, blood loss, hemoglobin loss, neck-shaft angle (NSA) loss, time to bony union and pain. Good to satisfactory clinical outcomes were obtained with both types of implants. Significant differences were not found in the functional results or complication rate between the two groups at different time points during the follow-up period.Conclusions: Treatment with both locking intramedullary nails and locking plates achieves similar and good to satisfactory clinical outcomes in elderly patients. We favor locking intramedullary nails, especially in the treatment of 2-part proximal humeral surgical neck fractures.Trial registration: Medical Ethics Committee for Clinical Research of Zhongda hospital, ZDYJLY (2014) new No. 9. Registered 05 March 2014，http://www.njzdyy.com

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