bluuebunny/crossref_metadata_2025_split huggingface dataset:
375 Volume-Outcome Relationships in Pediatric Neurosurgery: An Analysis of the Kids’ Inpatient Database
Authors: Brandel Michael G. , Rennert Robert , Steinberg Jeffrey , Gonda David D. , Levy Michael L. 
Published: March 2022

INTRODUCTION:
Surgical volume has been established as an important determinant of patient outcomes, with progressive regionalization and subspecialization of care.

METHODS:
We identified patients 0-20 years of age who underwent neurosurgical treatment for 1 of 11 conditions in the Kids’ Inpatient Database (KID), 2003-2009: malignant brain tumor, adolescent idiopathic scoliosis (AIS), tethered cord, Chiari malformation, craniosynostosis, traumatic brain injury (TBI), traumatic spinal injury, unruptured intracranial aneurysm, hydrocephalus, peripheral nerve injury, and epilepsy. High-volume (HV) surgeons/hospitals were those in the top tertile of annual case volume. We used multivariable two-level mixed-effects logistic regression analyses to account for clustering of patients within surgeons and clustering of surgeons within hospitals.

RESULTS:
Overall, 40,973 patients met inclusion criteria. Patients were more likely to be treated by a HV surgeon if they were at a HV hospital (range, 51.4% for peripheral nerve repair to 75.6% for aneurysm) for all conditions except for spinal injury (34.8%). There was reduced risk of complications for HV surgeons in tethered cord, TBI, AIS, and aneurysm (all p<0.05). Adjusted for hospital volume, the effect of HV surgeons was maintained only for TBI (OR=0.81, p=0.026). HV hospitals accounted for 42% of the HV surgeon effect for tethered cord, whereas HV surgeons accounted for 94% of the HV hospital effect for aneurysm. Adjusted for hospital volume, HV surgeons had lower length of stay (LOS) for tethered cord (OR=0.31, p=0.010), nerve injury (OR=0.44, p=0.004), hydrocephalus (OR=0.60, p<0.001), and AIS (OR=0.48, p<0.001). HV hospitals accounted for 60% of the effect of HV surgeons on LOS in tumor, whereas HV surgeons accounted for 88% of the effect of HV hospitals in tethered cord, 62% in hydrocephalus, and 31% in aneurysm. Adjusted for hospital volume, HV surgeons had reduced adverse discharge for craniosynostosis (OR=0.12, p=0.005) and hydrocephalus (OR=0.52, p<0.001). HV surgeons accounted for 89% of the effect of HV hospitals in craniosynostosis, and 26% in hydrocephalus.

CONCLUSION:
Although surgeon and hospital volume are sometimes used interchangeably, the two may have different effects on outcomes in pediatric neurosurgery, with one at times explaining variation in the other.
379 Timing of Intra-abdominal Surgery and Ventriculoperitoneal Shunt Placement in the Pediatric Population: Risk of Shunt Infection
Authors: Harward Stephen C. , Komisarow Jordan M. , Rames Jess , Hodges Sarah E. , Rice Henry , Thompson Eric M. , Fuchs Herbert E. , Muh Carrie R. , George Timothy M. , Grant Gerald A. 
Published: March 2022

INTRODUCTION:
Patients requiring placement of a ventriculoperitoneal (VP) shunt during the first year of life often have other comorbidities necessitating additional intra-abdominal surgeries during this first year. Some have suggested that the temporal proximity and sequence of these procedures may lead to a higher risk of subsequent shunt infection; however, data supporting such suggestions have proven limited and inconsistent.

METHODS:
We performed a retrospective review of all children during the first year of life who underwent both a VP shunt and an intra-abdominal procedure at a single institution between January 1, 2000 and January 1, 2018. We examined the impact of timing as well as sequence of surgeries (VP shunt first versus intra-abdominal procedure first) on shunt infection rates within 1 year of the last procedure. We additionally examined the effect of gestation age, birth weight, and placement of a prior ventricular reservoir on shunt infection.

RESULTS:
We identified 53 total patients undergoing both procedures with 16 having the intra-abdominal procedure first compared to 33 having the VP shunt first. Patients who had the intra-abdominal procedure first had a significantly higher rate of infection – 44% (7 of 16 patients) – compared to those who had the VP shunt first – 3% (1 of 33 patients). Further analysis failed to attribute this difference in shunt infection rate to differences in gestational age, birth weight, or time between the procedures.

