Hospital frailty risk score predicts postoperative outcomes after endoscopic endonasal resection of non-functioning pituitary adenomas.

Purpose: Frailty indices are invaluable resources in risk stratification and predicting high-value care outcomes for neurosurgical patients. The Hospital Frailty Risk Score (HFRS) is a recently developed and validated method for evaluating frailty; however, its implementation has yet to be assessed in patients with non-functioning pituitary adenomas undergoing endoscopic endonasal resection. In this study, we aimed to evaluate HFRS's predictive ability for high-value care outcomes, namely postoperative complications, length of stay (LOS), and hospital charges, and to compare it to other traditionally used frailty indices.

Creating a predictive model and online calculator for high-value care outcomes following glioblastoma resection: incorporating neighborhood socioeconomic status index.

Purpose: Social determinants of health including neighborhood socioeconomic status, have been established to play a profound role in overall access to care and outcomes in numerous specialized disease entities. To provide glioblastoma multiforme (GBM) patients with high-quality care, it is crucial to identify predictors of hospital length of stay (LOS), discharge disposition, and access to postoperative adjuvant chemoradiation. In this study, we incorporate a novel neighborhood socioeconomic status index (NSES) and develop three predictive algorithms for assessing post-operative outcomes in GBM patients, offering a tool for preoperative risk stratification of GBM patients.

Laser interstitial thermal therapy for cavernous malformations: a meta-analysis of individual patient-level data.

Objective: Several case series have investigated the use of laser interstitial thermal therapy (LITT) to treat cavernous malformations (CMs), for either seizure control or reduction of neurological symptoms and future hemorrhage risk. However, pooled outcomes are largely unknown. The authors aimed to quantify posttreatment seizure freedom, symptomatic progression or hemorrhage, perioperative complications, and imaging outcomes from the available literature.

Hospital frailty risk score predicts high-value care outcomes following brain metastasis resection.

Objective: Brain metastases (BM) are the most common adult intracranial tumors, representing a significant source of morbidity in patients with systemic malignancy. Frailty indices, including 11- and 5-factor modified frailty indices (mFI-11 and mFI-5), American Society of Anesthesiologists (ASA) physical status classification, and Charlson Comorbidity Index (CCI), have recently demonstrated an important role in predicting high-value care outcomes in neurosurgery. This study aims to investigate the efficacy of the newly developed Hospital Frailty Risk Score (HFRS) on postoperative outcomes in BM patients.

External Validation of Predictive Models for Failed Medical Management of Spinal Epidural Abscess.

Objective: There is limited consensus regarding management of spinal epidural abscesses (SEAs), particularly in patients without neurologic deficits. Several models have been created to predict failure of medical management in patients with SEA. We evaluate the external validity of 5 predictive models in an independent cohort of patients with SEA.

Quality of life in chordoma survivors: results from the Chordoma Foundation Survivorship Survey.

Objective: Chordomas are rare malignant bone tumors whose location in the skull base or spine, invasive surgical treatment, and accompanying adjuvant radiotherapy may all lead patients to experience poor quality of life (QOL). Limited research has been conducted on specific demographic and clinical factors associated with decreased QOL in chordoma survivors. Thus, the aim of the present study was to investigate several potential variables and their impact on specific QOL domains in these patients as well the frequencies of specific QOL challenges within these domains.

The Socioeconomic Distressed Communities Index Predicts 90-Day Mortality Among Intracranial Tumor Patients.

Background: Socioeconomic status (SES) is a major determinant of quality of life and outcomes. However, SES remains difficult to measure comprehensively. Distress communities index (DCI), a composite of 7 socioeconomic factors, has been increasingly recognized for its correlation with poor outcomes.

The hospital frailty risk score independently predicts postoperative outcomes in meningioma patients.

Objective: The Hospital Frailty Risk Score (HFRS) is a recently developed tool that uses ICD-10 codes to measure patient frailty. However, the effectiveness of HFRS has not yet been assessed in meningioma patients specifically. The present study aimed to evaluate the effectiveness of HFRS in predicting surgical outcomes for patients with meningiomas.

Effectiveness of a thrombin-gelatin flowable for treating severe liver bleeding: an experimental study.

Background: Current scientific evidence has pointed out the relevance of hemostatic products for improving clinical outcomes in liver trauma, including increased survival rates and reductions in bleeding-related complications. The purpose of this study was to compare the use of the gelatin-thrombin flowable (Flowable) versus the standard technique of Packing in a new experimental liver injury model.

Methods: Twenty-four swine were prospectively randomized to receive either Flowable or standard packing technique.

