Results Of Surgical Management Research Articles

Outcomes of Surgical and Non-Surgical Management of Primary Intracerebral Haemorrhage: A Non-Randomized Clinical Trial

Background: Management of primary intracerebral haemorrhage is very important in the context of outcomes. Objective: The purpose of the present study was to compare the outcomes of surgical and non-surgical management of primary intracerebral haemorrhage. Methodology: This non-randomized clinical trial study was conducted in the Department of Neurosurgery at Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2006 to December 2007 for a period of two (02) years. All patients with primary intracerebral haematoma admitted in the Department of Neurosurgery in study period managed conservatively or surgically is the study population. Selected patients were divided into two group of which patients in group A were treated surgically and the group B patients were treated conservatively. Best medical treatment was given for nonsurgical group and operation were done for surgical group and followed up after surgery till discharge by observing GCS, neurological improvement and GOS at discharge. Results: Of the total 60 subjects selected for study, 30 cases were in group A and the rest of 30 cases were in group B. The both groups were almost identical in terms of age. Distribution of patients in relation to age had no significant difference (P­=0.7). In group A 13(43.3%) patients were died and the survival rate was in 17(56.6%) cases. On the other hand, in group B mortality rate were 15(50.0%) patients and survival rate were 15(50%) patients (P=0.605). Considering the Glasgow outcome scale, in group A 13(43.3%) patients died and 7(23.3%) patients had severe and moderate disability and 3(10.0%) patients had good outcome. In group B 15(50%) patients died and 8(26.7%) patients had severe disability as well as 7(23.3%) patients had moderate disability (p=0.360). Conclusion: In conclusion there is no significant difference of outcomes of surgical and non-surgical management of primary intracerebral haemorrhage. Journal of National Institute of Neurosciences Bangladesh, January 2024;10(1):12-16

Outcomes in surgical management of microprolactinomas: an international multi-institutional series.

Prolactinomas represent the most common pituitary adenoma subtype, the majority of which are microprolactinomas. Dopamine agonists (DAs) remain the first-line intervention for microprolactinomas, however, many patients either cannot tolerate DAs or require lifelong therapy to maintain hormonal control. As endoscopic endonasal surgery (EES) continues to revolutionize the surgical management of sellar lesions, we sought to reassess the feasibility and efficacy of early surgical resection for microprolactinoma. Retrospective chart review from 2010 to 2021 of adults who underwent EES for microprolactinoma was performed across three medical centers. Surgical failure was defined as a need to restart DAs, a serum prolactin level greater than 30ng/mL at last follow-up, tumor recurrence, or a need for reoperation. A total of 56 patients were identified with a mean age of 32.9 years and an average of 26.4 months of follow-up. The majority had been on DAs preoperatively (98.2%). The most common surgical indications were DA intolerance (73.2%), tumor unresponsiveness (19.6%), and desire for pregnancy (7.1%). Gross total resection was achieved in 51 (91.1%) cases. The overall surgical remission rate was approximately 70% with failures observed in 17 (30.4%) patients. Multivariate logistic regression identified subtotal resection as the only independent predictor of surgical failure (p = 0.038*). The most common postoperative complication was transient arginine vasopressin deficiency (AVP-D) (21.4%). There were no cases of permanent AVP-D, new visual deficits, or cerebrospinal fluid leak. With a surgical remission rate of nearly 70%, EES represents a safe and viable alternative strategy to long-term DA treatment for microprolactinomas.

P-1158. Surgical Outcomes Following Paenibacillus Infant Infectious Hydrocephalus

