Risk Factors For Neurological Complications Research Articles

Perioperative Neurologic Complications in Adult Spinal Deformity Surgery: Incidence and Risk Factors in 564 Patients.

Prognostic study-case controlled. Describe the rate of neurologic complications in adult spinal deformity surgery and describe the effect of these complications on clinical outcomes. The incidence of neurologic complications and the risk factors for neurologic complications have not been reported in a large series of patients with adult spinal deformity (ASD). Existing series include a mixed patient cohort undergoing different types of spine surgery. Patients with ASD undergoing surgery between 2008 and 2014 were analyzed. Patients with neurologic complications were identified; demographics, operative details, and radiographic and clinical outcomes were compared. A subanalysis of those with surgical and nonsurgical (e.g., stroke) neurologic complications was performed. Statistical analysis included t tests or χ tests as appropriate and a multivariate analysis. A P value of less than 0.025 was considered significant. A total of 564 patients met the inclusion criteria. The average age was 57 years. There were a total of 116 neurologic complications in 99 patients (17.6%). There were 88 surgical procedure-related neurologic complications in 77 patients (13.7%) and 28 nonsurgical neurologic complications in 28 patients (5.0%). The most common complications were radiculopathy (30%), motor deficits (22%), mental status changes (12%), and sensory deficits (12%). Revisions (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.2-2.4) and interbody fusions (OR 2.1, 95% CI 1.4-3.2) were associated with an increased risk of neurologic complications. Decompression and osteotomies (including three-column osteotomies) did not increase the risk of neurologic complications. Patients with neurologic complications were not more likely to sustain other complications; however, they were more likely to undergo another operation during the follow-up period (OR 1.9, 95% CI 1.3-2.8). The overall incidence of neurologic complications in ASD surgery was 17.6%. The incidence of surgical neurologic complications was 13.7%. There was a higher risk of neurologic complications in revision cases and in cases in which interbody fusion was required. 3.

Neurologic Complications After Cardiac Transplant.

Cardiac transplant is the best available therapy for patients with end-stage heart failure. Neurologic complications occur at a rate of 30% to 70% in patients undergoing cardiac transplant, and they affect mortality and morbidity of these patients. Risk factors for neurologic complications include immunosuppressive medication toxicity, infections, brain lesions, and metabolic disorders. The aim of our study was to determine the incidence of neurologic complications in adult patients undergoing cardiac transplant. We retrospectively evaluated the medical records of 70 patients who underwent cardiac transplant between 2004 and April 2016. We recorded the demographic data, neurologic symptoms, neurologic examination findings, laboratory test results, brain imaging study results, and treatments received of the patients. Of the 70 patients enrolled, 55 were male and 15 were female patients. The age range was 18 to 63 years, and the mean age was 42.4 years. Twelve patients had encephalopathy, 4 had neuropathic pain, 3 had tremor, 2 had ischemic cerebrovascular accident, 7 had posterior reversible encephalopathy syndrome, and 1 had drop foot. Encephalopathy usually developed secondary to other neurologic disorders. The incidence of neurologic complications in adult patients undergoing cardiac transplant was 30%. Neurologic complications are common after cardiac transplant. We observed an incidence of 30% for neurologic complications in our clinic, with encephalopathy being the most common complication. Encephalopathy most commonly developed secondary to posterior reversible encephalopathy syndrome.

Comprehensive risk assessment for early neurologic complications after liver transplantation.

To determine risk factors for early neurologic complications (NCs) after liver transplantation from perspective of recipient, donor, and surgeon. In all, 295 adult recipients were enrolled consecutively between August 2001 and February 2014 from a single medical center in Taiwan. Any NC in the first 30 d post-liver transplantation, and perioperative variables from multiple perspectives were collected and analyzed. The main outcome was a 30-d NC. Generalized additive models were used to detect the non-linear effect of continuous variables on outcome, and to determine cut-off values for categorizing risk. Risk factors were identified using multiple logistic regression analysis. In all, 288 recipients were included, of whom 142 (49.3%) experienced at least one NC, with encephalopathy being the most common 106 (73%). NCs prolonged hospital stay (35.15 ± 43.80 d vs 20.88 ± 13.58 d, P < 0.001). Liver recipients' age < 29 or ≥ 60 years, body mass index < 21.6 or > 27.6 kg/m(2), Child-Pugh class C, history of preoperative hepatoencephalopathy or mental disorders, day 7 tacrolimus level > 8.9 ng/mL, and postoperative intra-abdominal infection were more likely associated with NCs. Novel risk factors for NCs were donor age < 22 or ≥ 40 years, male-to-male gender matching, graft-recipient weight ratio 0.9%-1.9%, and sequence of transplantation between 31 and 174. NCs post- liver transplantation occurs because of factors related to recipient, donor, and surgeon. Our results provide a basis of risk stratification for surgeon to minimize neurotoxic factors during transplantation.

