Trend Toward Vaginal Versus Cesarean Deliveries in Pregnant Patients with Unruptured Intracranial Aneurysms in the 2010s: A Nationwide Inpatient Analysis.

Objective: The safety of spontaneous vaginal delivery in pregnant patients with known unruptured intracranial aneurysms (UIAs) has been supported by increasing evidence over the past 2 decades. However, the extent to which this increased evidence has since influenced changes, if any, in actual clinical practice, has yet to be studied.

Methods: Using the 2012 to 2020 Nationwide Inpatient Sample, trends in vaginal versus caesarian delivery among mothers with UIAs were assessed in temporal fashion and compared to overall trends in delivery modality during the same period.

Clinical risk factors for mortality in low severity acute epidural hematoma.

Background: Epidural hematomas (EDH) pose life-threatening risks with considerable morbidity and mortality if left untreated. The prognosis for patients with low-severity acute EDH managed conservatively is variable, with limited understanding of risk factors. This study aims to identify clinical risk factors for mortality in low-severity acute epidural hematoma patients managed conservatively, helping clinicians recognize cases where deviation from conservative management may be necessary.

Two-Sample Mendelian Randomization Study Identifies Tissue-Dependent Risk Genes in Autoimmune Diseases.

Autoimmune diseases are among the most prevalent diseases across the world with genetic and environmental factors that contribute to their etiology. Because the exact causes of autoimmune diseases are largely unknown, a Mendelian randomization (MR) approach is used here to examine the potential causal association between gene expression levels and disease risk across various tissues. Specifically, this study focuses on six autoimmune diseases including Crohn's disease, ulcerative colitis, rheumatoid arthritis, multiple sclerosis, type 1 diabetes mellitus, and systemic lupus erythematosus.

Use of MRI in patients with severe diffuse traumatic brain injury: A matched National Trauma Data Bank analysis.

Objective: Magnetic resonance imaging (MRI) is increasingly used to evaluate patients with diffuse traumatic brain injury (dTBI). However, the utility of early MRI is understudied. We hypothesize that early MRI patients will have increased length of stay but no changes in intracranial pressure (ICP) management or disposition.

Effect of perioperative anticoagulant prophylaxis in patients with traumatic subdural hematoma and a history of anticoagulant use: a propensity-matched National Trauma Data Bank analysis.

Objective: The use of anticoagulation to prevent venous thromboembolism (VTE) is controversial in the setting of neurosurgical decompression for traumatic subdural hematoma (SDH). In these patients, there is concern that anticoagulation may cause secondary hemorrhage, increasing the risk of death and other complications. Patients with a history of anticoagulant use are at further risk of VTE, but the effect of VTE prophylaxis (VTEP) following neurosurgery for SDH has not been thoroughly investigated in this population.

Factors correlated with neuropathic pain among industrial workers in Vietnam: a multi-site cross-sectional study.

Introduction: Neuropathic pain is a debilitating condition resulting from various etiologies such as diabetes, multiple sclerosis, and infection, and is associated with decreased quality of life, poor health outcomes, and increased economic burden. However, epidemiological studies on neuropathic pain have been largely limited in Vietnam.

Methods: A cross-sectional study was conducted on adult Vietnamese industrial workers across three manufacturing plants.

Characteristics of work-related spine injury in the USA: a National Trauma Data Bank analysis.

Purpose: Workplace injury is a commonplace occurrence in the USA. Spine injuries are especially devastating as they can cause chronic pain and limit mobility which prevents patients from returning to work. Gaining a better understanding of the patients, mechanisms, and treatments associated with these injuries can aid in improving outcomes.

Racial Disparities in Time to Decompression in Central Cord Syndrome: A National Trauma Database Analysis.

Objective: Cervical cord syndrome (CCS) is the most common type of incomplete spinal cord injury. Prompt surgical decompression within 24 hours increases neurologic function and rates of home discharge. Racial disparities exist in spinal cord injury, with Black patients experiencing longer lengths of stay and higher rates of complications than in White patients.

Application of anti-Xa assay in monitoring unfractionated heparin therapy in contemporary antithrombotic management.

Introduction: Unfractionated heparin remains the most widely used agent in the prevention and acute treatment of thrombosis. Pharmacological complexities of this intriguing agent mandate frequent monitoring of its anticoagulant properties to maintain safe and effective hematological outcomes. Although activated partial thromboplastin time has been the standard test to monitor unfractionated heparin therapy for many decades, the anti-Xa assay has emerged as a substitute or adjunct in many institutions.

Current Trends and Socioeconomic Disparities in the Utilization of Spine Augmentation for Patients With Osteoporotic Vertebral Compression Fracture: A Nationwide Inpatient Sample Analysis From 2012 to 2016.

Introduction: Osteoporotic vertebral compression fracture (OVCF) is a growing health care problem in today's aging population. Since the advent of kyphoplasty and vertebroplasty, these interventions have been commonly utilized in the treatment of symptomatic OVCF. However, the use of these interventions varies because there is not a standard of care for the management of OVCF.

Gender Disparities in Outpatient Management of Postlaminectomy Syndrome.

Introduction: Postlaminectomy syndrome (PLS), also known as failed back surgery syndrome, is the persistence of radicular pain in the face of surgical intervention. Despite its prevalence in 10 to 40% of spine surgery patients, outpatient pharmacologic and interventional management remains poorly characterized.

Methods: The 2007 to 2016 National Ambulatory Medical Care Survey (NAMCS) was utilized to include all outpatients diagnosed with PLS.

Anterior vs Posterior Approach in Multilevel Cervical Spondylotic Myelopathy: A Nationwide Propensity-Matched Analysis of Complications, Outcomes, and Narcotic Use.