Abstract Background We previously identified Paenibacillus species in the cerebrospinal fluid of 44% of infants presenting for neurosurgical evaluation with findings consistent with postinfectious hydrocephalus (PIH) in Eastern Uganda. Here we sought to compare outcomes among hydrocephalic infants with and without Paenibacillus detection at the time of hydrocephalus surgery. Methods In a prospective observational trial, 78 infants with PIH who underwent a cerebrospinal fluid (CSF) diversion had a positive CSF polymerase chain reaction result for Paenibacillus species (PP), and 111 had a negative result (PN). The primary outcome was diversion failure-free survival defined as being alive without diversion failure at the end of the observation period adjusted for age at the time of diversion and surgery type. Secondary outcomes included overall survival and diversion success. Results After a median follow-up period of 35.7 months, the primary outcome had occurred in 42 PP patients (54%) and in 76 PN patients (68%) (adjusted hazard ratio (aHR), 2.45; 95% confidence interval [CI], 1.42 to 4.22; P=0.001). PP patients who underwent endoscopic diversion had the worst primary event rate (aHR, 6.47; 95% CI, 2.40 to 17.42; P< 0.001). Death from any cause occurred in 16 PP patients (20%) and 9 PN patients (8%) (aHR, 3.47; 95% CI, 1.44 to 8.37; P=0.006). Diversion failure occurred in 28 PP patients (36%) and in 29 PN patients (26%) (aHR, 2.24; 95% CI, 1.31 to 3.85; P=0.003). Conclusion Paenibacillus detection in the CSF at the time of hydrocephalus surgery was associated with a significantly increased rate of the composite of diversion failure or death, death, and diversion failure, and was particularly increased for patients who had an endoscopic diversion. Preoperative testing and treatment of Paenibacillus infections may improve outcomes for surgical management of PIH. Disclosures Jessica E. Ericson, MD, MPH, Abbvie: Advisor/Consultant

The Functional Outcome in Surgical Management of Bimalleolar Ankle Fractures in Adults

The Functional Outcome in Surgical Management of Bimalleolar Ankle Fractures in Adults

Advanced paranasal sinuses osteomas: a retrospective multicentric analysis on surgical management outcomes and intra- and postsurgical complications.

This study examines the management and outcomes of large paranasal sinus osteomas (PSO), especially those abutting or encasing critical structures of the skull base and orbit. A multicentric retrospective analysis was conducted between June 2007 and September 2023. The study included surgically treated (regardless the type of approach chosen) PSO, exceeding 3 cm in diameter and/or located in critical anatomical areas. An analysis was performed to assess the association between the critical relationships, size, presence of residual disease, and incidence of intra- and postoperative complications. The series included 160 patients. Most PSO were diagnosed due to clinical symptoms, predominantly for those located in the frontal sinus. Residual disease was observed in 9.4% of patients, with its occurrence influenced by PSO size and relationships with specific anatomical structures. Thirty-five/160 (21.9%) of patients experienced one or more intra- and/or postoperative complications. Intraoperative complications were associated with the proximity of PSO to the cribriform plate. Long-term complications were more frequently observed in cases involving the anterior and posterior plate of the frontal bone. This study highlights the complexities involved in managing large PSO, demonstrating that size and anatomical relationships of these osteomas can critically influence surgical decisions, residual disease, and complication rate. The study's retrospective design limited the collection of standardized symptom outcomes, highlighting the need for future studies to address this apect.

Supranormal renal function in pediatric ureteropelvic junction obstruction: a multiparameter analysis to guide clinical management.

The clinical significance and optimal management of supranormal differential renal function (DRF ≥ 55%) in pediatric ureteropelvic junction obstruction (UPJO) remain debated. This study investigated supranormal DRF clinical characteristics and evaluated surgical versus conservative management outcomes to guide decision-making. We retrospectively reviewed 76 children with unilateral UPJO who underwent standardized DMSA and DTPA scans at a single center (2020-2022). Patients were stratified into: normal DRF (40-55%) with pyeloplasty (n = 38), supranormal DRF with pyeloplasty (n = 12), and supranormal DRF with observation (n = 26). Primary outcomes included changes in DRF, renal parenchymal parameters, and hydronephrosis severity. Supranormal DRF occurred in 11.1% of cases, predominantly in younger children (median 20 vs 42months, p = 0.01). Surgically managed supranormal cases demonstrated more severe hydronephrosis (75% grade 4, median APD 3.6cm) compared to conservatively managed cases (27% grade 4, median APD 2.9cm, p < 0.001). Post-pyeloplasty, supranormal kidneys showed consistent normalization of both DRF (58.2% to 51.6%, p < 0.001) and anatomical parameters. However, 77% of conservatively managed cases with less severe hydronephrosis maintained stable supranormal function without deterioration over median 14-month follow-up. Only 8% required delayed surgery for clinical progression. Supranormal DRF warrants careful evaluation, particularly when accompanied by severe hydronephrosis (grade 4 or APD ≥ 3.0cm). While early pyeloplasty effectively normalizes renal parameters in severe cases, observation may be appropriate for selected patients with less severe hydronephrosis. Treatment decisions should prioritize anatomical severity over DRF values alone.

