Heart Transplantation-Postoperative Considerations.

Heart transplantation (HT) remains the best treatment of patients with severe heart failure who are deemed to be transplant candidates. The authors discuss postoperative management of the HT recipient by system, emphasizing areas where care might differ from other cardiac surgery patients. Working together, critical care physicians, heart transplant surgeons and cardiologists, advanced practice providers, pharmacists, transplant coordinators, nursing staff, physical therapists, occupational therapists, rehabilitation specialists, nutritionists, health psychologists, social workers, and the patient and their loved ones partner to increase the likelihood of a successful outcome.

Outcomes of Two Different Techniques Using the Lateral Approach for Lumbar Interbody Arthrodesis.

Study Design Retrospective cohort study. Objective To determine the short-term outcomes of two different lateral approaches to the lumbar spine. Methods This was a retrospective review performed with four fellowship-trained spine surgeons from a single institution.

Cervical Fracture Stabilization within 72 Hours of Injury is Associated with Decreased Hospitalization Costs with Comparable Perioperative Outcomes in a Propensity Score-Matched Cohort.

Introduction: Prior studies have indicated that early decompression of traumatic cervical fractures can be performed safely and is associated with improved outcomes, though the economic impact of the timing of surgery in the American population has not been studied. After adjusting for patient, hospital, and injury confounders, we performed propensity score modeling (PSM) on a large clinical administrative database to determine associated costs depending upon timing of surgery for acute cervical fracture.

Methods: A total of 3,348 patients with surgically treated, traumatic, cervical fractures were identified.

Orbital fractures: national inpatient trends and complications.

Purpose: The present study aimed to examine cost, demographics, and short-term complications associated with orbital fractures and their surgical repair in the inpatient population in the United States over a 7-year period.

Methods: A retrospective cohort study was performed by using the Nationwide Inpatient Sample from 2002 to 2008 and searching the database for discharges classified with International Classification of Disease-9 diagnosis codes of orbital fractures, orbital fracture repair, and associated diagnoses.

Results: There was nearly a 50% increase in the annual number of orbital fracture admissions from 2002 to 2008.

Using bioabsorbable fixation systems in the treatment of pediatric skull deformities leads to good outcomes and low morbidity.

Background: Bioabsorbable fixation systems have been widely employed in pediatric patients for cranial reconstruction, obviating the complications of hardware migration and imaging artifact occurring with metallic implants. Recent concern over complications unique to bioabsorbable materials, such as inflammatory reaction and incomplete resorption, necessitates additional conclusive studies to further validate their use in pediatric neurosurgery and craniofacial surgery. Likewise, long-term follow-up in this clinical cohort has not previously been described.

Trends in the diagnosis and treatment of pediatric primary spinal cord tumors.

Object: Pediatric primary spinal cord tumors (PSCTs) are rare, with limited comprehensive data regarding incidence and patterns of diagnosis and treatment. The authors evaluated trends in the diagnosis and treatment of PSCTs using a nationwide database.

Methods: The Surveillance, Epidemiology, and End Results (SEER) registry was queried for the years 1975-2007, evaluating clinical patterns in 330 patients 19 years of age or younger in whom a pediatric PSCT had been diagnosed.

Retrospective, propensity score-matched cohort study examining timing of fracture fixation for traumatic thoracolumbar fractures.

The timing of surgery in patients with traumatic thoracic/thoracolumbar fractures, with or without spinal cord injury, remains controversial. The objective of this study was to determine the importance of the timing of surgery for complications and resource utilization following fixation of traumatic thoracic/thoracolumbar fractures. In this retrospective cohort study, the 2003-2008 California Inpatient Databases were searched for patients receiving traumatic thoracic/thoracolumbar fracture fixation.

Modulation of soleus H reflex by spinal DC stimulation in humans.

Transcranial direct current stimulation (tDCS) of the human motor cortex induces changes in excitability within cortical and spinal circuits that occur during and after the stimulation. Recently, transcutaneous spinal direct current stimulation (tsDCS) has been shown to modulate spinal conduction properties, as assessed by somatosensory-evoked potentials, and transynaptic properties of the spinal neurons, as tested by postactivation depression of the H reflex or by the RIII nociceptive component of the flexion reflex in the lower limb. To further explore tsDCS-induced plastic changes in spinal excitability, we examined, in a double-blind crossover randomized study, the stimulus-response curves of the soleus H reflex before, during, at current offset and 15 min after anodal, cathodal, and sham tsDCS delivered at the Th11 level (2.

Venous thromboembolism after thoracic/thoracolumbar spinal fusion.

Objective: Venous thromboembolism (VTE), which includes deep venous thrombosis and pulmonary embolism, is a serious and potentially fatal surgical complication. The goal of our study was to examine preoperative characteristics, incidence, and outcomes of patients with VTE after elective thoracic/thoracolumbar level spine fusion.

