Surgical decision making in the era of supramarginal glioma resections: a current perspective and narrative review.

To appraise the literature on long-term neuropsychological and functional outcomes in stroke survivors and identify the gaps, challenges and future research in this area. Stroke care resources are scarce, and the number of stroke survivors is likely to increase with the ageing of the population. Thus, evaluating the cost, frequency and prognostic factors of long-terms stroke functional and neuropsychological outcomes is of paramount importance for evidence-based clinical decision making, including the rationale, planning, provision and allocation of health services, and the development of effective interventions. Summary of review Stroke has an enormous physical, emotional and economic impact on the patients, families and society. However, accurate data on frequency, relationship and predictors of various long-term functional (body functioning, activity and participation) outcomes and costs of stroke are scarce, and no accurate and comprehensive data exist on long-term neuropsychological outcomes and their relationships with other functional outcomes poststroke. There is a lack of accurate data on the frequency, relationship and predictors of various long-term functional outcomes and costs of stroke. There is a pressing need for good-quality population-based studies for evaluating the frequency and prognostic factors of long-term functional and neuropsychological outcomes of stroke in various populations.

Self-Reported Functional Outcomes and Quality of Life Assessments in Long-Term Survivors of Ewing Sarcoma

Hemicondylar fresh frozen allografts address partial knee defects while preserving native anatomy and bone stock. This study evaluated long-term survival, failure modes, and functional outcomes following hemicondylar reconstruction. We conducted a retrospective analysis of hemicondylar fresh frozen allograft reconstructions. Allograft failure was assessed using the Henderson classification and osteoarthritis via Kellgren-Lawrence classification. Functional outcomes were evaluated using MSTS scores and patient-reported measures, with radiographic evaluation performed preoperatively and at 1, 2, 5, and 10 years postoperatively. A total of 17 patients (13 femoral, 4 tibial allografts) with a median age of 29 years and a median follow-up of 16.9 years were included. Four patients (24%) experienced allograft failure, including two structural failures, one infection, and one soft-tissue failure. Overall allograft survival was 87.5% at 1 year, 80.8% at 2 years, and 74% at 5-20 years, with a median MSTS score of 21/30. While all patients developed progressive osteoarthritis, only six required total knee arthroplasty for symptomatic arthritis rather than allograft failure. Hemicondylar allografts demonstrate acceptable long-term survival and functional outcomes, with progressive osteoarthritis/chondrolysis representing expected evolution rather than treatment failure. Structural collapse remains the predominant failure mechanism requiring removal. These findings support hemicondylar allografts as viable reconstructive options for selected patients. Level IV.

Background and Purpose: While neuropsychological deficits have been the focus of research post-subarachnoid haemorrhage (SAH), population-based information on long-term neuropsychological impairment post-SAH are lacking. Neither the profile of long-term neuropsychological deficits nor its relationship to long-term functional outcomes has been established. Methods: This was a cross-sectional population-based study of long-term (5 years) neuropsychological and functional outcomes post-SAH. Participants were 27 five-year survivors of SAH previously enrolled in the Auckland Regional Community Stroke study (2002–2003). Twenty-six age-, gender- and ethnicity-matched controls were used to compare mood, functional (i.e. disability; handicap; quality of life, QoL) and neuropsychological outcomes (i.e. verbal memory, visual memory, executive functioning, language, processing speed and visuoperceptual abilities) of SAH survivors. Results: SAH survivors were more depressed and significantly more impaired in the areas of disability, handicap, and QoL than controls. SAH survivors also had significant cognitive deficits across domains when compared to controls. Depressed mood and baseline functioning were related to worse functional outcomes at 5 years post-SAH. Whilst poor cognitive functioning, particularly in the domains of visual memory and language, impacted long-term functional outcomes of SAH survivors. Conclusions: Five-year SAH survivors have many functional and cognitive deficits compared to matched controls. Language and visual memory emerged as independent factors associated with their current functioning.