Atherosclerosis of the ascending aorta as a risk factor for neurological complications in surgical treatment of coronary artery disease

The aim of this study is to analyze the personal experience of surgical treatment of coronary heart disease in atherosclerotic lesions of the ascending aorta. The results of surgery can determine the optimal method of diagnosis and surgical treatment of this pathology.

Apex of deformity for three-column osteotomy. Does it matter in the occurrence of complications?

BackgroundPosterior vertebral column resection (PVCR) is a challenging but effective technique for the correction of complex spinal deformity. However, it has a high complication rate and carries a substantial risk for neurologic injury. PurposeThe aim was to test whether the apex of the deformity influences the clinical outcomes and complications in patients undergoing PVCR. Study designA historical cohort was recruited from a single center and evaluated preoperatively, postoperatively, and at final follow-up. Patient sampleNinety-eight hyperkyphotic patients undergoing PVCR were included. Inclusion criteria consisted of kyphoscoliosis and hyperkyphosis surgically treated with PVCR as a primary or revision procedure. Outcome measuresThe outcome measures included a number of neurologic complications. MethodsReceiver operator characteristic (ROC) curve analysis and Youden index (J) were used to estimate the optimum cut-off to predict neurologic complications for each potential risk factor. In three ROC analyses, we included separately body mass index (BMI), kyphosis degree, and age as independent variables and neurologic complications as the dependent variable. Logistic regression was used to estimate the odds ratios (ORs) and construct 95% confidence intervals (CIs). ResultsAmong the 98 patients, the etiologies were: post infectious (50), congenital (31), and others (17). The averages were: age 14±6.5 years, BMI 20±10 kg/m2, American Society of Anesthesiologists 3±0.7, forced vital capacity 76±23%, fusion levels 10±3, estimated blood loss 1,319±720 mL, surgical time 375±101 minutes, and preoperative localized kyphosis 104±30°. Thirty-three patients had abnormal preoperative neurologic status. Major complications occurred in 46 patients (neurologic in 25). The apex of kyphosis was proximal thoracic T1–T5 (five patients), thoracic (TH) T6–T9 (17 patients), thoracolumbar T10–L2 (55 patients), and lumbar L3–S1 (nine patients). The level of apex and BMI were independent risk factors for neurologic complications: TH apex (OR: 101.30, 95% CI: 1.420–infinite; p=.037); BMI (OR: 1.92, 95% CI: 1.110–infinite; p=.026). ConclusionsPosterior vertebral column resection for severe spine deformity is technically demanding and carries a substantial risk. The apex is a variable that influences the occurrence of neurologic complications, and the presence of a TH apex in particular could be a preoperative risk factor for neurologic complications.

OP38 – 3035: Incidence of and risk factors for neurological complications of cardiac bypass surgery in children with congenital heart disease

