Important Predictors Of Surgical Outcome Research Articles

Spontaneous Intracerebral Hematoma: A Single Center 10-Year Analysis

Objective: In this study, we aimed to contribute to the literature by determining data such as mortality rates, demographic, clinical and radiological characteristics of patients who applied to our hospital's emergency department between January 2011 and December 2020 with the diagnosis of SISH and were operated on in our clinic. Methods:53 patients who were operated on for SISH diagnosis between January 2011 and December 2020 were retrospectively examined. Patients with SISH on brain tomography (CT) were evaluated. Hematoma localization is lobar; those with frontal, parietal, temporal and occipital locations; Those in the thalamic, putaminal and basal ganglia were considered to be deeply located. Patients were divided into three groups according to the Glasgow coma score (GCS): GCS 5–8, GCS 9–12, and GCS 13–15. Results: In our cohort, the patients mean age was 62.8 years (range, 19–92). The overall mortality rate was 62.87%. Age showed no significant association with mortality. Mortality was associated with increased hematoma volume and low GCS score at the first presentation (p < 0.001). In receiver operating characteristic curve analysis, hematoma volume was an important predictor of surgical outcome; the optimal cut-off value of 59.5 cm3 was associated with 84.4% sensitivity and 90.5% specificity (p < 0.001). Similarly, the optimal GCS score cut-off value of 8.5 was associated with a 96.9% sensitivity and 71.4% specificity for predicting mortality (p < 0.001). Conclusions:Low GCS, increased hematoma volume, and especially the presence of concomitant hypertension (HT) are associated with poor prognosis in SISH patients.

THE IMPACT OF PREOPERATIVE STEROIDS ADMINISTRATION ON ENDOSCOPIC SINUS SURGERY: A COMPREHENSIVE SYSTEMATIC REVIEW

Background: Chronic rhinosinusitis (CRS) is one of the most common diseases in the world, affecting approximately 14 of people in the USA. It is defined as chronic inflammation of nasal and sinus cavities lasting longer than 12 weeks, it can be with or without nasal polyposis (CRSwNP or CRSsNP), primary and secondary, localized or diffuse disease regarding anatomic distribution, either type 2 or non-type 2, considering the endotype dominance, eCRS, and non-eCRS for eosinophilic and non-eosinophilic CRS. The aim: This study aims to show about the impact of preoperative steroids administration on endoscopic sinus surgery. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 51 articles, whereas the results of our search on SagePub brought up 74 articles. The results of the search conducted for the last year of 2014 yielded a total 24 articles for PubMed and 48 articles for SagePub. The result from title screening, a total 5 articles for PubMed and 12 articles for SagePub. In the end, we compiled a total of 8 papers. We included five research that met the criteria. Conclusion: Low dose preoperative systemic steroid (PSS) does not seem to have an effect on the long term outcome after endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) with nasal polyposis (NP). Eosinophilic infiltration and presence of asthma are important predictors of surgical outcome in such cases.

The impact of patient activation on the effectiveness of digital health remote post-discharge follow-up and same-day-discharge after elective colorectal surgery.

Low patient activation (PA) is associated with worse postoperative outcomes, however, its impact on the effectiveness of digital health interventions is unknown. We sought to determine the impact of PA on the effectiveness of digital health application for remote post-discharge follow-up for patients undergoing elective colectomy. Data analysis included a control cohort (CC) of patients undergoing elective colorectal surgery from 10/2017 to 04/2018 without the digital health intervention and a digital application cohort (DAC) that received a smart phone application for remote post-discharge follow-up from 03/2021 to 08/2022, including a subset of same-day discharge (SDD) patients. PA was measured using the Patient Activation Measure (PAM; score 0-100) and categorized into low (< 55.1) and high (≥ 55.1). The PAM was administered 4-6weeks before surgery in the DAC group and on postoperative day (POD) 1 in the CC group. The main outcome measure was 30-day emergency department (ED) visits. A total of 164 patients were included (89DAC with 50 SDD, 75CC), with no differences in patient characteristics other than more stoma closures in the DAC group. Overall, 77% of patients had high PA level, with no difference between CC and DAC (77% vs. 81%, p = 0.25). There was no difference in ED visits between CC and DAC (19% vs. 18%, p = 0.90). Overall, low PA was associated more ED visits (29% vs 14%, p = 0.04). In the SDD subgroup, low PA patients had more ED visits (38% vs. 7%, p = 0.015). PA level did not affect app usage metrics. On multiple regression, only low PA remained independently associated with ED visits (OR 3.42, 95%CI 1.27, 9.24). Low PA remains an important predictor of surgical outcomes after elective colorectal surgery regardless of the use of a digital health application for remote post-discharge follow-up. This suggests that improving PA levels may improve postoperative outcomes.