CONCLUSION:
In our study, for patients needing both a VP shunt and a separate intra-abdominal surgery, the order of surgery greatly impacted one’s subsequent risk of VP shunt infection. These data suggest that if at all possible, the VP shunt should be performed prior to an intraabdominal procedure.
412 Outcome Forecasting in Aneurysmal Subarachnoid Hemorrhage: Comparison of a Neural Network Model With Conventional Logistic Regression
Authors: Feghali James , Sattari Shahab Aldin , Wicks Elizabeth , Gami Abhishek , Rapaport Sarah , Azad Tej D. , Yang Wuyang , Xu Risheng , Tamargo Rafael J. , Huang Judy 
Published: March 2022

INTRODUCTION:
Interest in machine-learning-(ML)-based predictive modeling has led to the development of models predicting aneurysmal subarachnoid hemorrhage (aSAH) outcome, including the Nijmegen acute Subarachnoid Hemorrhage calculator (Nutshell). Generalizability of such models to external data and their performance in comparison to more established conventional logistic-regression-based models, such as the Subarachnoid-Hemorrhage-International-Trialists-(SAHIT) calculator tool, remains unclear.

METHODS:
A prospectively-maintained database of aSAH patients presenting consecutively to our institution in the 2013-2018 period was used. The web-based Nutshell (https://nutshell-tool.com/) and SAHIT (http://sahitscore.com) calculators were used to derive the risks of poor long-term (12-18 month) outcome and 30-day mortality. Discrimination and calibration were evaluated using area under the curve (AUC) and calibration plots. Literature on relevant ML models was surveyed for a synopsis.

RESULTS:
The SAHIT models outperformed the Nutshell tool in predicting long-term functional outcome (AUC: 0.786 vs. 0.689, p = 0.025) and 30-day mortality (AUC: 0.810 vs. 0.636, p < 0.001). Calibration properties were additionally more favorable for the SAHIT models. Most published aneurysm-related ML-based outcome models lack external validation and usable testing platforms. In total, 24 studies utilizing ML models were identified in our literature review, evaluating various aSAH-related and aneurysm treatment outcomes. Only two studies pursued external validation, and only five provided a testing platform for their model to be used by external researchers (e.g. scoring system, calculator, decision tree etc.).

CONCLUSION:
The Nutshell tool demonstrated limited performance upon external validation in comparison to the SAHIT models. External validation and the dissemination of testing platforms for ML models must be emphasized.
414 Flow Diversion for Middle Cerebral Artery Bifurcation Aneurysms: A Multicenter Cohort
Authors: Salem Mohamed M. , Dmytriw Adam A. , Khorasanizadeh MirHojjat , Lay Sovann Vathana , Renieri Leonardo , Sweid Ahmad , Moore Justin M. , Jabbour Pascal , Ogilvy Christopher S. , Limbucci Nicola , Cognard Christophe , Thomas Ajith J. 
Published: March 2022

INTRODUCTION:
Data regarding safety and efficacy of flow diversion in treatment of middle cerebral artery (MCA) bifurcations aneurysms are scarce and limited to small single center series, with particular concern for increased risk of ischemic complications with jailing one of the M2 branches.

METHODS:
We retrospectively reviewed prospectively-maintained databases for patients harboring MCA bifurcation aneurysms who underwent flow diversion treatment in 4 US and European centers in the period from 2011-2018. The relevant clinical and radiographic data was collected from the medical records. The primary outcome was aneurysm occlusion at the last follow up with secondary outcomes of clinical status and complications.

RESULTS:
Sixty-two patients (median age 57.1 years, 66% females) harboring 62 aneurysms were included. Majority of aneurysms were unruptured (79%); 74.2% were saccular and with a mean maximal diameter of 9 mm. Last imaging follow-up was performed at a median of 16.3 months after the treatment, showing complete occlusion in 61.3%, and near complete occlusion (90-99%) in 17.7% of aneurysms. The overall rate of ischemic and hemorrhagic complications were 11.3% and 1.6% respectively. Symptomatic and permanent complications were encountered in 4.8% and 3.2% of patients respectively. Retreatment was pursued in 3.2% of the patients. Jailed branch occlusion was detected in 12.9% of cases. Last follow up mRS of 0-2 was noted in 96.8% of patients.