Methods: We identified 430,081 patients from the Nationwide Inpatient Sample database who underwent spinal fusion between 2002 and 2008.

Health-related quality-of-life status in Veterans with spinal disorders.

Purpose: To measure the impact of spinal disorders on health-related quality of life (HRQOL) among Veterans, to describe demographic patterns of Veterans with spinal disorders, and to quantify HRQOL scores as they relate to demographics, medical comorbidities, pain severity, and depressive symptoms.

Methods: From 2009 to 2010, 112 lumbar and 56 cervical spinal disorder patients completed SF-12, Oswestry Disability Index, visual analog pain scale, and Beck Depression Inventory surveys. Multivariate analysis identified predictors of HRQOL, disability, and depressive symptoms.

Morbidity and mortality of C2 fractures in the elderly: surgery and conservative treatment.

Background: Closed C2 fractures commonly occur after falls or other trauma in the elderly and are associated with significant morbidity and mortality. Controversy exists as to best treatment practices for these patients.

Objective: To compare outcomes for elderly patients with closed C2 fractures by treatment modality.

A population-based study of inpatient outcomes after operative management of nontraumatic intracerebral hemorrhage in the United States.

Background: In the United States, data on patient outcomes after operative management of nontraumatic intracerebral hemorrhage (ICH) have been largely derived from tertiary care academic institutions. Given that outcomes of patients treated at these specialized centers may differ from those treated at community hospitals, our aim was to report patient outcomes on a population-based, national level.

Methods: The Nationwide Inpatient Sample (NIS) was utilized to identify all patients with a primary diagnosis of nontraumatic ICH (431.

Morbid obesity increases cost and complication rates in spinal arthrodesis.

Study Design: A retrospective cross-sectional study of all spinal fusions in California from 2003 to 2007.

Objective: This study analyzes whether morbid obesity alters rates of complications and charges in patients undergoing spinal fusion.

Summary Of Background Data: Prior studies of obesity have focused on lumbar fusion; some identified increases in wound complications.

A socioeconomic survey of spinal cord stimulation (SCS) surgery.

Objective: We evaluated trends in inpatient spinal cord stimulation (SCS) for the 14-year period from 1993 to 2006.

Materials And Methods: We utilized the Nationwide Inpatient Sample data base from the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality.

Results: A total of 57,486 patients underwent inpatient placement of SCS systems from 1993 to 2006.

Impact of age, injury severity score, and medical comorbidities on early complications after fusion and halo-vest immobilization for C2 fractures in older adults: a propensity score matched retrospective cohort study.

Study Design: Propensity score matched retrospective cohort study.

Objective: To report early complication rates and associated risk factors in patients with C2 fractures who underwent fusion or halo immobilization.

Summary Of Background Data: There is limited data on the impact of age, injury severity score, and medical comorbidities on overall complication rates from surgical fixation versus halo-vest immobilization of C2 fractures.

Patterns of care and survival for glioblastoma patients in the Veterans population.

Survival outcomes and patterns of care for brain tumor patients in the USA Veterans population have not been previously published and the extent of variation in outcomes between Veterans and the rest of the USA is currently unknown. The Veterans healthcare administration (VA) provides comprehensive care to Veterans and their families and maintains the Veterans affairs central cancer registry (VACCR). This was a retrospective review of microscopically-confirmed, supratentorial glioblastoma multiforme in male Veterans actively followed by the VACCR; survival was analyzed and compared to a national cohort from the surveillance, epidemiology and end results program.

Charlson score is a robust predictor of 30-day complications following spinal metastasis surgery.

Study Design: Retrospective chart review.

Objective: To identify predictors of 30-day complications after the surgical treatment of spinal metastasis.

Summary Of Background Data: Surgical treatment of spinal metastasis is considered palliative with the aim of reducing or delaying neurologic deficit.

Is cauda equina syndrome being treated within the recommended time frame?

Background: Cauda equina syndrome (CES) is a rare but devastating medical condition requiring urgent surgery to halt or reverse neurological compromise. Controversy exists as to how soon surgery must be performed after diagnosis, and clinical and medicolegal factors make this question highly relevant to the spine surgeon. It is unclear from the literature how often CES patients are treated within the recommended time frame.

Predictors of survival after surgical treatment of spinal metastasis.

Background: Surgery for spinal metastasis is a palliative treatment aimed at improving patient quality of life by alleviating pain and reversing or delaying neurologic dysfunction, but with a mean survival time of less than 1 year and significant complication rates, appropriate patient selection is crucial.

Objective: To identify the most significant prognostic variables of survival after surgery for spinal metastasis.

Methods: Chart review was performed on 200 surgically treated spinal metastasis patients at Stanford Hospital between 1999 and 2009.