Computed tomography angiography assessment of the degree of simple coarctation of the aorta and its relationship with surgical outcome: Aretrospective analysis.

To investigate the correlation between the degree of aortic coarctation and surgical prognosis in infants with simple coarctation of the aorta (CoA) using computed tomography angiography (CTA). This study was a retrospective study. Twenty-seven infants with simple CoA who underwent surgical correction from January 2020 to June 2022 were enrolled. Aortic diameters were measured at five different levels and normalized to Z scores based on the square root of body surface area. The relevant data were collected and analyzed, and the predictors associated with surgical outcome were determined. Patients were divided into the mild CoA group and the severe CoA group according to the severity of coarctation. The mechanical ventilation duration and the length of ICU stay in the mild CoA group were significantly lower than those in the severe CoA group. Multiple linear regression analyses revealed that the degree of aortic coarctation was a significant risk factor for a prolonged postoperative ICU stay. In addition, gestational age and age at operation were risk factors for a prolonged postoperative ICU stay. Correlation analysis showed that the degree of aortic coarctation correlated with the Z scores of the ascending aorta and postcoarctation aorta. The degree of the CoA is an important predictor of surgical outcomes in infants with simple CoA and was significantly correlated with the ascending aorta and postcoarctation aorta Z scores. Therefore, preoperative CTA should be routinely performed to assess the degree of aortic coarctation and better identify risk factors.

Factors Predicting Poor Surgical Outcome in Patients with Thoracic Ossified Ligamentum Flavum - Analysis Of 106 Patients in a Tertiary Care Hospital in South India.

Ossified ligamentum flavum (OLF) is the major cause of thoracic myelopathy in our locality. Surgical outcomes and their related factors for patients with thoracic OLF (T-OLF) remain unclear because of the few studies on this condition. The present study aimed to examine the factors predicting poor surgical outcomes and the effectiveness of decompressive laminectomy and OLF resection in patients with T-OLF. A total of 106 patients with T-OLF operated at our institute from 2007 to 2018 were included. The mJOA score was used in neurological assessment preoperatively and during the follow-up. Multiple regression analysis was conducted to know the best correlation between factors and surgical outcomes. The mean mJOA score was 5.67 ± 2.13 preoperatively and 7.50 ± 2.60 postoperatively at the end of follow-up. The recovery rate was 43.29 ± 30.55%. After decompressive laminectomy, the mean mJOA score, modified Nurick score, and Ashworth's grade showed significant improvement (P < 0.001). Multiple regression analysis showed that the age of the patient, associated trauma, OLF level, tuberous type OLF, intramedullary signal change on T2WI, preoperative severity of myelopathy, pre-op mJOA score, and pre-op Nurick grade were significantly correlated with the surgical outcome (P < 0.001). No correlation was identified with the duration of symptoms, dural ossification, dural tear, and CSF leak (P > 0.05). It is important to identify preventable risk factors for poor surgical outcomes for T-OLF. Age of the patient, associated trauma, OLF level, tuberous type OLF, intramedullary signal change on T2WI, preoperative severity of myelopathy, preoperative mJOA score, and Nurick grade were important predictors of surgical outcome in our study series.