Background: There is unclear evidence regarding the optimal surgical approach for multilevel cervical spondylotic myelopathy (CSM). The objective of this study was to compare complications, outcomes, and narcotic use in anterior discectomy and fusion (ACDF) vs posterior decompression and fusion (PCDF) in CSM patients.

Study Design: Registry-based retrospective cohort analysis.

Depressive symptoms are associated with immunological failure among HIV-positive patients in Vietnam.

As the lives of people living with HIV (PLWH) become increasingly normalized, more focus is being given to the associated comorbidities of HIV, including those related to mental health such as depression. This study aims to evaluate the correlation between depressive symptoms and HIV outcomes in Vietnam through the measurement of CD4 cell count. A mixed design was utilized, in which both a longitudinal assessment of CD4 cell counts and a cross-sectional survey of depressive symptoms were conducted on 481 patients in the Bach Mai and Ha Dong HIV clinics (Hanoi, Vietnam).

Cannabis Abuse and Perioperative Complications After Treatment of Intracranial Aneurysms: A Nationwide Analysis.

Objective: In the present retrospective cohort analysis, we examined the differences in baseline characteristics and peri- and postoperative outcomes stratified by 3 groups: cannabis abuse or dependence versus none, surgical versus endovascular treatment, and unruptured and ruptured intracranial aneurysms.

Methods: A study population of 26,868 patients was defined using the 2009-2016 National Inpatient Sample database. The baseline characteristics were compared between the cannabis and no-cannabis groups, and the traits that differed significantly were factored into the multivariate analysis using 1:1 propensity score matching.

Implementing a High-Value Care Discharge Protocol in Patients Undergoing CABG Reduces Readmission.

Background: Readmission after coronary artery bypass grafting (CABG) is associated with adverse outcomes and increased cost. We evaluated the impact of a high-value care discharge protocol on readmission, length of stay (LOS), and discharge destination in patients undergoing isolated CABG.

Methods: In 2016, a comprehensive, patient-centered discharge protocol was implemented.

Socioeconomic Inequities in the Surgical Management of Moyamoya Disease.

Background: Given the vasculopathic nature of moyamoya disease (MMD) and high susceptibility to ischemic events, patients with MMD often require surgical revascularization via an indirect or direct bypass, and analysis of disparities in receipt of appropriate management is critical.

Methods: The 2012-2016 Nationwide Inpatient Sample was queried for patients admitted with a diagnosis of MMD using International Classification of Diseases codes. Patient baseline demographics, hospital characteristics, and associated symptoms were collected.

Inpatient outcomes of posterior fossa decompression with or without duraplasty for Chiari malformation type I.

Objective: Chiari malformation type 1 (CM-1) is a congenital neurologic condition in which the cerebellar tonsils herniate below the foramen magnum, resulting in symptoms such as headache and neck pain. Two common surgical treatment approaches are posterior fossa decompression with (PFDD) and without duraplasty (PFD). Previous single-center studies have demonstrated increased neurologic complications after PFDD compared to PFD.

Effect of the FDA Safety and Innovation Act on racial and gender diversity in neurosurgical device trials.

Objective: The US FDA uses evidence from clinical trials in its determination of safety and utility. However, these trials have often suffered from limited external validity and generalizability due to unrepresentative study populations with respect to clinical patient demographics. Section 907 of the FDA Safety and Innovation Act (FDASIA) of 2012 attempted to address this issue by mandating the reporting of certain study demographics in new device applications.

Pediatric cerebral cysts: comparison of early complications following fenestration versus shunting procedures.

: Characterize practice patterns and acute (30-day) surgical complications following fenestration and shunt procedures for the treatment of cerebral cysts in pediatric patients.: This study utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database. Patients were identified by International Classification of Disease codes for cerebral cysts and Current Procedural Terminology codes for shunting or fenestration.

Optimal timing and sequence of ventriculoperitoneal shunt and gastrostomy placement.

The optimal timing of ventriculoperitoneal shunt (VPS) and gastrostomy placement, relative to the safety of simultaneous versus staged surgery, has not been clearly delineated in the literature. To study the optimal inter-procedural timing relative to distal VPS infection and pertinent reoperation. A fifteen-year, retrospective, single-center study was conducted on adults undergoing VPS and gastrostomy within 30-days.

Disparities in the symptomatic presentation of Moyamoya disease in the United States: A nationwide all-payer analysis.

Background: Moyamoya disease is a chronic occlusive cerebrovascular disease that can present with either hemorrhagic or ischemic symptoms. The objective of this study was to evaluate whether the symptomatology of Moyamoya disease differs according to patient demographic groups.

Methods: In this study, we used the Nationwide Inpatient Sample (NIS) to investigate differences in the presentation of Moyamoya disease by age group, gender, and ethnicity from 2012 to 2016.

Cannabis Abuse and Perioperative Complications Following Inpatient Spine Surgery in the United States.

Due to its complicated legal status, the effects of cannabis on elective spine surgery patients have not been well studied. In this nationwide analysis, we find that cannabis abuse is associated with higher perioperative thromboembolism and neurologic complications, respiratory complications, sepsis, length of stay, hospital charges, and rates of unfavorable discharge disposition.

Assessing the Clinical Safety Profile of Computer-Assisted Navigation for Posterior Cervical Fusion: A Propensity-Matched Analysis of 30-Day Outcomes.

Background: Computer-assisted navigation (CAN) has been shown to improve accuracy of screw placement in procedures involving the posterior cervical spine, but whether the addition of CAN affects complication rates, neurologic or otherwise, is presently unknown. The objective of this study is to determine the effect of spinal CAN on short-term clinical outcomes following posterior cervical fusion.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2011 to 2018.