CONCLUSION:
Flow diversion for MCA bifurcation aneurysms is feasible with reasonable safety and efficacy profile when utilized in carefully selected aneurysms. Jailing of M2 branches is not associated with a high risk of post-procedural ischemic complications.
440 Have We Made Temporal Advancements in Optimizing Surgical Outcomes and Recovery for High Risk Spinal Deformity Patients?
Authors: Passias Peter G. , Passfall Lara , Lafage Virginie , Lafage Renaud , Line Breton G. , Vira Shaleen , Tretiakov Peter S. , Gum Jeffrey L. , Kebaish Khaled , Than Khoi D. , Mundis Gregory M. , Hostin Richard A. , Gupta Munish C. , Eastlack Robert , Anand Neel , Ames Christopher P. , Hart Robert A. , Burton Douglas C. , Schwab Frank , Shaffrey Christopher I. , Smith Justin S. , Klineberg Eric , Bess Shay ,   International Spine Study Group
Published: March 2022

INTRODUCTION:
Surgical correction of adult spinal deformity (ASD) has high rates of complication. However, patients often derive significant benefits in functional status and quality of life from surgery despite high-risk status. It has yet to be investigated whether spine surgeons are improving surgery for high risk patients and minimizing poor outcomes.

METHODS:
Included: operative ASD pts =18 yrs with pre-(BL) and 2-year (2Y) postop radiographic/HRQL data. Pts were categorized as having undergone surgery from 2009 to 2013[Early] or 2014 to 2018[Late]. High risk [HR] pts were defined as meeting =2 of the following BL criteria: 1) ++PILL or SVA by SRS-Schwab, 2) elderly [=70yrs], 3) severe frailty[Miller index], 4) high CCI [=1 SD above cohort mean], 5) three column osteotomy, and 6) fusion of >12 levels, or >7 levels for elderly pts. Differences in Smith et al. best/worst clinical outcomes, radiographic alignment targets(SRS-Schwab, age-adjusted, GAP score), and complication rates were assessed by time of surgery(Early/Late) for HR pts.

RESULTS:
725 ASD pts included (61yrs, 77%F, CCI: 1.82±1.74, levels fused 11.0±4.4). 18.5% underwent 3CO. SRS-Schwab modifiers at BL: 41.4% ++PI-LL, 30.3% ++SVA, 28.8% ++PT. 47% of pts (n=338) had surgery prior to 2014[Early], and 53% (n=387) underwent surgery in 2014 or later[Late]. Overall, 52% of pts (n=377) were deemed high risk[HR]. There was a higher proportion of HR pts in the Late group (p=0.028). In terms of individual HR criteria: Late pts were older, more likely to be ++PI-LL at BL, had higher CCI, and were less likely to undergo 3CO (all p<0.05). Analysis of HR pts by Early/Late status showed no significant differences in radiographic alignment by SRS-Schwab, age-adjusted target, or GAP score by 2Y (all p>0.05). Late/HR pts were less likely to have a poor outcome by Smith et al. definition for SRS and ODI (both p<0.01). Late/HR pts had lower rates of complication, reoperation, deep surgical infection, early PJK (before 6 months), and PJF by 2Y (p<0.05).

CONCLUSION:
Over time in our data set, spine surgeons have both increased and optimized operating on high risk patients, while minimizing the occurrence of poor clinical outcomes and reducing complication rates.
445 Lumbar Intervertebral Disc mRNA Sequencing Identifies the Regulatory Pathway in Young Adult Patients with Disc Degeneration
Authors: Moinuddin F.M. , Bhandarkar Archis R. , Onyedimma Chiduziem , Jarrah Ryan , Bydon Mohamad 
Published: March 2022

INTRODUCTION:
The process of intervertebral disc degeneration disease (DDD) is thought to be an age-related phenomenon that includes inflammation and cell apoptosis leading to decreased proteoglycan synthesis with resultant disc dehydration and loss of disc height. It has been reported that 42% of young adults have DDD characterized by a signal change on MRI, it seems beneficial to examine young adults to clarify the process of DDD.

METHODS:
We performed next generation RNA sequencing on 9 nucleus pulposus (NP) of the lumbar intervertebral disc from young adults (<40 years age, n = 4) and old adults (>40 years of age, n = 5) patients. GO (Gene Ontology) and KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway analyses were performed to identify the biological functions of differentially expressed mRNAs.