Outcomes of Surgical Management of Late Presenting Intra-Articular Distal Femoral Physeal Fracture: A Multicentric Retrospective Case Series

Outcomes of Surgical Management of Late Presenting Intra-Articular Distal Femoral Physeal Fracture: A Multicentric Retrospective Case Series

The Five-Year Outcomes of Breast Cancer Surgical Management at the Colentina Surgical Clinic, Bucharest, Romania: A Descriptive Retrospective Analysis Between 2019 and 2023.

Background: Breast cancer still represents the most commonly diagnosed cancer among women, accounting for 12.5% of all new annual cancer cases worldwide. In Romania in 2020, breast cancer was the most common, with a share of new cases of 26.9%, far behind the rates of colon cancer (11.8%) and cervix cancer (7.5%). The aim of this study is to reveal five years of experience in treating breast cancer at the Surgical Clinic of the Colentina Hospital in Bucharest, Romania. Methods: Retrospective analysis, including 68 patients admitted to our clinic between January 2019 and December 2023 undergoing modified radical mastectomy, sectorectomy, or subcutaneous mastectomy. Results: Madden-modified radical mastectomy with total excision of the axillary lymph nodes accounted for 77.94% of surgeries, with a complication rate of 13.2%, represented by lymphedema of the ipsilateral arm and prepectoral seroma. Conclusions: Continuous innovation regarding early diagnosis and treatment methods in our surgical clinic will, hopefully, contribute to improving the outcomes of our patients.

TOS UK (Thoracic Outlet Syndrome, United Kingdom): A Retrospective Review of Practice.

Thoracic outlet syndrome (TOS) is caused by compression of the neurovascular bundle at the thoracic outlet which often poses a diagnostic challenge. Patient management is often based on surgeon choice and experience. This study aims to describe practices relating to the diagnosis and management of TOS in the UK over a 1-year period. This multicentre, retrospective UK study included data from 16 vascular centres, analysing surgical management and postoperative outcomes of patients treated for TOS in 2019. Outcomes were evaluated by TOS type: neurogenic (nTOS), venous (vTOS), or arterial (aTOS). Data on 133 patients from 16 units were collected over a 1-year period. Most patients were female (87/133; 65%). Surgeries addressed neurogenic TOS (53/133; 40%), venous TOS (48/133; 36%), and arterial TOS (32/133; 24%), with TOS type unspecified in 2 patients. Five imaging modalities were used for diagnosis. Surgical approaches included supraclavicular (90/133; 68%), transaxillary (23/133; 17%), infraclavicular (13/133; 10%), paraclavicular (6/133; 5%), and thoracoscopic (1/133; <1%). Pleural injury was the most reported complication (16/133; 12%). Most patients with pleural injury were managed conservatively, with only one-quarter requiring the insertion of a chest drain (4/16; 25%). Most patients (119/133; 89%) had symptom resolution, lower in neurogenic TOS compared to arterial and venous (p<0.05). There is considerable variability in the diagnosis and management of patients with TOS across vascular centres in the UK. This study supports the development of a national registry and the creation of best practice guidelines in the future.

Management of a Right Tibial Proximal Third Open Comminuted Fracture: Surgical Disarticulation of Right Stifle Joint in a 1-Year-Old Hen Pigeon (Columba livia domestica)

Traumatic pelvic limb fractures in pet birds are rare and primarily result from trauma. Avian bones are fragile and prone to fragmentation due to various natural and anthropogenic events. This case report describes the diagnosis, anesthesia protocol, surgical management, post-operative care, and remarkable outcome of a right tibial comminuted fracture in a one-year-old hen pigeon (Columba livia domestica). A one-year-old hen pigeon was presented to the Veterinary Teaching Hospital, University of Jos, Nigeria, with a broken right pelvic limb after being attacked by a young lad. The attack occurred 30 minutes prior to presentation. Clinical examination revealed extensive tissue damage including an open wound with a complete fracture and bone fragment at the proximal third of the right tibia, accompanied by hemorrhages, tenderness, pale ocular mucous membranes, and lethargy. The impact of the attack was the primary cause of the comminuted fracture. Due to logistical constraints and the patient's critical condition, pre-operative radiographic imaging was not feasible. A definitive diagnosis of right tibial proximal third open comminuted fracture was readily made based on the gross tissue damage. Following standard aseptic protocol, stifle disarticulation was performed under local anesthesia to alleviate the bird's excruciating pain. Local anesthesia was achieved with 10mg lidocaine hydrochloride via local infiltration at the stifle. Due to the bird's critical condition, local anesthesia was preferred over general anesthesia. A 5mm stab skin incision was made distal to the right stifle, followed by blunt dissection of the musculature and disarticulation at the tibiofemoral joint. 5mm musculature distal to the stifle was transected and the skin was routinely sutured with size 3/0 silk suture. Post-operative care included injectable amoxicillin, piroxicam, and iron dextran administration, along with alternative-day wound dressing. Skin sutures were removed eight days post-surgery. The pigeon made a remarkable recovery, regaining balance and flying comfortably. Post-recovery imaging was not feasible as all arrangements made with the client following the bird's recovery ultimately fell through. To our knowledge, this case represents the first reported instance of a comminuted tibial fracture in a pigeon managed with stifle disarticulation. The successful outcome of this case proves stifle disarticulation to be an effective treatment option for complex fractures in birds, underscoring the importance of innovative strategies, prompt surgical intervention and addressing a significant gap in the literature. At the time of this report, the pet bird is currently nesting and brooding its eggs. Keywords: Hen pigeon, Comminuted tibial fracture, Proximal third, Stifle disarticulation.