The Hospital Frailty Risk Score Independently Predicts Postoperative Outcomes in Glioblastoma Patients.

Objective: The Hospital Frailty Risk Score (HFRS) is a tool for quantifying patient frailty using International Classification of Diseases, Tenth Revision codes. This study aimed to determine the utility of the HFRS in predicting surgical outcomes after resection of glioblastoma (GBM) and compare its prognostic ability with other validated indices such as American Society of Anesthesiologists score and Charlson Comorbidity Index.

Methods: A retrospective analysis was conducted using a GBM patient database (2017-2019) at a single institution.

Decreasing Reimbursement of Pituitary Tumor Surgery: An Analysis of Medicare Data From 2010 to 2020.

Background And Objectives: Despite the extensive amount of research aimed at comparing patient outcomes between microscopic transsphenoidal surgery (MTSS) and endoscopic transsphenoidal surgery (ETSS) approaches, there has been relatively little recent investigation into the nationwide utilization and reimbursement trends of both techniques. This study aimed to identify trends in pituitary tumor surgery utilization, charges to Medicare, and reimbursement dependent on (1) MTSS/ETSS surgery type, (2) provider type (ie, neurosurgeon vs ear, nose, and throat), and (3) cosurgery status.

Methods: This study used publicly available data from the Medicare Physician/Supplier Procedure Summary for the years 2010-2020.

An asynchronous web-based intervention for neurosurgery residents to improve education on cost-effective care.

Objective: To gauge resident knowledge in the socioeconomic aspects of neurosurgery and assess the efficacy of an asynchronous, longitudinal, web-based, socioeconomics educational program tailored for neurosurgery residents.

Methods: Trainees completed a 20-question pre- and post-intervention knowledge examination including four educational categories: billing/coding, procedure-specific concepts, material costs, and operating room protocols. Structured data from 12 index cranial neurosurgical operations were organized into 5 online, case-based modules sent to residents within a single training program via weekly e-mail.

The mFI-5 and Postoperative Outcomes in Brain Tumor Patients: A Bayesian Approach to Quantifying Uncertainty.

Objective: To the best of our knowledge, prior research has not investigated the uncertainty in the relationship between patient frailty and postoperative outcomes after brain tumor surgery. The present study used Bayesian methods to quantify the statistical uncertainty between the 5-factor modified frailty index (mFI-5) and postoperative outcomes for patients undergoing brain tumor resection.

Methods: The present study used retrospective data collected from patients undergoing brain tumor resection during a 2-year period (2017-2019).

Contemporary Trends in Minimally Invasive Sacroiliac Joint Fusion Utilization in the Medicare Population by Specialty.

Background And Objectives: Sacroiliac (SI) joint dysfunction constitutes a leading cause of pain and disability. Although surgical arthrodesis is traditionally performed under open approaches, the past decade has seen a rise in minimally invasive surgical (MIS) techniques and new federally approved devices for MIS approaches. In addition to neurosurgeons and orthopedic surgeons, proceduralists from nonsurgical specialties are performing MIS procedures for SI pathology.

High-Value Care Outcomes of Meningiomas.

High-value health care has become a widely researched topic within neurosurgery. The concept of "high-value" care involves optimizing resource expenditures relative to patient outcomes, and therefore, high-value care research within neurosurgery has involved identifying prognostic factors for outcomes such as hospital length of stay, discharge disposition, monetary charges/costs incurred during hospitalization, and hospital readmission. The following article will discuss the motivation of high-value health-care research for optimizing the surgical treatment of intracranial meningiomas, highlight recent research investigating high-value care outcomes in patients with intracranial meningioma, and explore future avenues for high-value care research in this patient population.

Clinical trial implementation: a primer for neurosurgeons.

In the current landscape of evidence-based medicine, prospective clinical trials are an important avenue through which to establish the efficacy and safety of biomedical treatments compared with standard-of-care interventions. Depending on their scope and aims, clinical trials can be extremely costly and time intensive, and significant coordination is needed to ensure optimal utilization of healthcare resources, adherence to the principles of biomedical ethics, and appropriate interpretation of study results. This review highlights the core principles for designing and implementing clinical trials within neurosurgery, with the aim to provide clinicians with a framework for implementing both investigator-initiated and industry-sponsored trials.

Quality of Life in Chordoma Co-Survivors: Results from the Chordoma Foundation Survivorship Survey.

Background: Chordomas are a rare form of aggressive bone cancer and are associated with poor quality of life (QOL). The present study sought to characterize demographic and clinical characteristics associated with QOL in chordoma co-survivors (caregivers of patients with chordoma) and assess whether co-survivors access care for QOL challenges.