RESULTS:
A total of 98 genes were found to be significantly upregulated in young adults NP tissue compared to old adults NP tissue. These upregulated mRNAs were primarily involved in signal peptide, collagen, and extracellular matrix organization. Among the top upregulated genes such as LGALS1, COL6A2 and PTMS may have the key regulatory functions related to early age disc degeneration. In addition, we found 346 genes were significantly downregulated in young adults NP tissue compared to old adults NP tissue. They were primarily involved in glycoprotein, membrane, and immunoglobulin-like fold.

CONCLUSION:
This investigation provides a comprehensive overview of mRNA expression in the nucleus pulposus of intervertebral disc tissue in young adult patients compare with old adult patients. By applying computational analyses to our large dataset of human clinical specimens, we have been able to identify candidate gene regulatory networks that act in early age disc degeneration.
453 Long-Term Outcomes Following Minimally Invasive Laminectomy for the Treatment of Lumbar Synovial Cysts
Authors: Chesney Kelsi , Elsouri Mohamad , Stylli Jack , Phelps Emily , Fayed Islam , Voyadzis Jean-Marc , Sandhu Faheem A. 
Published: March 2022

INTRODUCTION:
Lumbar synovial cysts (LSC), most often occurring at L4-5, can cause painful radiculopathy and/or sensory or motor deficits when symptomatic. The etiology of these lesions is thought to be related to degeneration of the facet joints. Historically, the first-line surgical treatment has been decompression with fusion. More recently, minimally invasive laminectomy without fusion has been shown to achieve equal or superior results to traditional decompression and fusion methods.

METHODS:
A retrospective review was performed at a single institution, over a 10-year period, of patients undergoing minimally invasive laminectomy for symptomatic LSCs. The primary outcome in this study was the rate of revision surgery requiring fusion. Secondary outcomes were based on analysis of baseline patient characteristics, operative details, and postoperative outcomes.

RESULTS:
Eighty-five patients with symptomatic LSC underwent minimally invasive laminectomy alone from January 2010 to August 2020 at our institution. The most common location was L4-5 (71%), followed by L5-S1 (17%), and then L3-4 (11%). The average patient was 65 years old with a BMI of 28.6. All patients (100%) presented with symptoms of painful radiculopathy. Pre-operative imaging identified spondylolisthesis in 44 (57%) patients, none of which were considered unstable on dynamic X-rays. Average length of the procedure was 93 minutes, with 78% of patients discharged home on the same day of their procedure. There was only one reported intraoperative durotomy. Over 45 months of mean follow-up, seventeen patients (20%) required eighteen revision operations. Of those, 15 were primary spinal fusions (17.6%), 2 were washouts for epidural hematoma (2.4%), and 1 was a revision decompression for recurrent cyst (1.2%). Mean time to fusion surgery was 31 months. There were no identifiable risk factors on multivariate regression analysis that predicted the need for fusion.

CONCLUSION:
After minimally invasive laminectomy for lumbar synoval cyst, only 18% of the 85 patients in our cohort went on to require a fusion over a ten-year period.
458 Pulsed Electromagnetic Fields (PEMF) Used in Cervical Spine Fusion for Patients with Risk Factors for Non-Union
Authors: Wind Joshua J. , Weinstein Marc , Radcliff Kris , Lansford Todd , Aleem Ilyas , Patel Vikas V. , Vokshoor Amir A. 
Published: March 2022

INTRODUCTION:
A post market prospective study was conducted to examine the effect of the adjunctive use of a pulsed electromagnetic field (PEMF) device on cervical fusion rate in subjects with risk factors for non-union. PEMF has been shown to stimulate bone healing and can be a valuable tool to help overcome biological deficiencies in patients at risk for non-union.

METHODS:
Patients undergoing cervical fusion surgery were identified for enrollment from 11 investigator sites based on being classified as having one or more risk factors for non-union. Subjects were those having a multi-level (2 or more) fusion, prior cervical spine fusion, diabetes, osteoporosis, or smokers. Subjects were required to wear the PEMF device for 4 hours/day for 6 months. Compliance was measured based on usage data downloaded from the device. The primary outcome measure was fusion status at 12 month follow-up period as indicated by x-ray and CT. Fusion status was determined by the site investigator using A/P, lateral, and flexion/extension radiographs in addition to CT (without contrast).