Outcomes of surgical management of hallux abductovalgus with concomitant metatarsus adductus deformity: A systematic review

Outcomes of surgical management of hallux abductovalgus with concomitant metatarsus adductus deformity: A systematic review

Introducing and Validating the Multiphasic Evidential Decision-Making Matrix (MedMax) for Clinical Management in Patients with Intrahepatic Cholangiocarcinoma.

Background: Despite the significant advancements of liver surgery in the last few decades, the survival rate of patients with liver and pancreatic cancers has improved by only 10% in 30 years. Precision medicine offers a patient-centered approach, which, when combined with machine learning, could enhance decision making and treatment outcomes in surgical management of ihCC. This study aims to develop a decision support model to optimize treatment strategies for patients with ihCC, a prevalent primary liver cancer. Methods: The decision support model, named MedMax, was developed using three data sources: studies retrieved through a systematic literature review, expert opinions from HPB surgeons, and data from ihCC patients treated at Heidelberg University Hospital. Expert opinions were collected via surveys, with factors rated on a Likert scale, while patient data were used to validate the model's accuracy. Results: The model is structured into four decision-making phases, assessing diagnosis, treatment modality, surgical approach, and prognosis. Prospectively, 44 patients with ihCC were included for internal primary validation of the model. MedMax could predict the appropriate treatment considering the resectability of the lesions in 100% of patients. Also, MedMax could predict a decent surgical approach in 77% of the patients. The model proved effective in making decisions regarding surgery and patient management, demonstrating its potential as a clinical decision support tool. Conclusions: MedMax offers a transparent, personalized approach to decision making in HPB surgery, particularly for ihCC patients. Initial results show high accuracy in treatment selection, and the model's flexibility allows for future expansion to other liver tumors and HPB surgeries. Further validation with larger patient cohorts is required to enhance its clinical utility.

Symptomatic Progression, Recurrence, and Long-Term Follow-Up of Patients With Intracranial Epidermoid Cysts.

Intracranial epidermoid cysts are rare, slow-growing but highly recurrent tumors with incompletely understood symptoms, progression, complications, and outcomes. The aim of the study was to characterize the symptomatology, surgical management, and long-term outcomes of these tumors. This single-center retrospective analysis identified patients with pathologically confirmed intracranial epidermoid cysts from 1989 to 2023. Demographic and clinical variables were collected at diagnosis, before and after each resection, and at the latest follow-up. Differences across time points were evaluated using analysis of variance with post hoc Tukey's honestly significant difference tests and Pearson χ2 test with posthoc Bonferroni-corrected z-tests for independent proportions (significance: P ≤ .05). Kaplan-Meier, Cox regression, and multivariate logistic regression analyses were used to investigate predictors for recurrence-free survival and 30-day readmission following first surgery, respectively. Of 146 patients in the final cohort, the average age at diagnosis was 40.3 years, and 52.1% of patients were female. The mean maximum tumor dimension at presentation was 4.3 cm. Most presenting symptoms were significantly reduced at the latest follow-up, including headaches (presentation: 40.4%/latest follow-up: 8.8%, P < .001), vertigo/nausea/vomiting (33.1%/3.7%, P < .001), ataxia/incoordination (22.8%/4.4%, P < .001), and seizures (11.8%/2.9%, P < .005). Similarly, significant improvements were observed in cranial nerve (CN) II deficits (11.0%/3.7%, P = .020) and CN V (11.8%/3.7%, P = .012) and CN VIII excitatory symptoms (11.8%/2.9%, P = .005). Following the first resection, 12.5% of patients were readmitted within 30 days; lumbar drain placement was associated with higher odds of readmission (adjusted odds ratio [95% CI] = 8.26 [1.29-88.19]). Evidence of tumor remnant on the immediate postoperative MRI was associated with a shorter time to recurrence following the first surgery (P = .023). The clinical progression of intracranial epidermoid cysts is marked by a spectrum of troublesome presenting symptoms and a notable tendency for recurrence, particularly following subtotal resection. Nevertheless, symptomatic improvement is the rule even if reoperations are needed, and mortality is exceedingly rare.