Objectives Mortality associated with cardiopulmonary bypass (CPB) for correction or palliation of congenital heart defects (CHD) has decreased. Emphasis is shifting towards morbidity as a primary outcome. This case review conducted in a centre currently providing paediatric cardiac services was designed to establish the current incidence of and risk factors for post-operative neurological complications. Methods All children with CHD undergoing surgery involving CPB (including those needing circulatory arrest) between 01/04/2003–31/03/2010 were included. Patients were identified from the electronic procedural database, and discharge summaries were reviewed independently by two consultant paediatric neurologists, with case note review if information required clarification, and for all with neurological complications (NC). Data on haematology, EEG and cerebral CT/MRI images were retrieved and cross- referenced. Each procedure was categorised according to consensus definitions of the Multi-Societal Database Committee for Paediatric and Congenital Heart Disease. Results Of 922 operations, there were 19 (2.06%) deaths. Longer cardiac bypass and cross-clamp times were associated with death (p=0.004, p=0.032 respectively), but not with NC, which occurred in 46 (5%), including seizures (n=9, of which 3 were post-arrest and 5 were hypocalcaemic); vocal cord palsy (n=6), eye movement disorder (n=5), new or evolving intraventricular haemorrhage (n=2, both on ECMO), Horner's syndrome (n=1), peripheral neuropathy (n=1), chorea (n=1), headache (n=2) and phrenic nerve palsy (n=19). There were no pyramidal/extrapyramidal disorders. All NC other than Horner's syndrome and vocal cord palsy were transient. Post-operative haematocrit was lower in those with NC (0.357±0.07) than in controls (0.389±0.075) matched for date of birth, gender and diagnosis (p=0.049). Conclusions The range of observed NC following CPB may be changing, and only detailed analysis will provide an insight into the processes resulting in this change. Further studies should examine pre- and peri-operative factors leading to lower haematocrit, a potentially modifiable risk factor for NC. Mortality associated with cardiopulmonary bypass (CPB) for correction or palliation of congenital heart defects (CHD) has decreased. Emphasis is shifting towards morbidity as a primary outcome. This case review conducted in a centre currently providing paediatric cardiac services was designed to establish the current incidence of and risk factors for post-operative neurological complications. All children with CHD undergoing surgery involving CPB (including those needing circulatory arrest) between 01/04/2003–31/03/2010 were included. Patients were identified from the electronic procedural database, and discharge summaries were reviewed independently by two consultant paediatric neurologists, with case note review if information required clarification, and for all with neurological complications (NC). Data on haematology, EEG and cerebral CT/MRI images were retrieved and cross- referenced. Each procedure was categorised according to consensus definitions of the Multi-Societal Database Committee for Paediatric and Congenital Heart Disease. Of 922 operations, there were 19 (2.06%) deaths. Longer cardiac bypass and cross-clamp times were associated with death (p=0.004, p=0.032 respectively), but not with NC, which occurred in 46 (5%), including seizures (n=9, of which 3 were post-arrest and 5 were hypocalcaemic); vocal cord palsy (n=6), eye movement disorder (n=5), new or evolving intraventricular haemorrhage (n=2, both on ECMO), Horner's syndrome (n=1), peripheral neuropathy (n=1), chorea (n=1), headache (n=2) and phrenic nerve palsy (n=19). There were no pyramidal/extrapyramidal disorders. All NC other than Horner's syndrome and vocal cord palsy were transient. Post-operative haematocrit was lower in those with NC (0.357±0.07) than in controls (0.389±0.075) matched for date of birth, gender and diagnosis (p=0.049). The range of observed NC following CPB may be changing, and only detailed analysis will provide an insight into the processes resulting in this change. Further studies should examine pre- and peri-operative factors leading to lower haematocrit, a potentially modifiable risk factor for NC.

Relationship between neurological complications, cerebrovascular and cerebral perfusion following off-pump coronary artery bypass grafting

Objective:To investigate risk factors for neurological complications after off-pump coronary artery bypass grafting (OPCABG).Methods:We reviewed the cases of 813 patients who underwent OPCABG between August 2010 and September 2013.Data from preoperative 320 dynamic volume computed tomography (CT), CT angiography (CTA), CTA perfusion, and cerebrovascular function examinations were assessed. Neural function was assessed before and 7 days after operation, and patients were assigned to either the neurological complications or non-neurological complications group.Results:Neurological complications were observed in 23.4% (190/813) of patients; cerebral infarction in 1.1% (9/813); hypoxic ischemic encephalopathy in 2.3% (19/813); delirium in 1.5% (12/813); postoperative cognitive dysfunction in 12.9% (105/813); and anxiety/depression in 8.2% (67/813). Patients in the neurological complications group were older, were more likely to have a previous history of cerebrovascular disease and diabetes, had more severe extra-cranial carotid artery stenosis, had more severe stenosis on CTA, and had more perfusion abnormalities compared to patients in the non-neurological- complications group (P < 0.05). Logistic regression analysis identified the following independent risk factors for neurological complications: male gender (odds ratio [OR], 1.816; 95% confidence interval [CI], 1.017–3.244; P = 0.044); cerebrovascular disease history (OR, 1.837; 95% CI, 1.075–3.141; P = 0.026); and perfusion abnormalities (OR, 3.224; 95% CI, 2.073–5.013; P = 0.000). Occipital lobe cerebral blood flow (CBF); differences in temporal lobe, occipital lobe, and basal ganglial time to peak (TTP); and the difference in occipital lobe and basal ganglial mean transit time (MTT) were significantly higher in the neurological complications group (P < 0.05). For the TTP difference, the area under the receiver operating characteristic (ROC) curve was 0.606.Discussion:Neurological complications were observed in 23.4% of patients following OPCABG. Male gender, cerebrovascular disease history, and perfusion abnormalities were independent risk factors for neurological complications. Temporal lobe TTP on CTA perfusion was the best predictor of neurological complications.

