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Article ; Online: Perioperative glucocorticoids - replacing old ideas.

Weil, Robert J

2020 Volume 16, Issue 5, Page(s) 261–262

MeSH term(s)	Adrenal Insufficiency ; Glucocorticoids ; Humans
Chemical Substances	Glucocorticoids
Language	English
Publishing date	2020-03-09
Publishing country	England
Document type	News ; Comment
ZDB-ID	2489381-X
ISSN	1759-5037 ; 1759-5029
ISSN (online)	1759-5037
ISSN	1759-5029
DOI	10.1038/s41574-020-0342-z
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Zs.A 6336: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Lumbar Decompression with and without Fusion for Lumbar Stenosis with Spondylolisthesis: A Cost Utility Analysis.

Sastry, Rahul A / Levy, Joseph F / Chen, Jia-Shu / Weil, Robert J / Oyelese, Adetokunbo A / Fridley, Jared S / Gokaslan, Ziya L

Spine

2024

Abstract: Study design: Markov model.: Objective: To compare the cost-effectiveness of lumbar decompression alone (DA) with lumbar decompression with fusion (DF) for the management of adults undergoing surgery for lumbar stenosis with associated degenerative ... ...

Abstract	Study design: Markov model. Objective: To compare the cost-effectiveness of lumbar decompression alone (DA) with lumbar decompression with fusion (DF) for the management of adults undergoing surgery for lumbar stenosis with associated degenerative spondylolisthesis. Summary of background data: Rates of lumbar fusion have increased for all indications in the United States over the last 20 years. Recent randomized controlled trial data, however, have suggested comparable functional outcomes and lower reoperation rates for lumbar decompression and fusion as compared to lumbar decompression alone in the treatment of lumbar stenosis with degenerative spondylolisthesis. Materials and methods: A multi-state Markov model was constructed from the U.S. payer perspective of a hypothetical cohort of patients with LSS requiring surgery. Data regarding clinical improvement, costs, and reoperation were generated from contemporary randomized trial evidence, meta-analyses of recent prospective studies, and large retrospective cohorts. Base case, one-way sensitivity analysis, and probabilistic sensitivity analyses were conducted and results were compared to a willingness to pay threshold of $100,000 (in 2022 USD) over a 2-year time horizon. A discount rate of 3% was utilized. Results: The incremental cost and utility of decompression with fusion relative to decompression alone were $12,778 and 0.00529 QALYs. The corresponding ICER of $2,416,281 far exceeded a willingness to pay threshold of $100,000. In sensitivity analysis, the results varied the most with respect to rate of improvement after lumbar decompression alone, rate of improvement after lumbar decompression and fusion, and odds ratio of reoperation between the two groups. 0% of one-way and probabilistic sensitivity analyses achieved cost-effectiveness at the willingness to pay threshold. Conclusions: Within the context of contemporary surgical data, DF is not cost effective compared with DA in the surgical management of LSS over a 2-year time horizon.
Language	English
Publishing date	2024-01-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	752024-4
ISSN	1528-1159 ; 0362-2436
ISSN (online)	1528-1159
ISSN	0362-2436
DOI	10.1097/BRS.0000000000004928
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Article ; Online: Cranial Irradiation for Childhood Cancers and Adult Risk of Meningioma.

Garcia, Catherine M / Ganga, Arjun / Weil, Robert J / Toms, Steven A

Pediatric neurosurgery

2022 Volume 57, Issue 6, Page(s) 396–406

Abstract: Introduction: Following cranial irradiation, there is an increased risk of developing secondary neoplasms, especially meningiomas. Despite childhood cancer survivors who have undergone cranial irradiation having an increased risk of acquiring radiation- ... ...