Patient frailty as a risk assessment tool in surgical management of long bone fractures

BackgroundFrailty is an important predictor of surgical outcomes and has been quantified by several models. The modified frailty index (mFI) has recently been adapted from an 11-item index to a 5-item index and has promise to be a valuable risk assessment tool in orthopedic trauma patients. We perform a retrospective analysis of the 5-item mFI and evaluate its effectiveness in predicting outcomes in patients with long bone fractures. MethodsThe National Surgery Quality Improvement Program (NSQIP) 2006–2016 database was queried for surgical procedures in the treatment of long bone fractures by current procedural terminology (CPT) codes, excluding those performed on metacarpals and metatarsals. Cases were excluded if they were missing demographic, frailty, and variable data. The 5-item frailty index was calculated based on the sum of presence of 5 conditions: COPD/pneumonia, congestive heart failure, diabetes, hypertension, and impaired functional status. Chi square was used to determine variables significantly associated with each outcome. The significant variables were included in multivariate logistic regression along with the mFI. Significance was defined as p < 0.05. ResultsOf the 140,249 fixation procedures performed on long bone fractures in NSQIP, 109,423 cases remained after exclusion criteria were applied. The majority of patients were between the ages of 61 and 80 (34.0%), were female (65.6%) and Caucasian (86.3%). Multivariate analysis revealed that mFI scores ≥3 were predictive of unplanned reoperation (OR = 1.57), wound disruption (OR = 2.83), unplanned readmission (OR = 2.12), surgical site infection (OR = 1.90), major complications (OR = 3.04), and discharge destination (OR = 3.06). ConclusionsOur study analyzed the relationship of frailty and postoperative complications in patients with long bone fractures. Patients had increased likelihood of morbidity, independent of other comorbidities and demographic factors. The mFI may have a role as a simple, easy to use risk assessment tool in cases of orthopedic trauma.

Impact of Surgeon’s Experience on Surgical Outcomes in Colorectal Surgery

To investigate the influence of surgeon’s experience on outcome among patients undergoing colectomy for benign and malignant diseases. Using medical record folders in this single center retrospective study, we analyzed operative morbidity and mortality in patients undergoing surgery either for colon cancer or diverticulitis between January 1, 2008, and June 30, 2015. Surgeons were divided into three groups: A (surgical experience 20 years). Logistic regression analysis was used to assess the relation between experience and outcome. Five hundred twenty-eight colonic resections were performed by group A (12.9%), group B (63.6%), and group C (23.5%), respectively. There were no differences in patient characteristics between the groups. Surgery due to colon cancer was more frequent, and sigmoid colectomy due to diverticulitis was less frequent in group A vs. groups B and C (p < 0.001). Right colectomy was more frequent in group A, whereas patients underwent a higher percentage of sigmoid colectomy in groups B and C (p < 0.001). There was no difference in morbidity, conversion rate, and mortality rate between the groups. Surgeon’s experience was not associated with morbidity and mortality. The results of our study suggest that for colectomies due to both, benign and malignant lesions, years of professional experience are not an important predictor of surgical outcome. However, large bowel resections can also be performed safely by less experienced surgeons without increase in morbidity and mortality.

Frailty, cognitive impairment, and functional disability in older women with female pelvic floor dysfunction.

There is a growing body of evidence demonstrating frailty as an important predictor of surgical outcomes in older adults undergoing major surgeries. The age-related onset of many symptoms of female pelvic floor dysfunction (PFD) in women suggests that many women seeking treatment for PFD may also have a high prevalence of frailty, which could potentially impact the risks and benefits of surgical treatment options. Our primary objective was to determine the prevalence of frailty, cognitive impairment, and functional disability in older women seeking treatment for PFD. We conducted a cross-sectional study with prospective recruitment between September 2011 and September 2012. Women, age 65 years and older, were recruited at the conclusion of their new patient consultation for PFD at a tertiary center. A comprehensive geriatric screening including frailty measurements (Fried Frailty Index), cognitive screening (Saint Louis University Mental Status score), and functional status evaluation for activities of daily living (Katz ADL score) was conducted. Sixteen percent (n/N = 25/150) of women were categorized as frail according to the Fried Frailty Index score. After adjusting for education level, 21.3 % of women (n/N = 32/150) screened positive for dementia and 46 (30.7 %) reported functional difficulty or dependence in performing at least one Katz ADL. Sixty-nine women (46.0 %) chose surgical options for treatment of their PFD at the conclusion of their new patient visit with their physician. Frailty, cognitive impairment, and functional disability are common in older women seeking treatment for PFD.