Guideline on the management of acute chest syndrome in sickle cell disease.

1. Department of Haematology, Guy’s and St Thomas’ NHS Foundation Trust 2. Lane Fox Respiratory Unit, St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust 3. Department of Haematology, North Middlesex Hospital 4. Department of Paediatric Haematology, Bristol Royal Hospital for Children 5. Department of Haematological Medicine, King’s College Hospital 6. Department of Haematology, Whittington Hospital

Predictive factors of neurological complications and one-month mortality after liver transplantation.

Background: Neurological complications are common after orthotopic liver transplantation (OLT). We aimed to characterize the risk factors associated with neurological complications and mortality among patients who underwent OLT in the post-model for end-stage liver disease (MELD) era.Methods: In a retrospective review, we evaluated 227 consecutive patients at the Keck Hospital of the University of Southern California before and after OLT to define the type and frequency of and risk factors for neurological complications and mortality.Results: Neurological complications were common (n = 98), with encephalopathy being most frequent (56.8%), followed by tremor (26.5%), hallucinations (11.2%), and seizure (8.2%). Factors associated with neurological complications after OLT included preoperative dialysis, hepatorenal syndrome, renal insufficiency, intra-operative dialysis, preoperative encephalopathy, preoperative mechanical ventilation, and infection. Preoperative infection was an independent predictor of neurological complications (OR 2.83, 1.47–5.44). One-month mortality was 8.8% and was independently associated with urgent re-transplant, preoperative intubation, and intra-operative arrhythmia.Conclusion: Neurological complications are common in patients undergoing OLT in the post-MELD era, with encephalopathy being most frequent. An improved understanding of the risk factors related to both neurological complications and one-month mortality post-transplantation can better guide perioperative care and help improve outcomes among OLT patients.

Monocytes-Derived Macrophages Mediated Stable Expression of Human Brain-Derived Neurotrophic Factor, a Novel Therapeutic Strategy for NeuroAIDS

HIV-1 associated dementia remains a significant public health burden. Clinical and experimental research has shown that reduced levels of brain-derived neurotrophic factor (BDNF) may be a risk factor for neurological complications associated with HIV-1 infection. We are actively testing genetically modified macrophages for their possible use as the cell-based gene delivery vehicle for the central nervous system (CNS). It can be an advantage to use the natural homing/migratory properties of monocyte-derived macrophages to deliver potentially neuroprotective BDNF into the CNS, as a non-invasive manner. Lentiviral-mediated gene transfer of human (h)BDNF plasmid was constructed and characterized. Defective lentiviral stocks were generated by transient transfection of 293T cells with lentiviral transfer plasmid together with packaging and envelope plasmids. High titer lentiviral vector stocks were harvested and used to transduce human neuronal cell lines, primary cultures of human peripheral mononocyte-derived macrophages (hMDM) and murine myeloid monocyte-derived macrophages (mMDM). These transduced cells were tested for hBDNF expression, stability, and neuroprotective activity. The GenomeLab GeXP Genetic Analysis System was used to evaluate transduced cells for any adverse effects by assessing gene profiles of 24 reference genes. High titer vectors were prepared for efficient transduction of neuronal cell lines, hMDM, and mMDM. Stable secretion of high levels of hBDNF was detected in supernatants of transduced cells using western blot and ELISA. The conditioned media containing hBDNF were shown to be protective to neuronal and monocytic cell lines from TNF-α and HIV-1 Tat mediated cytotoxicity. Lentiviral vector-mediated gene transduction of hMDM and mMDM resulted in high-level, stable expression of the neuroprotective factorBDNF in vitro. These findings form the basis for future research on the potential use of BDNF as a novel therapy for neuroAIDS.