Abstract	Introduction: Following cranial irradiation, there is an increased risk of developing secondary neoplasms, especially meningiomas. Despite childhood cancer survivors who have undergone cranial irradiation having an increased risk of acquiring radiation-induced meningioma (RIM), there is no widely used standard guideline for meningioma screening. Methods: At a single institution, we reviewed three adult survivors of childhood cancer who were treated for RIM between 2010 and 2020. We recorded age at diagnosis for the primary lesion, the radiation dose, age at RIM diagnosis, and tumor characteristics including treatment, pathology, and outcome. Two had had T-cell acute lymphocytic leukemia and one a rhabdomyosarcoma. The age of diagnosis of the RIM ranged from 20 to 40 years, with latencies ranging from 18 to 33 years. All lesions were classified as WHO Grade I meningiomas, and only 1 patient had a subsequent recurrence. A literature search identified articles that address RIM: a total of 684 cases were identified in 36 publications. Results: Mean radiation doses ranged from 1.4 gray to 70 gray. Mean age of diagnosis for secondary meningioma ranged from 8 to 53.4 years old, with latency periods ranging from 2.8 to 44 years. Given variability in the way that investigators have published their results, it is difficult to make a single recommendation for RIM screening. Using our experience and the literature, we devised two different screening protocols and calculated their expense. Conclusions: We recommend that data be standardized in a registry to provide greater insight into the clinical and resource allocation questions, especially as long-term survival of children with pediatric cancer into full adulthood becomes more commonplace worldwide.
MeSH term(s)	Child ; Adult ; Humans ; Adolescent ; Young Adult ; Middle Aged ; Meningioma/etiology ; Meningioma/pathology ; Neoplasms, Radiation-Induced/epidemiology ; Neoplasms, Radiation-Induced/etiology ; Neoplasms, Radiation-Induced/diagnosis ; Cranial Irradiation/adverse effects ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/etiology ; Meningeal Neoplasms/radiotherapy
Language	English
Publishing date	2022-10-17
Publishing country	Switzerland
Document type	Review ; Journal Article
ZDB-ID	1091757-3
ISSN	1423-0305 ; 1016-2291
ISSN (online)	1423-0305
ISSN	1016-2291
DOI	10.1159/000527565
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Zs.A 1133: Show issues

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Article ; Online: Postnatal Myelomeningocele Repair Rates: A Reflection of Their Milieu.

Kozel, Olivia A / Shao, Belinda / Sastry, Rahul A / Klinge, Petra M / Svokos, Konstantina A / Weil, Robert J

World neurosurgery

2023 Volume 180, Page(s) 241–242

MeSH term(s)	Humans ; Meningomyelocele/surgery ; Hydrocephalus
Language	English
Publishing date	2023-10-13
Publishing country	United States
Document type	Letter
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2023.10.062
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Article ; Online: Mitochondrial reactive oxygen species impact human fibroblast responses to protracted γ-ray exposures.

Whitcomb, Luke A / Cao, Xu / Thomas, Dilip / Wiese, Claudia / Pessin, Alissa S / Zhang, Robert / Wu, Joseph C / Weil, Michael M / Chicco, Adam J

International journal of radiation biology

2024 , Page(s) 1–13

Abstract: Purpose: ...

Abstract	Purpose:
Language	English
Publishing date	2024-04-17
Publishing country	England
Document type	Journal Article
ZDB-ID	3065-x
ISSN	1362-3095 ; 0020-7616 ; 0955-3002
ISSN (online)	1362-3095
ISSN	0020-7616 ; 0955-3002
DOI	10.1080/09553002.2024.2338518
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Article ; Online: Short term outcomes associated with patients requiring blood transfusion following elective laminectomy and fusion for lumbar stenosis: A propensity-matched analysis.

Darveau, Spencer C / Pertsch, Nathan J / Toms, Steven A / Weil, Robert J

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

2021 Volume 90, Page(s) 184–190

Abstract: Perioperative blood transfusion has been associated with poor outcomes but the impacts of transfusion after fusion for lumbar stenosis have not been well-described. We assessed this effect in a large cohort of patients from 2012 to 2018 in the National ... ...