Surgical results and prognostic factors of anterior cervical corpectomy and fusion for ossification of the posterior longitudinal ligament.

BackgroundMechanism of ossification of the posterior longitudinal ligament (OPLL) has not been elucidated clearly. Surgical decompression is usually necessary for the patients with neurological symptoms. Anterior decompression and resection of OPLL seems to be a radical surgical option, because the spinal cord is compressed from the anterior direction.MethodsAmong 229 patients who underwent ACF for OPLL between January 2001 and December 2007 in our hospital, a total of 133 patients responded to the invitation and made return visits, with a follow-up rate of 58.1%. For these patients, clinical data were collected from medical and operative records. Neurological status were evaluated by using the Japanese Orthopedic Association (JOA) scoring system. Radiological evaluations including C2-7 lordotic angle, sagittal vertical axis (SVA), occupying rate of OPLL, double-layer sign and high-intensity zone were obtained from all the patients. Complications and causes of revision surgery were also investigated. Correlations between the long-term surgical outcome and various prognostic factors were statistically analyzed.FindingsEighty-four males and forty-nine females completed the follow-up, with a mean age at operation of 56.8 years. The overall average JOA score significantly increased, with a mean recovery rate of 64.1%±14.2%. The mean C2-7 lordotic angle and SVA were also significantly improved, and fusion rate was satisfactory. The incidence of complications was consistent to the previous reports and most of them were controllable by suitable treatments. Multiple regression analysis showed that number of corpectmies and preoperative JOA score were important predictors of surgical outcome.ConclusionsACF is a reliable and effective method for treating OPLL patients in terms of neurological recovery, maintenance of radiological parameters, fusion rate and complications. Number of corpectomies and preoperative JOA score are important predictors for the clinical outcome when this procedure is used.

Availability of preoperative systemic steroids on endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis.

PurposeTo analyze the outcome of endoscopic sinus surgery (ESS) after preoperative systemic steroid (PSS) treatment for chronic rhinosinusitis (CRS) with nasal polyposis (NP) and to investigate and compare clinicopathological factors associated with the outcome.Materials and MethodsWe performed a retrospective chart review of 468 patients with CRS with NP who underwent primary ESS between January 2005 and October 2011. 124 patients who met the inclusion criteria were included. Beginning from 2008, our clinic administered steroid preoperatively in patients of CRS with NP, thus there were 84 patients with preoperative systemic steroid (PSS group) and another 40 patients without such regimen (no PSS group). To evaluate the outcome after ESS, poor outcome and complication were analyzed according to the following parameters: age, sex, follow-up duration, eosinophilic infiltration, atopy, asthma, Lund-Mackay score, and polyp grade.ResultsThere was no significant difference in poor outcome rates between the PSS and no PSS group (35.0% vs. 47.6%, p=0.185). There was no significant difference in complication rates between the PSS and no PSS group (10% vs. 6%, p=0.468). As with the multivariate analysis of the clincopathological factors to the poor outcome rate, presence of asthma and eosinophilic infiltration were significantly related (odds ratio as 6.555 and 4.505, respectively), whereas PSS was confirmed as less likely related (odds ratio 0.611).ConclusionLow dose PSS administration does not seem to have an effect on the outcome after ESS in patients who have CRS with NP. Eosinophilic infiltration and presence of asthma are important predictors of surgical outcome.