Inflammatory bowel disease: An increased risk factor for neurologic complications

Only a very few systematic studies have investigated the frequency of neurologic disorders in patients with Crohn's disease (CD) and ulcerative colitis (UC), which are the two main types of inflammatory bowel disease (IBD). Results have been inconsistent and variable, owing to differences in case-finding methods and evaluated outcomes in different studies. The most frequent neurologic manifestations reported in CD and UC populations are cerebrovascular disease (with either arterial or venous events), demyelinating central nervous system disease, and peripheral neuropathy (whether axonal or demyelinating); however, the literature describes numerous nervous system disorders as being associated with IBD. The pathogenesis of nervous system tissue involvement in IBD has yet to be elucidated, although it seems to be related to immune mechanisms or prothrombotic states. The recently-introduced tumor necrosis factor (TNF) inhibitors have proven successful in controlling moderate to severe IBD activity. However, severe neurologic disorders associated with TNF inhibitors have been reported, which therefore raises concerns regarding the effect of anti-TNF-α antibodies on the nervous system. Although neurological involvement associated with IBD is rarely reported, gastroenterologists should be aware of the neurologic manifestations of IBD in order to provide early treatment, which is crucial for preventing major neurologic morbidity.

TRANSCATHETER AORTIC VALVE IMPLANTATION IN PATIENTS WITH LEFT ATRIAL APPENDIX THROMBUS

Aim. The transcatheter aortic valve implantation (TAVI) which developed in the recent years has become an alternative for surgery. However, in spite of new developments the process based vascular and neurological complications still remain to be a problem with elderly patients who also tend to have many co-morbid conditions. With this study we aimed to evaluate the TAVI efficacy and reliability on patients with scarcely relative contraindication and with intracardiac thrombus who are mostly left out of the study. Methods and Results. There has been a successful TAVI process conducted in our clinic for antiplatelet and anticoagulation for 6 cases in which thrombus was seen in left atrial appendix (LAA) via transesophageal echocardiography (TEE) and which are not suitable for surgical valve replacement due to atrial fibrillation (AF) and severe AS comorbid reasons. Edwards SAPIEN XT valve was implanted to all patients transfemorally with general anaesthesia. The process was facilitated successfully and no major/minor stroke was observed in post-process early period, and 9 month controls, in average. Conclusion. Other than AS, also AF, whose frequency increases with age, is an important risk factor for neurological complications. In patients who has AF and AS the source of the cardioembolic focus is mainly LAA. The post-TAVI antiplatelet and anticoagulation treatment is not clear for these patients. We tried to show that TAVI process is reliable in terms of the risk of stroke, in careful processing and suitable anticoagulation treatment for the patients with AF, AS and LAA in this first case study in literature, as far as we know.

Risk factors for neurological complications and their correlation with survival following pediatric liver transplantation

Despite the improved outcomes of LT, post-operative NCs remain a significant cause of morbidity and mortality. The aim of the study was to identify the incidence of and risk factors for NCs in children who underwent LT. The medical records of pediatric patients who underwent LT at Asan Medical Center Children's Hospital between January 1994 and December 2010 were retrospectively analyzed. The onset and types of NC and pretransplant variables associated with NC were evaluated. We identified 190 children (85 boys [44.7%], 105 girls [55.3%]) of mean age 4.1 ± 4.7 yr, who underwent LT. Forty-six NCs occurred in 41 (21.6%) patients after LT, the most common being seizures (n = 13, 28.3%) and encephalopathy (n = 10, 21.7%). Of the 46 NCs, 24 (52.2%) occurred within three months after LT. Multivariate analysis showed that primary liver disease, preoperative neurological problems, preoperatively higher serum creatinine concentration, and graft failure were significant risk factors for NCs. The survival rate was significantly lower for patients with NCs than for those without (p < 0.001). NCs after pediatric LTs were common and associated with a higher mortality rate in our study. Close monitoring and appropriate risk management may improve the long-term outcomes of pediatric patients who undergo LT.

Neurologic Complications In Pediatric Sickle Cell Patients Hospitalized For Priapism: An Analysis Of The Pediatric Health Information System (PHIS) Database