To evaluate the long-term survival and functional outcomes of patients with prolonged disorders of consciousness (pDoC) 1-8 years after brain injuries. Retrospective study to assess the long-term survival and functional outcomes of patients with pDoC was conducted. We performed Cox regression and multivariate logistic regression to calculate hazard ratios (HRs) for the outcome of survival and to identify risk factors of the functional outcome. We recruited 154 patients with pDoC. The duration of follow-up from disease onset was 1-8 years. The median age was 46 years (IQR, 32-59), and 65.6% (n = 101) of them were men. During the follow-up period, one hundred and ten patients (71.4%) survived; among them, 52 patients had a good outcome. From the overall survival curve, the 1-, 3-, and 8-year survival rates of patients were about 80.5%, 72.0%, and 69.7%, respectively. Cox regression analysis revealed a significant association between the lower APACHE II score (p = 0.005) (cut-off score ≥ 18) and the presence of sleep spindles (p = 0.001) with survival. Logistic regression analysis demonstrated a higher CRS-R score (cut-off score ≥ 7), and presence of sleep spindles were related to a favorable outcome among patients with pDoC. Sleep spindles are correlated with both long-term survival and long-term functional outcome in pDoC patients.

LONG-TERM MORTALITY, READMISSION AND FUNCTIONAL OUTCOMES AMONG HOSPITAL SURVIVORS OF OUT-OF-HOSPITAL CARDIAC ARREST

PD07-04 OFF-CLAMP ROBOTIC PARTIAL NEPHRECTOMY: 10-YEAR SURVIVAL AND FUNCTIONAL OUTCOMES FROM A HIGH-VOLUME SINGLE CENTER SERIES

Satisfactory long-term survival, functional and radiological outcomes of open-wedge high tibial osteotomy for managing knee osteoarthritis: Minimum 10-year follow-up study.

Extracorporeal Cardiopulmonary Resuscitation: Prehospital or In-Hospital Cannulation?

Introduction:Patients with advanced carcinoma tongue end up with near-total/total glossectomy (NTG/TG). We intended to compare functional, oncological, and survival outcomes of patients undergoing pedicled and microsurgical flap reconstruction in NTG/TG patients at our hospital.Methodology:A prospective study was conducted for 7 years on 91 patients with carcinoma tongue who underwent NTG/TG at our institute. Patients underwent anterolateral thigh (ALT), free radial artery forearm flap (FRAFF), and pectoralis major myocutaneous (PMMC) flap reconstruction and were followed up for immediate complications and functional outcomes for speech, swallowing, and decannulation after completion of adjuvant treatment and then for survival rates for a period of 60 months and statistically analysed with log rank test and Fisher’s exact test for correlation.Results:Ninety-one (42.85%) patients underwent NTG, while 57.14% underwent TG. 85% of patients had >5 mm margin, 14% had ≤ of 5 mm, and none were positive. 57% of patients did not have postoperative complications and 10% underwent re-exploration. During follow-up, 85.7% of patients were able to take orally: 52% soft diet and 32% liquid diet. Multivariate analysis of individual flaps, swallowing, and speech intelligibility values were significant. After 5 years of postadjuvant therapy, there was 76% overall survival, 11% local recurrence and 12% had regional recurrence.Discussion:Morbidity and functional outcome depends on the extent of resection. PMMC flaps can be done on lack of expertise. FRAFF has better functional outcomes owing to pliability of flap. ALT and other bulky flaps require expertise and are prone to flap-related complications. Planning of reconstruction should be based on the defect size together with counseling of patients regarding the risk of complications and delay in adjuvant therapy.

Quality of life: changing the face of outcome measurements in critical care.

Distal radius fractures are the second most common type of fractures encountered in the emergency room, with an incidence of 16 to 32 fractures per 10,000 person/year (the most common being hand bone fractures). The objective of this study was to review the literature on the long-term (a minimum of 3 years' follow-up) functional outcomes of treating distal radial fractures with different methods and get insight into the possible superiority of certain treatment methods (operative vs conservative) over other methods. Randomized clinical trials and observational studies reporting on functional and radiological outcomes of distal radial fractures treated conservatively vs operatively in adult patients found in the PubMed and Medline databases were reviewed. Published papers from the PubMed and Medline databases were included. Nine studies were found that met the inclusion criteria for the analysis. The range of follow-up duration varied from 3 to 14 years, the size of the study groups ranged from 32 to 342 individuals and age of the patients ranged from 18 to 76 years. All the papers reported no significant differences between long-term functional outcomes after surgical vs conservative treatment. All studies reported better radiological outcomes after surgical treatment and worse outcomes for plaster cast immobilization, the latter combined with a high rate of re-dislocations and frequent malunions. This, however, did not translate into worse clinical outcomes. We noticed some significant bias in the studies analysed that significantly affects the reliability and validity of conclusions drawn from these studies. 1. Our review shows that treatment outcomes of distal radial fractures are generally good regardless of the method used. 2. Current literature does not provide uniform evidence to prove the superiority of a particular treatment method when long-term functional outcomes are compared. 3. Conservative treatment by closed reduction and plaster cast immobilization still appears to be a good option for treatment of these fractures, particularly in older patients. 4. There is still a need for research conducted according to trustworthy and credible scientific criteria, to obtain reliable data and improve the treatment guidelines.