A Clinical Prediction Model to Determine Outcomes in Patients with Cervical Spondylotic Myelopathy Undergoing Surgical Treatment

Cervical spondylotic myelopathy is a progressive spine disease and the most common cause of spinal cord dysfunction worldwide. The objective of this study was to develop a prediction model, based on data from a prospective multi-center study, relating a combination of clinical and imaging variables to surgical outcome in patients with cervical spondylotic myelopathy. Two hundred and seventy-eight patients diagnosed with cervical spondylotic myelopathy treated surgically were enrolled at twelve different sites in the multi-center AOSpine North America study. Univariate analyses were performed to evaluate the relationship between outcome, assessed with the modified Japanese Orthopaedic Association (mJOA) score, and various clinical and imaging predictors. A set of important candidate variables for the final model was selected on the basis of author consensus, literature support, and statistical findings. Logistic regression was used to formulate the final model. Univariate analyses demonstrated that the odds of a successful outcome decreased with a longer duration of symptoms (odds ratio [OR] = 0.80, 95% confidence interval [CI] = 0.65 to 0.98, p = 0.030); a lower baseline mJOA score (OR = 0.74, 95% CI = 0.65 to 0.84, p < 0.0001); the presence of psychological comorbidities (OR = 0.51, 95% CI = 0.29 to 0.92, p = 0.024); the presence of broad-based, unstable gait (OR = 2.72, 95% CI = 1.47 to 5.06, p = 0.0018) or other gait impairment (OR = 3.56, 95% CI = 1.75 to 7.22, p = 0.0005); and older age (OR = 0.96, 95% CI = 0.93 to 0.98, p = 0.0004). The dependent variable, the mJOA score at one year, was dichotomized for logistic regression: a "successful" outcome was defined as a final score of ≥16 and a "failed" outcome was a score of <16. The final model included age (OR = 0.97, 95% CI = 0.94 to 0.99, p = 0.0017), duration of symptoms (OR = 0.78, 95% CI = 0.61 to 0.997, p = 0.048), smoking status (OR = 0.46, 95% CI = 0.21 to 0.98, p = 0.043), impairment of gait (OR = 2.66, 95% CI = 1.17 to 6.06, p = 0.020), psychological comorbidities (OR = 0.33, 95% CI = 0.15 to 0.69, p = 0.0035), baseline mJOA score (OR = 1.22, 95% CI = 1.05 to 1.41, p = 0.0084), and baseline transverse area of the cord on magnetic resonance imaging (OR = 1.02, 95% CI = 0.99 to 1.05, p = 0.19). The area under the receiver operator characteristic curve was 0.79, indicating good model prediction. On the basis of the results of the AOSpine North America study, we identified a list of the most important predictors of surgical outcome for cervical spondylotic myelopathy.

Clinical features and surgical outcomes of patients with thoracic myelopathy caused by multilevel ossification of the ligamentum flavum

Background contextThoracic myelopathy caused by multilevel (three or more levels) ossification of the ligamentum flavum (OLF) is rare. Little is known about its clinical features, and the surgical outcomes along with its related factors are also unclear. PurposeTo describe the clinical features, assess the safety and effectiveness of surgical decompression, and determine the prognostic factors relevant for patients with thoracic myelopathy caused by multilevel OLF. Study design/settingA retrospective clinical study. Patient sampleSeventy-five consecutive multilevel OLF patients who underwent surgical decompression were analyzed. Outcome measuresModified Japanese Orthopedic Association (JOA) scale and the recovery rate. MethodsPatients who underwent surgical decompression for symptomatic multilevel OLF during January 1996 to June 2010 were all included. Clinical data were collected from medical and operative records; patients were evaluated by using the JOA scale preoperatively and during the follow-up. Correlations between the surgical outcome and various factors were also analyzed. ResultsForty-three men and 32 women with a mean age of 54.7 years (range 36–78 years) were included. The mean number of involved levels is 4.6 and contiguous OLF presented in 73.3% of these patients. The most common involved levels were T10/T11 (15.4%), T9/T10 (13.3%), and T11/T12 (12.5%). Coexisting spinal disorders were found in 41 patients (54.7%). Preoperative evaluation showed the mean JOA score was 5.8±1.7; 37.3% of these patients had mild myelopathy, 53.3% had moderate myelopathy, and 9.3% had severe myelopathy. All patients received posterior laminectomy. The JOA score (mean 8.2±2.1) significantly increased postoperatively (p<.05), and multiple regression analysis showed that preoperative duration of symptoms and preoperative JOA score were important predictors of surgical outcome. ConclusionsLaminectomy with partially internal fixation is safe and effective in treatment of patients with symptomatic multilevel OLF. The results of our study show that preoperative JOA score and preoperative duration of symptoms were important predictors for the clinical outcome.