RESULTS:
Out of 152 subjects, 138 (90.8%) were graded as fused (all levels) at the 12 month visit About half of the subjects (49.3%) had 3 or more levels fused. Fusion success for subjects with 2 or more risk factors was 88.5%, and was 94.4% for subjects with a single risk factor. On average, compliance rates (minutes using device/minutes prescribed) were 83.8% and 74.9% for the 3 and 6 month visit, respectively. The followup rate at the 12 month visit was 97%.

CONCLUSION:
The results of our study suggest that adjunctive use of PEMF is effective in cervical spine fusion patients with factors associated with non-union. Favorable fusion rates were obtained with patients having elevated comorbidity and/or complex surgeries. Further research is planned to include a control group in a real world setting to better assess the impact of the PEMF device in this population.
463 Incidence and Impact of Surgical Glove Contamination on Surgical Site Infection (SSI)
Authors: Herbert Joseph , Litofsky N. Scott , Vallabhaneni Ahdarsh 
Published: March 2022

INTRODUCTION:
Surgical site infection (SSI) is a significant source of increased cost and morbidity among patients undergoing elective neurosurgical operations. Although much research has focused on the impact of various patient and surgical factors on SSI, studies examining the role of unintended surgical glove contamination (SGC) on SSI are unavailable.

METHODS:
Patients undergoing elective neurosurgical operations were prospectively collected over 1 year in this prospective quality improvement project. At the conclusion of the key portion of the operation, just prior to the start of closure, the gloves of the attending, resident, and scrub tech were swabbed using standard culture swabs and sent for aerobic and anaerobic culture. Preoperative antibiotics, choice of skin preparation, length of operation, and type of wound dressing were also recorded. Any wound infection or breakdown during follow up was recorded.

RESULTS:
Ninety-seven patients (36 spine and 56 cranial, and 5 “other” operations) were included for analysis. Overall incidence of SSI was 4.12%. SGC incidence was 10.3%, with the majority of positive cultures (60%) found on the scrub tech’s gloves. None of the patients in which SGC was identified went on to develop SSI.

CONCLUSION:
The incidence of SGC in our cohort was over 10%. SGC identified at the time of closure did not correlate with development of SSI. SSI does not appear to result from wound contamination prior to closure.
464 Hospital Frailty Risk Score and Healthcare Resource Utilization After Surgery for Metastatic Spinal Column Tumors
Authors: Elsamadicy Aladine A. , Koo Andrew B. , Reeves Benjamin , Pennington Zach , Yu James , Goodwin C. Rory , Kolb Luis , Laurans Maxwell S. H. , Lo Sheng-fu L. , Shin John H. , Sciubba Daniel 
Published: March 2022

INTRODUCTION:
The Hospital Frailty Risk Score (HFRS) was recently developed utilizing ICD-10 diagnostic codes to identify frailty and predict adverse outcomes in large national database studies. While other studies have examined frailty in spine oncology, HFRS has not been assessed in this patient population.

METHODS:
A retrospective cohort study was performed using the National Inpatient Sample (NIS) database from the years 2016 to 2018. All adult patients (=18 years-old) undergoing surgery metastatic spinal column tumor were identified using the ICD-10-CM diagnostic and procedural coding systems. Patients were categorized into two cohorts based on the criteria of the HFRS: No Frailty (HFRS <5) and Frail (HFRS = 5). A multivariate logistic regression analysis was used to identify independent predictors of prolonged LOS, non-routine discharge, and increased cost.

RESULTS:
Of the 8,500 patients identified, 3,230 (38.0%) were found to be Frail by HFRS criteria. Compared to the Non-Frail cohort, the Frail cohort was found to have a significantly longer LOS (Non-Frail: 7.9 ± 5.0 vs Frail: 14.8 ± 13.0, p < 0.001), a significantly higher rate of Non-Routine discharge (Non-Frail: 639.8% vs Frail: 61.7%, p = 0.001), and a significantly greater mean total cost of hospital admission (Non-Frail: $48,108 ± $29,654 vs Frail: $66,798 ± $45,712, p < 0.001). On multivariate regression analysis, Frailty was found to be a significant predictor of both prolonged LOS [OR: 4.02, CI (3.06, 5.27), p < 0.001] and non-routine discharge [OR: 2.13, CI (1.68, 2.71), p < 0.001].

CONCLUSION:
Our study is the first to use the HFRS to assess the impact of frailty on patients with metastatic bony spinal tumors. We found that in this patient population, Frailty was associated with prolonged hospital LOS, non-routine discharge and total hospital costs.