Background: Decompressive craniectomy (DC) is a life-saving procedure for severe traumatic brain injury (TBI); however, its long-term outcomes remain controversial. Cranioplasty traditionally performed to restore cranial integrity, has been increasingly recognized for its potential role in neurological recovery. This study aimed to investigate the impact of cranioplasty timing and status on long-term mortality and functional outcomes after DC for severe TBI. Methods: We retrospectively reviewed 151 patients who underwent DC between 2014 and 2018. Patients were categorized into three groups according to cranioplasty timing: early (<3 months), late (≥3 months), and no cranioplasty. Clinical and radiologic data, including the Rotterdam CT scores, were analyzed. The primary endpoints were 5-year mortality and 12-month functional outcome assessed by the Glasgow Outcome Scale (GOS). Univariate and multivariate logistic regression analyses identified independent predictors and receiver operating characteristic (ROC) curves with are under the curve (AUC) values evaluated model performance. Results: Of 151 eligible patients (mean age = 53.9 ± 17.4 years; 82.1% male), overall 5-year mortality was 76.8% (116/151). Mortality differed substantially by cranioplasty group: 64.5% in early cranioplasty, 70.8% in late cranioplasty, and 82.3% in patients who did not undergo cranioplasty. Unfavorable 12-month functional outcomes occurred in 45.2%, 79.2%, and 91.7% of these groups, respectively. In multivariate analysis, no cranioplasty independently predicted both higher 5-year mortality (OR = 2.78, 95% CI = 1.06–7.25, p = 0.038) and unfavorable functional outcome (OR = 3.09, 95% CI = 1.18–8.09, p = 0.022). Older age was also associated with increased mortality (p = 0.019). ROC analysis showed moderate discriminative performance for 5-year mortality (AUC = 0.71) and good discrimination for unfavorable functional outcome (AUC = 0.80). Conclusions: Absence of cranioplasty was associated with higher long-term mortality and poorer functional recovery following DC for severe TBI. Early cranioplasty may enhance cerebral restoration and rehabilitation potential, improving both survival and neurological outcomes.

Long-Term Results of the Fontan Operation for Double-Inlet Left Ventricle

Patients with hematologic malignancy (HM) commonly develop critical illness. Their long-term survival and functional outcomes have not been well described. We conducted a prospective, observational study of HM patients admitted to seven Canadian intensive care units (ICUs) (2018-2020). We followed survivors at 7days, 6months and 12months following ICU discharge. The primary outcome was 12-month survival. We evaluated functional outcomes at 6 and 12months using the functional independent measure (FIM) and short form (SF)-36 as well as variables associated with 12-month survival. We enrolled 414 patients including 35% women. The median age was 61 (interquartile range, IQR: 52-69), median Sequential Organ Failure Assessment (SOFA) score was 9 (IQR: 6-12), and 22% had moderate-severe frailty (clinical frailty scale [CFS] ≥ 6). 51% had acute leukemia, 38% lymphoma/multiple myeloma, and 40% had received a hematopoietic stem cell transplant (HCT). The most common reasons for ICU admission were acute respiratory failure (50%) and sepsis (40%). Overall, 203 (49%) were alive 7days post-ICU discharge (ICU survivors). Twelve-month survival of the entire cohort was 21% (43% across ICU survivors). The proportion of survivors with moderate-severe frailty was 42% (at 7days), 14% (6months), and 8% (12months). Median FIM at 7days was 80 (IQR: 50-109). Physical function, pain, social function, mental health, and emotional well-being were below age- and sex-matched population scores at 6 and 12 months. Frailty, allogeneic HCT, kidney injury, and cardiac complications during ICU were associated with lower 12- month survival. 49% of all HM patients were alive at 7 days post-ICU discharge, and 21% at 12months. Survival varied based upon hematologic diagnosis and frailty status. Survivors had important functional disability and impairment in emotional, physical, and general well-being.