Laparoscopic Pyelolithotomy: Comparison of Surgical Outcomes in Relation to Stone Distribution Within the Kidney

Abstract Purpose: To evaluate surgical outcomes of laparoscopic pyelolithotomy (LP) in relation to stone distribution within the kidney. Between August 2008 and February 2012, 77 patients underwent LP as first-line treatment for renal stone(s). Cases were classified into four groups, depending on stone location: Group I (located in only renal pelvis), Group II (located only in renal calyx), Group III (located in renal pelvis and in one calyx), and Group IV (located in renal pelvis and in multiple calyces). Patient and stone characteristics, surgical outcomes, and complications were evaluated. Sixty-seven (81.8%) cases were stone-free after LP for large renal stones. Stone-free rates in a single session significantly decreased with greater stone dispersion (p<0.001). Mean hospital stay in group IV was significantly longer than in other groups (p=0.038). However, there were no significant differences in mean operation times (p=0.214), mean change in serum hemoglobin (p=0.709), postoperative analgesics usages (p=0.153), and number of analgesics used on an as-needed basis (p=0.079). There were no complications of grade IIIb or of greater severity. One patient in group II received blood transfusion, and 1 in group III required percutaneous drainage due to perirenal urine collection. LP is an effective and safe modality for managing renal stones diseases. Distribution of stone burden, and total stone burden, is an important predictor of surgical outcome of LP in renal stone diseases.

Predictors of Surgical Outcomes of Uvulopalatopharyngoplasty for Obstructive Sleep Apnea Hypopnea Syndrome

To investigate predictors of surgical outcomes of uvulopalatopharyngoplasty (UPPP) for obstructive sleep apnea hypopnea syndrome (OSAHS). Case series with planned data collection. A university medical center. Thirty-nine patients with OSAHS received Z-palatopharyngoplasty (ZPPP) or Han-uvulopalatopharyngoplasty (H-UPPP). All patients were evaluated within 3 months before surgery and at 6 to 12 months after surgery. Statistical analyses were conducted on preoperative parameters that could have affected surgical efficacy and outcome. Success was defined as an apnea-hypopnea index (AHI) fewer than 20 times per hour and a decrease of more than 50%. The success rate was 56.4% (22/39 patients). There were statistically significant differences in AHI, lowest oxygen saturation (L-Sao(2)), time with oxygen saturation less than 90% (CT90), percentage of time with oxygen saturation less than 90% (CT90%), microarousal index (MI), apolipoprotein E (ApoE), high-density lipoprotein (HDL), fasting blood glucose (FBG), and Friedman OSA stage between the treatment success and failure groups. Higher success rate was predicted by lower severity, as indicated by lower AHI, CT90, CT90%, and MI; higher L-Sao(2); and fewer glucose and lipid metabolism abnormalities, shown by lower ApoE and FBG and higher HDL. Disease severity, glucose and lipid metabolism, and Friedman OSA stage may be important predictors of surgical outcome of UPPP for OSAHS.

Patient preparedness: an important predictor of surgical outcome

The objective of the study was to determine the influence of patient readiness for reconstructive pelvic surgery on surgical outcomes. After undergoing standardized informed consent, consecutive women planning pelvic surgery completed a questionnaire assessing their knowledge and readiness for surgery pre- and postoperatively. Subjects underwent standardized follow-up 3 months after surgery, including postoperative satisfaction questionnaire and validated condition specific quality of life (QOL) and global improvement scales. All subjects had standardized urogynecologic evaluation pre- and postoperatively. The 79 women who completed preparedness questionnaires self-rated their symptom severity as severe (34%), moderate (58%), and mild (8%). Preparedness was associated with postoperative improvement (P = .003), complete satisfaction (P = .0005), and improved QOL (P = .02). Objective measures of cure did not differ by preparedness. Readiness for reconstructive pelvic surgery is measurable and associated with patient-perceived surgical outcome. Satisfaction, symptom improvement, and QOL are strongly associated with patients' expectations and preparedness.