Abstract	Perioperative blood transfusion has been associated with poor outcomes but the impacts of transfusion after fusion for lumbar stenosis have not been well-described. We assessed this effect in a large cohort of patients from 2012 to 2018 in the National Surgical Quality Improvement Program (NSQIP). We evaluated baseline characteristics including demographics, comorbidities, hematocrit, and operative characteristics. We generated propensity scores using baseline characteristics and patients were matched to approximate randomization. We assessed odds of 30-day outcomes including prolonged length-of-stay (LOS), complications, discharge to facility, readmission, reoperation, and death using logistic regression. We identified 16,329 eligible patients who underwent lumbar fusion for stenosis; 1,926 (11.8%) received a transfusion. Before matching, there were multiple differences in baseline covariates including age, gender, BMI, ASA class, medical comorbidities, hematocrit, coagulation indices, platelets, operative time, fusion technique, number of levels fused, and osteotomy. However, after matching, no significant differences remained. In the matched cohorts, transfusion was associated with increased prolonged LOS (OR 1.66, 95% CI 1.45-1.91, p < 0.001), minor complication (OR 1.60, 95% CI 1.20-2.12, p = 0.001), major complication (OR 1.51, 95% CI 1.16-1.98, p = 0.003), any complication (OR 1.54, 95% CI 1.24-1.92, p < 0.001), discharge to facility (OR 1.70, 95% CI 1.48-1.95, p < 0.001), 30-day readmission (OR 1.56, 95% CI 1.23-1.99, p < 0.001), and 30-day reoperation (OR 1.85, 95% CI 1.35-2.53, p < 0.001). Although transfusion is performed based on perceived clinical need, this study contributes to growing evidence that it is important to balance the risks of perioperative blood transfusion with its benefits.
MeSH term(s)	Adult ; Aged ; Blood Transfusion/mortality ; Cohort Studies ; Constriction, Pathologic/etiology ; Elective Surgical Procedures/adverse effects ; Elective Surgical Procedures/mortality ; Female ; Humans ; Laminectomy/adverse effects ; Laminectomy/mortality ; Length of Stay ; Lumbosacral Region ; Male ; Middle Aged ; Patient Readmission ; Propensity Score ; Reoperation ; Retrospective Studies ; Spinal Diseases/mortality ; Spinal Diseases/surgery ; Spinal Fusion/adverse effects ; Spinal Fusion/mortality
Language	English
Publishing date	2021-06-10
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	1193674-5
ISSN	1532-2653 ; 0967-5868
ISSN (online)	1532-2653
ISSN	0967-5868
DOI	10.1016/j.jocn.2021.05.061
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Zs.A 3999: Show issues

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Article ; Online: In Reply: Early Outcomes After Carotid Endarterectomy and Carotid Artery Stenting: A Propensity-Matched Cohort Analysis.

Sastry, Rahul A / Pertsch, Nathan J / Sagaityte, Emilija / Poggi, Jonathan A / Toms, Steven A / Weil, Robert J

Neurosurgery

2022 Volume 91, Issue 1, Page(s) e16–e17

MeSH term(s)	Carotid Arteries ; Carotid Stenosis/surgery ; Cohort Studies ; Endarterectomy, Carotid ; Humans ; Stents ; Stroke
Language	English
Publishing date	2022-04-27
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	135446-2
ISSN	1524-4040 ; 0148-396X
ISSN (online)	1524-4040
ISSN	0148-396X
DOI	10.1227/neu.0000000000002006
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Zs.A 1424: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Operative duration and early outcomes in patients having a supratentorial craniotomy for brain tumor: A propensity matched analysis.

McHayle, Allison / Pertsch, Nathan J / Toms, Steven A / Weil, Robert J

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

2021 Volume 92, Page(s) 207–214

Abstract: It is unclear how variations in operative duration affect outcomes after craniotomy for supratentorial brain tumor. We characterized three populations of patients with typical, shorter, and longer durations of craniotomy for supratentorial brain tumor ... ...