Long-term patient-reported outcome for surgical management of pelvic organ prolapse: A retrospective cohort study.

Pelvic organ prolapse (POP) has traditionally been treated by vaginal native tissue repair. This study aimed to review two cohorts of women surgically treated for POP regarding surgical characteristics, and compare long-term outcomes based on subjective satisfaction and surgeon experience. Retrospective cohort study of 490 women undergoing a primary native-tissue POP procedure during 2002-2004 (cohort 1, n=201), or during 2012-2014 (cohort 2, n=289). Patient-reported questionnaire data were collected in 2008 (cohort 1) and 2018 (cohort 2, and repeat survey cohort 1 (n=97)). Clinical data were collected from patient files. Outcomes were assessed by Kaplan-Meier/log-rank test, binary logistic regression and Cox multivariate analysis. Women in cohort 2 were operated at a younger age (median 64 versus 66 years, P<0.001) with grade 2 as dominant prolapse (156/289, 54%), versus grade 3 dominant prolapse (130/201, 65%, P<0.001) in cohort 1. In cohort 2 a higher proportion (172/289 (60%) versus 39/201 (19%), P<0.001) were operated with a procedure including all three compartments (anterior, apical and posterior). For 24% (117/490) of all patients a peri-/postoperative procedure-related complication was noted. After a median observation time of 163 months (cohort 1, 95% confidence interval 160-169) and 63 months (cohort 2, 95% confidence interval 62-64), a total of 43 patients (9%) had been subjected to further prolapse surgery, median 41 months (95% confidence interval 23-72) after the primary surgery. In all, 89% of women (176/196 cohort 1, and 253/285 cohort 2, P=0.722) were very/somewhat satisfied 4-6 years postoperatively, although 18% (38/193 in cohort 1 and 50/282 in cohort 2) still reported prolapse symptoms. After 14-16 years 88% (84/97) remained satisfied, but 31% (30/97) reported prolapse symptoms. Neither satisfaction, peri-/post-operative complications, nor reoperation-rate differed regarding lead surgeon experience-level (gynecologist in-training versus specialist). Women operated by primarily native-tissue POP surgery report high levels of satisfaction, even 15 years after surgery, despite 31% reporting prolapse related symptoms. Outcomes were similar regardless of lead surgeon being in-training or certified gynecologist.

Outcomes of Surgical Management of Late Presenting Intra-Articular Distal Femoral Physeal Fracture: A Multicentric Retrospective Case Series.

The online version contains supplementary material available at 10.1007/s43465-024-01291-4.

Dexmedetomidine Nasal Packing Versus Intravenous Dexmedetomidine for Controlling Bleeding During Turbinate Surgeries: A Randomized Double-Blind Trial

Background: Nasal obstruction due to hypertrophied turbinates (HT) is one of the common reasons for patients undergoing turbinate operations. This condition is associated with intraoperative nasal bleeding, which can obscure visibility of the field and prolong surgery time. Objectives: The purpose of this study is to compare dexmedetomidine-soaked nasal packing (NP) and intravenous (IV) dexmedetomidine (DEX) for managing bleeding during turbinate surgeries to reduce blood loss and improve surgical field quality. Methods: This randomized, double-blind trial was conducted on 60 patients aged between 18 and 65 years undergoing turbinate surgeries. Patients were randomly assigned into two equal groups: Group NP received DEX-soaked NP (1.5 µg/kg for 10 minutes) and an IV saline bolus followed by saline infusion. Group IV received a 0.5 µg/kg DEX bolus over 10 minutes, followed by a 0.1 - 0.4 µg/kg per hour IV infusion and saline-soaked NP. Results: The mean intraoperative blood loss was 124.1 ± 34.85 mL in group NP and 115.63 ± 31.89 mL in group IV, with no significant difference. Intraoperative hemodynamics, surgical field quality scores, time to first rescue analgesia, total postoperative pethidine consumption, pain score, patient satisfaction, and side effects were comparable. Conclusions: Dexmedetomidine NP is non-inferior to IV DEX for controlling intraoperative bleeding during turbinate surgery. Both methods provided comparable surgical field quality, patient satisfaction, and pain management outcomes.