BackgroundPriapism is a known complication of sickle cell disease (SCD). Though, blood transfusion is often used in the management of SCD-associated priapism (SAP), its safety and efficacy is not known. Transfusion has been associated with neurologic events including ASPEN syndrome (Association of Sickle cell disease, Priapism, Exchange transfusion, and Neurologic events) [Siegel et al. J Urol 1993]. A recent systematic review suggests that transfusion does not appear to be effective in SAP as determined by time to detumescense (Merritt et al. Can J Emerg Med 2006). Our objective is to examine the relationship between blood transfusions and neurologic complications (NCs) in the management of SAP. MethodsWe reviewed the data from 33 children's hospitals within the Pediatric Health Information System (PHIS) database from 2000-2011. Patients ≤ 21 years of age with SCD were included for the analysis. SCD, priapism and all related conditions were identified by ICD-9 codes. We abstracted data on demographics, hospitalizations, transfusion, urologic procedures and neurologic changes (including stroke, seizure, headache, weakness, transient-ischemic attacks (TIAs), intracranial hemorrhage, and mental status changes). Fisher's exact test was used to compare the prevalence of NCs. A p-value <.05 was considered statistically significant. ResultsFrom the year 2000 to 2011, a total of 7,929 unique male pediatric patients with SCD were identified. Among these 465 (5.9%) patients with 1,069 hospitalizations were identified as having SAP. The majority of these patients were HbSS (n=447; 96%). The frequency of SAP hospitalizations at various age groups were; 4.7% (0-2 years of age), 11.2% (3-5 years), 38% (6-12 years) and 46% (13-21 years). In the majority of SAP hospitalizations (63%, n=673) neither transfusions nor urologic procedures were performed, whereas blood transfusions, urologic procedures or both were performed in 25.2% (n=269), 6.6% (n=71) and 5.2% (n=56) of SAP hospitalizations respectively. There was no significant difference in the incidence of NCs between the patients who received transfusions and those who did not (4.1% vs. 4.7%, p = NS). Both bivariate (Table 1) and multivariate regression analysis (Table 2) revealed no statistically significant associations between NCs and blood transfusion, urologic procedure, age at hospitalization for priapism, or other SCD co-morbidities (VOC and ACS).Table 1Bivariate analysis of risk factors for neurological complications in SAP hospitalizationsVariableNeurological Complicationsp-valueNo (n=1021)Yes (n=48)FrequencyPercentFrequencyPercentAcute Chest Syndrome0.202No96295.72434.28Yes5992.1957.81Vaso-Occlusive Crisis0.869No27495.80124.20Yes74795.40364.60Transfusion/Procedure Categorization0.856No Transfusion/Procedure64195.25324.75Transfusion-only25895.91114.09Procedure-only6997.1822.82Both Transfusion/Procedure5394.6435.36Table 2Predictors of neurological complications in SAP hospitalizations.VariableLog OddsStd. Errorp-valueAcute chest syndrome0.7400.5170.1527Vaso-occlusive crisis0.0530.3540.8807No Transfusion or Procedurereference----Transfusion Only-0.2340.3660.5243Procedure Only-0.5460.7480.4666Both Transfusion & Procedure0.2400.6330.7054Age at first Priapism0-2 yearsreference----3-5 years-0.3351.1930.77916-12 yrs-0.0451.0650.966413-15 yrs0.4311.0590.684016-21 yrs0.1961.0780.8554 ConclusionIn our large pediatric sickle cell cohort, NCs associated with priapism were rare. Moreover, there was no significant association between the neurologic complications and blood transfusions or urologic procedures in SAP hospitalizations. Further studies are needed to understand the mechanism behind these neurologic complications and any associated risk factors. Disclosures:No relevant conflicts of interest to declare.

Perioperative complications and risk factors of one-stage posterior vertebral column resection for severe spinal deformity

Objective To investigate the perioperative complications and risk factors of one-stage posterior vertebral column resection (VCR) for severe spinal deformity.Methods From September 2004 to July 2012,39 patients with severe and fixed spinal deformity underwent one-stage posterior VCR,including 15 males and 24 females,aged from 3 to 53 years (average,16.9 years).There were 24 cases of kyphoscoliosis (mean coronal Cobb angle:85.1°,mean sagittal Cobb angle:92.9°),7 cases of scoliosis (mean coronal Cobb angle:81.1°),and 8 cases of kyphosis (mean sagittal Cobb angle:94.4°).Eleven patients had neurological compromise.The perioperative complications and related risk factors of 39 patients were retrospectively analyzed.Results All patients were followed up for 3 to 72 months (average,29.4 months).There were 15cases (13 patients) of perioperative complications.Neurological complications occurred in 6 patients (15.4％),among whom one patient presented complete paraplegia after surgery and 5 patients presented transient paresthesia or muscle weakness.Adults had a significantly higher incidence of neurological complications than teenagers.The incidence rate of neurological complications was 36.4％ in patients with preoperative neurological compromise,while 7.1％ in patients without preoperative neurological compromise.All patients with postoperative neurological complications had kyphosis before operation,and the incidence of neurological complications increased significantly in patients with severe kyphosis (Cobb angle ≥90°).Prolonged respiratory support was conducted in 4 cases.Rupture of the parietal pleura occurred in 3 cases (7.7％),cerebrospinal fluid leak in 1 case (2.6％),and pulmonary infection in 1 case (2.6％).Conclusion One-stage posterior VCR is effective in the treatment of severe and rigid spinal deformity.However,the perioperative complications,especially the neurological complications are common.The risk factors of neurological complications include preoperative neurological compromise,degree of kyphosis and the age of patients. Key words: Scoliosis; Kyphosis; Intraoperative complications; Risk factors