Abstract	It is unclear how variations in operative duration affect outcomes after craniotomy for supratentorial brain tumor. We characterized three populations of patients with typical, shorter, and longer durations of craniotomy for supratentorial brain tumor using prospectively collected clinical data from 16,335 patients in the 2012-2018 ACS National Surgical Quality Improvement Program (NSQIP) database. We compared baseline characteristics including demographics, comorbidities, tumor type, and operative features. We used propensity score matching to attain covariate balance and logistic regression to assess odds of unfavorable outcomes. Patients with the shortest operation durations tended to be older, with fewer males, higher ASA class, more metastatic brain tumors, more medical comorbidities, and less use of intraoperative microscope or ultrasound. Patients with the longest operative durations tended to be younger, with more males, fewer non-white minorities, more obesity, lower ASA classes, more intrinsic brain tumors, fewer medical comorbidities, fewer emergency operations, and increased use of intraoperative microscope. For patients with the shortest operations, after matching, we observed significantly decreased odds of prolonged length-of-stay (LOS), major complication, any complication, reoperation, and discharge to a facility; however, there was a significantly increased risk of 30-day mortality. For patients with the longest operations, after matching, we observed significantly increased odds of prolonged LOS; minor, major, and any complication; discharge to facility; and 30-day reoperation. After matching to balance baseline characteristics, operative duration has implications for outcomes following craniotomy for supratentorial brain tumor.
MeSH term(s)	Brain Neoplasms/surgery ; Craniotomy ; Humans ; Length of Stay ; Male ; Postoperative Complications/epidemiology ; Reoperation ; Risk Factors
Language	English
Publishing date	2021-08-28
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	1193674-5
ISSN	1532-2653 ; 0967-5868
ISSN (online)	1532-2653
ISSN	0967-5868
DOI	10.1016/j.jocn.2021.08.005
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Article ; Online: Urinary Tract Infection after Elective Spine Surgery: Timing, Predictive Factors, and Outcomes.

Pertsch, Nathan J / Darveau, Spencer C / Tang, Oliver Y / Toms, Steven A / Weil, Robert J

Spine

2021 Volume 46, Issue 5, Page(s) 337–346

Abstract: Study design: Retrospective review of prospectively collected data.: Objective: The aim of this study was to investigate risk factors associated with the timing of urinary tract infection (UTI) after elective spine surgery, and to determine whether ... ...

Abstract	Study design: Retrospective review of prospectively collected data. Objective: The aim of this study was to investigate risk factors associated with the timing of urinary tract infection (UTI) after elective spine surgery, and to determine whether postoperative UTI timing affects short-term outcomes. Summary of background data: Urinary tract infection (UTI) is a common post-surgical complication; however, the predominant timing, location, and potential differential effects have not been carefully studied. Methods: We analyzed elective spine surgery patients from 2012 to 2018 in the ACS National Surgical Quality Improvement Program (NSQIP). We grouped patients with postoperative UTI by day of onset relative to discharge, to create cohorts of patients who developed inpatient UTI and post-discharge UTI. We compared both UTI cohorts with a control (no UTI) population and with each other to identify differences in baseline characteristics including demographic, comorbidity and operative factors. We performed multivariate logistic regression to identify predictors of UTI in each cohort and to assess adjusted risks of poor outcomes associated with UTI timing. Results: A total of 289,121 patients met inclusion criteria and 0.88% developed UTI (n = 2553). Only 31.6% of UTIs occurred before discharge (n = 806), with 68.4% occurring after discharge (n = 1747). The inpatient UTI cohort had significantly longer operative time, more fusion procedures, more posterior procedures, and more procedures involving the lumbar levels than the post-discharge cohort. Predictors of inpatient UTI included procedure type, spine region, and approach. Predictors of post-discharge UTI included length-of-stay and discharge destination. Both UTI cohorts were significantly associated with sepsis; however, post-discharge UTI carried a higher odds (adjusted odds ratio [aOR] = 24.90, 95% confidence interval [CI] = 21.05-29.45, P < 0.001 vs. aOR = 14.31, 95% CI = 11.09-18.45, P < 0.001). Inpatient UTI was not associated with 30-day readmission, although post-discharge UTI was (aOR = 8.23, 95% CI = 7.36-9.20, P < 0.001). Conversely, inpatient UTI was associated with increased odds of 30-day mortality (aOR = 3.23, 95% CI = 1.62-6.41, P = 0.001), but post-discharge UTI was not. Conclusion: Predictive factors and outcomes differ based on timing of UTI after elective spine surgery. Before discharge, procedure -specific details predict UTI, but after discharge they do not. These findings suggest that traditional thinking about UTI prevention may need modification.Level of Evidence: 3.
MeSH term(s)	Adult ; Aged ; Elective Surgical Procedures/adverse effects ; Elective Surgical Procedures/trends ; Female ; Humans ; Male ; Middle Aged ; Operative Time ; Patient Discharge/trends ; Patient Readmission/trends ; Postoperative Complications/diagnosis ; Postoperative Complications/epidemiology ; Predictive Value of Tests ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Urinary Tract Infections/diagnosis ; Urinary Tract Infections/epidemiology
Language	English
Publishing date	2021-01-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	752024-4
ISSN	1528-1159 ; 0362-2436
ISSN (online)	1528-1159
ISSN	0362-2436
DOI	10.1097/BRS.0000000000003794
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Article ; Online: Outcomes for Adults with Metabolic Syndrome Undergoing Elective Carotid Endarterectomy.