Retraction Note Thoracic myelopathy caused by ossification of ligamentum flavum of which fluorosis as an etiology factor

To evaluate the clinical feature, operative method and prognosis of thoracic ossification of ligamentum flavum caused by skeletal fluorosis. All the patients with thoracic OLF, who underwent surgical management in the authors' hospital from 1993–2003, were retrospectively studied. The diagnosis of skeletal fluorosis was made by the epidemic history, clinical symptoms, radiographic findings, and urinalysis. En bloc laminectomy decompression of the involved thoracic levels was performed in all cases. Cervical open door decompression or lumbar laminectomy decompression was performed if relevant stenosis existed. The neurological statuses were evaluated with the Japanese Orthopaedic Association (JOA) scoring system preoperatively and at the end point of follow up. Also, the recovery rate was calculated. 23 cases have been enrolled in this study. Imaging study findings showed all the cases have ossification of ligamentum flavum together with ossification of many other ligaments and interosseous membranes, i.e. interosseous membranes of the forearm in 18 of 23 (78.3%), of the leg in 14 of 23 (60.1%) and of the ribs in 11 of 23 (47.8%). Urinalysis showed markedly increased urinary fluoride in 14 of 23 patients (60.9%). All the patients were followed up from 12 months to 9 years and 3 months, with an average of 4 years and 5 months. The JOA score increased significantly at the end of follow up (P = 0.0001). The recovery rate was 51.83 ± 32.36%. Multiple regression analysis revealed that the preoperative JOA score was an important predictor of surgical outcome (p = 0.0022, r = 0.60628). ANOVA analysis showed that patients with acute onset or too long duration had worse surgical result (P = 0.0003). Fluorosis can cause ossification of thoracic ligamentum flavum, as well as other ligaments. En bloc laminectomy decompression was an effective method. Preoperative JOA score was the most important predictor of surgical outcome. Patients with acute onset or too long duration had worse surgical outcome.

Thoracic myelopathy caused by ossification of ligamentum flavum of which fluorosis as an etiology factor.

PurposeTo evaluate the clinical feature, operative method and prognosis of thoracic ossification of ligamentum flavum caused by skeletal fluorosis.MethodsAll the patients with thoracic OLF, who underwent surgical management in the authors' hospital from 1993–2003, were retrospectively studied. The diagnosis of skeletal fluorosis was made by the epidemic history, clinical symptoms, radiographic findings, and urinalysis. En bloc laminectomy decompression of the involved thoracic levels was performed in all cases. Cervical open door decompression or lumbar laminectomy decompression was performed if relevant stenosis existed. The neurological statuses were evaluated with the Japanese Orthopaedic Association (JOA) scoring system preoperatively and at the end point of follow up. Also, the recovery rate was calculated.Results23 cases have been enrolled in this study. Imaging study findings showed all the cases have ossification of ligamentum flavum together with ossification of many other ligaments and interosseous membranes, i.e. interosseous membranes of the forearm in 18 of 23 (78.3%), of the leg in 14 of 23 (60.1%) and of the ribs in 11 of 23 (47.8%). Urinalysis showed markedly increased urinary fluoride in 14 of 23 patients (60.9%). All the patients were followed up from 12 months to 9 years and 3 months, with an average of 4 years and 5 months. The JOA score increased significantly at the end of follow up (P = 0.0001). The recovery rate was 51.83 ± 32.36%. Multiple regression analysis revealed that the preoperative JOA score was an important predictor of surgical outcome (p = 0.0022, r = 0.60628). ANOVA analysis showed that patients with acute onset or too long duration had worse surgical result (P = 0.0003).ConclusionFluorosis can cause ossification of thoracic ligamentum flavum, as well as other ligaments. En bloc laminectomy decompression was an effective method. Preoperative JOA score was the most important predictor of surgical outcome. Patients with acute onset or too long duration had worse surgical outcome.