A prospective study of risk factors for neurological complications in childhood bacterial meningitis

ObjectiveTo prospectively analyze the prognostic factors for neurological complications of childhood bacterial meningitis. MethodsThis prospective study enrolled 77 children from 1 month until 16 years of age, treated for bacterial meningitis during the period of January 1, 2009 through December 31, 2010. 16 relevant predictors were chosen to analyze their association with the incidence of neurological complications. p-values < 0.05 were considered statistically significant. ResultsOf the 77 children treated for bacterial meningitis, 33 patients developed neurological complications (43%), and two children died (2.6%). The etiology of bacterial meningitis cases was proven in 57/77 (74%) cases: 32 meningococci, eight pneumococci, six Gram-negative bacilli, five H. influenzae, five staphylococci, and one S. viridans isolates were found. Factors found to be associated with increased risk of development of neurological complications were age < 12 months, altered mental status, seizures prior to admission, initial therapy with two antibiotics, dexamethasone use, presence of focal neurological deficit on admission and increased proteins in cerebrospinal fluid (CSF) (p < 0.05). Initial pleocytosis > 5,000 cells/mm3, pleocytosis > 5,000 cells/mm3 after 48hours, CSF/blood glucose ratio < 0.20, female gender, previous treatment with antibiotics, community-acquired infection, duration of illness > 48hours, presence of comorbidity, and primary focus of infection were not associated with increased risk for the development of neurological complications. ConclusionAge < 12 months and severity of clinical presentation at admission were identified as the strongest predictors of neurological complications and may be of value in selecting patients for more intensive care and treatment.

A prospective study of risk factors for neurological complications in childhood bacterial meningitis

ObjectiveTo prospectively analyze the prognostic factors for neurological complications of childhood bacterial meningitis. MethodsThis prospective study enrolled 77 children from 1 month until 16 years of age, treated for bacterial meningitis during the period of January 1, 2009 through December 31, 2010. 16 relevant predictors were chosen to analyze their association with the incidence of neurological complications. p-values < 0.05 were considered statistically significant. ResultsOf the 77 children treated for bacterial meningitis, 33 patients developed neurological complications (43%), and two children died (2.6%). The etiology of bacterial meningitis cases was proven in 57/77 (74%) cases: 32 meningococci, eight pneumococci, six Gram-negative bacilli, five H. influenzae, five staphylococci, and one S. viridans isolates were found. Factors found to be associated with increased risk of development of neurological complications were age < 12 months, altered mental status, seizures prior to admission, initial therapy with two antibiotics, dexamethasone use, presence of focal neurological deficit on admission and increased proteins in cerebrospinal fluid (CSF) (p < 0.05). Initial pleocytosis > 5,000 cells/mm3, pleocytosis > 5,000 cells/mm3 after 48hours, CSF/blood glucose ratio < 0.20, female gender, previous treatment with antibiotics, community-acquired infection, duration of illness > 48hours, presence of comorbidity, and primary focus of infection were not associated with increased risk for the development of neurological complications. ConclusionAge < 12 months and severity of clinical presentation at admission were identified as the strongest predictors of neurological complications and may be of value in selecting patients for more intensive care and treatment.

ASSA13-08-2 Risk Factors For Simultaneous Carotid Endarterectomy and Coronary Artery Bypass Grafting