Paediatric Head and Neck Hemangiomas: Scopes, Challenges and Outcome of Surgical Management

Paediatric Head and Neck Hemangiomas: Scopes, Challenges and Outcome of Surgical Management

Resection of Calcified and Giant Thoracic Disc Herniation Through Bilateral Postero-Lateral Approach and 360° Cord Release: A Technical Note.

Background/Objectives: Surgical treatment of thoracic disc herniation (TDH) is risky and technically demanding due to its proximity to the spinal cord and the high possibility of the TDH being calcified (up to 40%), making the resection even more complex. Calcified TDH may be resected from an anterior via thoracotomy/thoracoscopy, lateral extra-cavitary, or a postero-lateral approach. Here, we present our experience in managing such pathology with an original technique Methods: This original technique, used successfully in more than 40 patients, is introduced, with a precise description of the surgical anatomy and the surgical steps to take. Indications for surgical management and neurological outcomes are also analyzed. This surgical approach consisted of transverso-pediculectomy, most often bilaterally, partial vertebral body drilling, 360° release of the cord, and short fixation. Results: A total of 44 patients were collected, with a mean age of 52.4 ± 11.7 years. Seven patients (15.9%) had complete calcifications, and thirty-one had partial calcifications (70.5%), while the remaining six did not have signs of calcifications. There were only 4 intraoperative complications (2 dural tears and 2 loss of evoked potentials). The TDH could be resected in total for 39 patients (88.6%) and partially, according to the "floating" technique, in 5 patients (11.4%). In the postoperative follow-up, all of the patients except two (presenting with sensory aggravation) reported an improvement in neurological conditions leading to an overall risk of neurological aggravation of 4.5%. Conclusions: The bilateral postero-lateral approach provides a large decompression of the cord (360°) and gives safe access to the TDH, even calcified, permitting high rates of total resection. It also prevents any prejudicial pressure on the spinal cord, reducing the risk of severe postoperative deficits and permitting optimal instrumentation (pedicle screw-based) of the spinal segment. The surgical sequence to resect the bony structures around the spinal cord is of great importance.

Treatment of Spontaneous Subarachnoid Hemorrhage: A 20‐Year National Inpatient Sample Review

BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) is a major source of morbidity and mortality, and its management has undergone foundational changes over thepast 2 decades. We reviewed the National Inpatient Sample to outline the changes in severity of illness, surgical management, and patient outcomes over time. METHODS A retrospective cohort of admissions for spontaneous SAH in the National Inpatient Sample from 2001 to 2020 was reviewed, including those who underwent microsurgical or endovascular surgery to secure a ruptured aneurysm. National incidence was calculated, and multivariable regression was used to identify changes in incidence and outcome through time, segmented by epoch. RESULTS Review of the National Inpatient Sample identified 448 655 patients with SAH, of whom 181 590 underwent surgical aneurysm treatment. The incidence of spontaneous SAH fell −0.097 per 100 000 person‐years each year (95%CI, −0.144 to −0.049). Among patients surgically treated for aneurysmal SAH, the proportion of patients &lt;50 years old fell from 40% to 30% between first and final epochs, and the proportion of those in the lowest stroke scale category, roughly equivalent to Hunt and Hess grade 1 or 2, fell from 66% to 45%. The proportion treated by microsurgery fell from 70% to 23% in favor of endovascular surgery. Hospital mortality among these treated cases was stable at 13% throughout the study period despite increasing illness severity indices. After adjustment, there was a 42% reduction of odds of hospital mortality in the final epoch compared with the first. CONCLUSION The incidence of hospitalization for spontaneous SAH fell between 2001 and 2020. Patients undergoing surgery to secure an aneurysm were more severely ill through time yet experienced a stable hospital mortality rate.

Outcome of surgical management of clavicle shaft fracture in adult

Outcome of surgical management of clavicle shaft fracture in adult