Pertsch, Nathan J / Garcia, Catherine M / Daniel, Yonathan / Phillips, Ronald K / Sagaityte, Emilija / Hagan, Matthew J / Toms, Steven A / Weil, Robert J

World neurosurgery

2022 Volume 163, Page(s) e146–e155

Abstract: Background: Metabolic syndrome (MetS) is a disorder characterized by a constellation of cardiometabolic risk factors including abdominal obesity, dyslipidemia, hypertension, and glucose intolerance that has been associated with adverse perioperative ... ...

Abstract	Background: Metabolic syndrome (MetS) is a disorder characterized by a constellation of cardiometabolic risk factors including abdominal obesity, dyslipidemia, hypertension, and glucose intolerance that has been associated with adverse perioperative outcomes. We evaluated outcomes for patients with MetS after carotid endarterectomy (CEA) in the largest population to date. Methods: We performed a matched cohort analysis using clinical data from 2012 to 2018 in the American College of Surgeons National Surgical Quality Improvement Program. We used propensity scores to match patients to attain covariate balance and used logistic regression to assess odds of unfavorable outcomes, including a predefined primary outcome of composite cardiovascular incident. Results: We identified 50,423 eligible adult patients, of whom 14.2% qualified for MetS (n = 7156). Patients with MetS tended to have CEA at an earlier age, more functional dependence, and longer operative durations. After matching, MetS remained associated with the primary outcome of combined cardiovascular incident (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.18-1.72; P < 0.001), stroke (OR, 1.44; 95% CI, 1.12-1.85; P = 0.004), prolonged length of stay (OR, 1.31; 95% CI, 1.18-1.44; P < 0.001), and discharge to facility (OR, 1.32; 95% CI, 1.08-1.61; P = 0.007). We also found that obesity alone is protective against combined cardiovascular incident, whereas hypertension with diabetes and MetS increase odds of a cardiovascular complication. Conclusions: Metabolic syndrome is associated with adverse outcomes for adult patients undergoing elective CEA.
MeSH term(s)	Adult ; Carotid Stenosis/etiology ; Carotid Stenosis/surgery ; Databases, Factual ; Endarterectomy, Carotid/adverse effects ; Humans ; Hypertension/complications ; Hypertension/epidemiology ; Metabolic Syndrome/complications ; Metabolic Syndrome/epidemiology ; Obesity/etiology ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stroke/etiology ; Treatment Outcome
Language	English
Publishing date	2022-03-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2022.03.082
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