<h3>Objectives </h3> The determination of the risk factors of neurological complications for simultaneous carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) and the ways to reduce them. <h3>Methods</h3> 7568 patients (mean age 61.3 ± 7.3, men prevailed) underwent CABG during the period 2003 – 2010. Simultaneous surgical procedures (SSP) - CEA + CABG were performed in 229 (3.0%) cases. In all patients CEA was performed as the first stage, CABG as the next one. The present research consists of 2 parts: retrospective analysis of 123 SSP and prospective evaluation of 106 SSP. <h3>Results</h3> 229 SSP (CEA + CABG) were performed using cardiopulmonary bypass (CB) and warm blood cardioplegia. Mean duration of surgery was 287 ± 41min, CB – 96 ± 27 min, anoxia – 61 ± 27 min, carotid cross-clamping – 13.3 ± 3.5 min. Performing SSP at first we registered a considerable rate of neurological complications in patients with bilateral carotid disease: ischemic stroke – 11.2%, mortality rate – 5.8%. The retrospective multivariate logit regression analysis of the results of 123 SSP detected the following risk factors for ischemic stroke: contralateral stenosis of internal carotid artery (ICA) &gt; 75% (p = 0.049), system hypothermia (rectal temperature) &gt; 29 °C (p = 0.031). Consequently, since 2010 we changed the surgical approach in patients with combined coronary and carotid disease. Thus, patients with contralateral stenosis of ICA &gt; 75% undergo surgery in system hypothermia with &lt; 29 °C. In the prospective part of the analysis of 106 SSP 2 groups were reviewed: group 1 – 57 (53.7%) patients with bilateral stenosis of ICA &gt; 75%; group 2 – 49 (46.3%) patients with unilateral stenosis of ICA &gt; 75%.In group 1 stroke was registered in 1.75%, mortality rate was 1.75%. In group 2 stroke was observed in 2%, mortality rate was 2%. <h3>Conclusions</h3> The risk factors for ischemic stroke for SSP (CEA + CABG) are contralateral stenosis of ICA &gt; 75%, system hypothermia (rectal temperature) &gt; 29 °C. The use of hypothermic perfusion on the CEA phase of SSP in patients with bilateral stenosis of ICA &gt; 75% effectively reduces neurological complications (9 times less), stroke rate (6.5 times less (p = 0.047)), mortality rate (3 times less (p = 0.3)).

Rapid Correction Rate of Hyponatremia as an Independent Risk Factor for Neurological Complication Following Liver Transplantation

Hyponatremia is prevalent before liver transplantation and generally corrected immediately after transplantation. However, the clinical significance of correction rate of hyponatremia is not well investigated. The prognostic impact of pre-transplant serum sodium concentrations and post-transplant correction rate of hyponatremia were assessed. A total of 512 patients who received orthotopic liver transplants were enrolled. The correction rate of hyponatremia (delta sodium, ΔNa) was calculated based on the data collected during the first 48 hours following liver transplantation. Outcomes, including in-hospital mortality, delirium, neurological complications, acute kidney injury, and infections, were compared according to the serum sodium levels (sNa < 125, 125-135, and ≥ 135 mmol/L), and the risk factors for in-hospital mortality and neurological complications were analyzed using multivariate logistic regression methods. Patients with severe hyponatremia (sNa < 125 mmol/L) had higher rates of in-hospital mortality (9.6%, P = 0.010), delirium (54.8%, P = 0.003), neurological complications (24.7%, P = 0.003), and acute kidney injury (57.5%, P = 0.005). In multivariate analysis, serum sodium levels (OR = 0.975, P = 0.402) and delta sodium (OR = 1.097, P = 0.066) were not independent risk factors for in-hospital mortality. However, delta sodium (OR = 1.093, P = 0.003) and fast correction rate of hyponatremia (ΔNa ≥ 12 mmol/L/24h, OR = 3.397, P = 0.023) were significantly associated with post-transplant neurological complications. Pre-transplantation hyponatremia was not independently associated with clinical outcomes. However, rapid correction of hyponatremia is an independent risk factor for the development of post-transplant neurological complications.

Risk Factors for Neurologic Complications of Hand, Foot and Mouth Disease in the Republic of Korea, 2009

In 2009, the first outbreak of hand, foot and mouth disease (HFMD) or herpangina (HP) caused by enterovirus 71 occurred in the Republic of Korea. This study inquired into risk factors associated with complications of HFMD or HP. A retrospective medical records review was conducted on HFMD or HP patients for whom etiologic viruses had been verified in 2009. One hundred sixty-eight patients were examined for this investigation. Eighty patients were without complications while 88 were accompanied by complications, and 2 had expired. Enterovirus 71 subgenotype C4a was the most prevalent in number with 67 cases (54.9%). In the univariate analysis, the disease patterns of HFMD rather than HP, fever longer than 4 days, peak body temperature over 39℃, vomiting, headache, neurologic signs, serum glucose over 100 mg/dL, and having an enterovirus 71 as a causative virus were significant risk factors of the complications. After multiple logistic analysis, headache (Odds ratio [OR], 10.75; P < 0.001) and neurologic signs (OR, 42.76; P < 0.001) were found to be the most significant factors. Early detection and proper management of patients with aforementioned risk factors would be necessary in order to attain a better clinical outcome.