Methods: The Chordoma Foundation Survivorship Survey was electronically distributed to chordoma co-survivors.

Fractionated Radiotherapy After Gross Total Resection of Clival Chordoma: A Systematic Review of Survival Outcomes.

Background: Current treatment guidelines for clival chordomas recommend surgical resection followed by high-dose radiotherapy (RT). However, in patients in whom gross total resection (GTR) is achieved, the benefits of additional RT remain unclear.

Objective: To investigate whether RT offers any benefit to progression-free survival (PFS) in patients undergoing GTR of clival chordoma by performing a systematic review of all currently published literature.

Neurosurgical Utilization, Charges, and Reimbursement After the Affordable Care Act: Trends From 2011 to 2019.

Background: An estimated 50 million Americans receive Medicare health care coverage. Prior studies have established a downward trend in Medicare reimbursement for commonly billed surgical procedures, but it is unclear whether these trends hold true across all neurosurgical procedures.

Objective: To assess trends in utilization, charges, and reimbursement by Medicare for neurosurgical procedures after passage of the Affordable Care Act in 2010.

A comparative analysis of the Hospital Frailty Risk Score in predicting postoperative outcomes among intracranial tumor patients.

Objective: In recent years, frailty indices such as the 11- and 5-factor modified frailty indices (mFI-11 and mFI-5), American Society of Anesthesiologists (ASA) physical status classification, and Charlson Comorbidity Index (CCI) have been shown to be effective predictors of various postoperative outcomes in neurosurgical patients. The Hospital Frailty Risk Score (HFRS) is a well-validated tool for assessing frailty; however, its utility has not been evaluated in intracranial tumor surgery. In the present study, the authors investigated the accuracy of the HFRS in predicting outcomes following intracranial tumor resection and compared its utility to those of other validated frailty indices.

Radiotherapy After Gross Total Resection of Skull Base Chordoma: A Surveillance, Epidemiology, and End Results Database Analysis of Survival Outcomes.

Objective: Skull base chordoma is a rare and locally destructive malignancy which presents unique therapeutic challenges. While achieving gross total resection (GTR) confers the greatest survival advantage, the role of adjuvant radiotherapy (RT) for patients who receive GTR remains unclear in the absence of prospective trials. Here, we aim to assess the effect of RT on survival outcomes in skull base chordoma patients who receive GTR by utilizing the Surveillance, Epidemiology, and End Results (SEER) database.

Machine Learning Models for Predicting Postoperative Outcomes following Skull Base Meningioma Surgery.

 While predictive analytic techniques have been used to analyze meningioma postoperative outcomes, to our knowledge, there have been no studies that have investigated the utility of machine learning (ML) models in prognosticating outcomes among skull base meningioma patients. The present study aimed to develop models for predicting postoperative outcomes among skull base meningioma patients, specifically prolonged hospital length of stay (LOS), nonroutine discharge disposition, and high hospital charges. We also validated the predictive performance of our models on out-of-sample testing data.

Substance Use Disorders Are Independently Associated with Hospital Readmission Among Patients with Brain Tumors.

Background: Research on the effects of substance use disorders (SUDs) on postoperative outcomes within neurosurgical oncology has been limited. Therefore, the present study sought to quantify the effect of having a SUD on hospital length of stay, postoperative complication incidence, discharge disposition, hospital charges, 90-day readmission rates, and 90-day mortality rates following brain tumor surgery.

Methods: The present study used data from patients who received surgical resection for brain tumor at a single institution between January 1, 2017, and December 31, 2019.

H3K27M-Altered Diffuse Midline Gliomas Among Adult Patients: A Systematic Review of Clinical Features and Survival Analysis.

Objective: The objective of the study was to summarize the clinical characteristics, histo-genomic profiles, management strategies, and survival outcomes of H3K27M-altered adult diffuse midline gliomas (aDMGs).

Methods: PubMed, Scopus, and Cochrane databases were used to identify relevant articles. Papers including H3K27M-altered aDMGs with sufficient clinical outcome data were included.

Clinical predictors of survival for patients with atypical teratoid/rhabdoid tumors.

Purpose: Atypical teratoid/rhabdoid tumors (AT/RTs) are malignant central nervous system (CNS) neoplasms of the young. Our study analyzed a large AT/RT cohort from the National Cancer Database (NCDB) to elucidate predictors of short-term mortality and overall survival (OS).

Methods: Information was collected on patients with histologically confirmed AT/RT using the NCDB (2004-2016).