Nutritional concerns in the older surgical patient

q h h b a o o a t n p x urgeons, more than most other types of physicians, are equired to have a thorough knowledge of the principles f nutrition because many of their interventions alter the ormal route of alimentation. Yet when surgeons are olled about the frequency with which they conduct a utritional assessment of their older patients, most repond “rarely.” This apparent disconnect between the nowledge of perioperative nutritional issues and the reoperative assessment of nutritional status is unfortuate because the prevalence of undernutrition and malutrition in older patients is considerable. Nine percent o 15% of persons over age 65 years are found to be alnourished in the outpatient clinics, 12% to 50% in he acute inpatient hospital, and 25% to 60% or more in he chronic institutional setting. Because adequate nurition is an important predictor of surgical outcomes, urgeons need to be more aware of the factors involved in etermining the nutritional state of their older patients. o facilitate this understanding we will discuss four uestions: Why do the elderly become malnourished? hy is nutrition important? How is nutritional status ssessed? What can be done once malnutrition is dentified?

Surgeon volume compared to hospital volume as a predictor of outcome following primary colon cancer resection.

A strong association between high hospital procedure volume and survival following colon cancer resection has been demonstrated. However, the importance of surgeon case volume as a determinant of outcome has been less well studied, and it is unclear whether hospital or surgeon volume is the more powerful predictor of outcomes. A retrospective population-based cohort study utilizing the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database identified 24,166 colon cancer patients aged 65 years and older who had surgery for a primary tumor diagnosed in 1991-1996 in a SEER area. Hospital and surgeon-specific procedure volume was ascertained based on the number of claims submitted over the 6-year study period. Outcome measures were mortality at 30 days and 2 years, overall survival, and the frequency of operations requiring an intestinal stoma. Age, sex, race, comorbid illness, cancer stage, socioeconomic status, emergent hospitalization, and the presence of obstruction/perforation were used to adjust for differences in case-mix. After adjusting for surgeon procedure volume, high hospital procedure volume remained a strong predictor of low post-operative mortality rates (P < 0.001 for each outcome with and without adjustment for surgeon procedure volume). Surgeon-specific procedure volume was also an important predictor of surgical outcomes (P = 0.002 for 30-day mortality, P = 0.001 for 2-year mortality), although this effect was attenuated after adjusting for hospital volume (P = 0.03 for 30-day mortality, P = 0.02 for 2-year mortality). Hospital volume and surgeon volume were each an important predictor of the ostomy rate. Among high volume institutions and surgeons, individual providers with unusually high ostomy rates could be identified. Both hospital and surgeon-specific procedure volume predict outcomes following colon cancer resection; but hospital volume may exert a stronger effect. Therefore, efforts to optimize the quality of colon cancer surgery should focus on multidisciplinary aspects of hospital care rather than solely on intraoperative technique.

Imaging of degenerative and posttraumatic disease in the shoulder joint with ultrasound

This article reviews the examination technique of shoulder ultrasound, normal and abnormal ultrasound findings in acute (posttraumatic) and chronic (degenerative) lesions. Moreover, it reviews the effectiveness of ultrasound in relation to magnetic resonance (MR) imaging. Most authors report that full-thickness tears of the supraspinatus can reliably be diagnosed by ultrasound. However, the simple diagnosis of a full-thickness rotator cuff tear is no longer sufficient for surgical management. The precise localization and size of rotator cuff tears as well as the extent of muscle degeneration is important for surgical planning. For this aspect and for partial-thickness tears of the supraspinatus, for subscapularis lesions as well as for lesions of the long biceps tendons there is no consensus regarding the diagnostic value of ultrasound. To the present, ultrasound (contrary to MR imaging) has failed to demonstrate that it consistently influences the clinician’s degree of confidence in the clinical diagnosis or the treatment plan. Therefore, some orthopedic surgeons prefer MR imaging to ultrasound in the evaluation of rotator cuff tears and other abnormalities of the glenohumeral joint. Moreover, MR imaging, especially when combined with arthrography, represents a one-step investigation, which not only allows for assessment of rotator cuff lesion but also of lesions of the labrum (Bankart lesions, SLAP lesions), the joint capsule and the biceps tendon. It also demonstrates muscle atrophy, which represents an important predictor of surgical outcome in rotator cuff repair.