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Staikou C.,National and Kapodistrian University of Athens | Paraskeva A.,National and Kapodistrian University of Athens | Karmaniolou I.,Royal National Orthopedic Hospital | Mani A.,Klinikum Starnberg | Chondrogiannis K.,National and Kapodistrian University of Athens
Minerva Anestesiologica | Year: 2014

Background. New scientific findings are gradually implemented into daily clinical routine. The present questionnaire survey investigated the current practice in obstetric anesthesia in Europe. Methods. A 19-point questionnaire on obstetric anesthesia practices, regarding the techniques, drugs, fluids, vasopressors and safety measures, was uploaded on the site of the European Society of Anaesthesiology (21/12/2011 to 21/12/2012). Results. Three hundred and forty-one (341) completed questionnaires were analyzed. Single-shot subarachnoid anesthesia is preferred by 225 (66%) respondents in uncomplicated Cesarean deliveries and by 190 (55.7%) in preeclampsia. Most anaesthesiologists (N.=133, 39%) perform neuraxial techniques if platelet count exceeds 80000/mm3. In anticipated hemorrhage, general anesthesia is administered by 165 (48.4%) respondents. Anesthesia is induced with thiopental/succinylcholine by 193 (56.6%) survey participants, usually under cricoid pressure (N.=201, 58.8%). For prevention of the hypotension associated with regional anesthesia, coloading with 1L of crystalloid represents the most popular measure undertaken by 80 (40.2%) respondents, while vasopressors are not favored (N.=260, 76.2%). For hypotension treatment, ephedrine is preferred over phenylephrine by 124 (36.4%) versus 79 (23.2%) anesthesiologists. Supplemental oxygen is routinely administered to parturients receiving regional anesthesia by 176 (51.6%) respondents. The standard dose of oxytocin is 5IU, according to most answers (N.=160, 46.9%). Conclusion. Subarachnoid anesthesia is mostly favored among European anesthesiologists, while general anesthesia is reserved only for cases with anticipated hemorrhage. Fluid coloading and phenylephrine have gained popularity, in line with current knowledge. Conversely, cricoid pressure, standard supplemental oxygen and high oxytocin doses - though strongly questioned - are still advocated by most anaesthesiologists.

Smith J.S.,University of Virginia | Fu K.-M.G.,University of Virginia | Polly D.W.,University of Minnesota | Sansur C.A.,University of Maryland, Baltimore | And 11 more authors.
Spine | Year: 2010

Study Design. Retrospective review of a prospectively collected database. Objective. The Scoliosis Research Society (SRS) collects morbidity and mortality (M and M) data from its members. Our objectives were to assess complication rates for 3 common spine procedures, compare these results with prior literature as a means of validating the database, and to assess rates of pulmonary embolism (PE) and deep venous thrombosis (DVT) in all cases reported to the SRS over 4 years. Summary Of Background Data. Few modern series document complication rates of spinal surgery as routinely practiced across academic and community settings. Those available are typically based on relatively low numbers of procedures or confined to single-surgeon experiences. Methods. The SRS M and M database was queried for lumbar microdiscectomy (LD), anterior cervical discectomy and fusion (ACDF), and lumbar stenosis decompression (LSD) cases from 2004 to 2007. Revisions were excluded. The database was also queried for occurrence of clinically evident PE and DVT in all cases from 2004 to 2007. RESULTS.: A total of 9692 LDs, 6735 ACDFs, and 10,329 LSDs were identified, with overall complication rates of 3.6%, 2.4%, and 7.0%, respectively. These rates are comparable to previously published smaller series. For assessment of PE and DVT, 108,419 cases were identified and rates were calculated per 1000 cases based on diagnosis, age group, and implant use. Overall rates of PE, death due to PE, and DVT were 1.38, 0.34, and 1.18, respectively. Among 82,082 adults, the rate of PE ranged from 0.47 for LD to 12.4 for metastatic tumor. Similar variations were noted for DVT and deaths due to PE. Conclusion. Overall major complication rates for LD, ACDF, and LSD based on the SRS M and M database are comparable to those in previously reported smaller series, supporting the validity of this database for study of other less common spinal disorders. In addition, our data provide general benchmarks of clinically evident PE and DVT rates as a basis for ongoing efforts to improve care. © 2010, Lippincott Williams & Wilkins.

Fu K.-M.G.,University of Virginia | Smith J.S.,University of Virginia | Polly Jr. D.W.,University of Minnesota | Perra J.H.,Twin Cities Spine Center | And 11 more authors.
Spine | Year: 2011

Study Design. Retrospective analysis of prospectively collected database. Objective. To analyze the rate of complications, includ-ing neurologic deficits, associated with operative treatment of pediatric isthmic and dysplastic spondylolisthesis. Summary Of Background Data. Pediatric isthmic and dysplastic spondylolisthesis are relatively uncommon dis-orders. Several prior studies have suggested a high rate of complication associated with operative intervention. How-ever, most of these studies were performed with sufficiently small sample sizes such that the presence of one complica-tion could significantly affect the overall rate. The Scoliosis Research Society (SRS) prospectively collects morbidity and mortality (M&M) data from its members. This multicentered, multisurgeon database permits analysis of the surgi-cal treatment of this relatively rare condition on an aggre-gate scale and provides surgeons with useful information for preoperative counseling. Methods. Patients who underwent surgical treatment for isthmic or dysplastic spondylolisthesis from 2004 to 2007 were identified from the SRS M&M database. Inclu-sion criteria for analysis included age ≤21 and a primary diagnosis of isthmic or dysplastic spondylolisthesis. Results. Of 25,432 pediatric cases reported, there were a total of 605 (2.4%) cases of pediatric dysplastic (n = 62, 10%) and isthmic (n = 543, 90%) spondylolisthesis, with a mean age of 15 years (range, 4-21). Approximately 50% presented with neural element compression, and less than 1% of cases were revisions. Surgical procedures included fusions in 92%, osteotomies in 39%, and reduc-tions in 38%. The overall complication rate was 10.4%. The most common complications included postoperative neurologic deficit (n = 31, 5%), dural tear (n = 8, 1.3%), and wound infection (n = 12, 2%). Perioperative deep venous thrombosis and pulmonary embolus were re-ported in 2 (0.3%) and 1 (0.2%) patients, respectively. There were no deaths in this series. Conclusion. Pediatric isthmic and dysplastic spondylolisthesis are relatively uncommon disorders, repre-senting only 2.4% of pediatric spine procedures in the present study. Even among experienced spine surgeons, surgical treatment of these spinal conditions is associated with a relatively high morbidity. Copyright © 2011 Lippincott Williams & Wilkins.

Sansur C.A.,University of Maryland, Baltimore | Reames D.L.,University of Virginia | Smith J.S.,University of Virginia | Hamilton D.K.,University of Virginia | And 14 more authors.
Journal of Neurosurgery: Spine | Year: 2010

Object. This is a retrospective review of 10,242 adults with degenerative spondylolisthesis (DS) and isthmic spondylolisthesis (IS) from the morbidity and mortality (M&M) index of the Scoliosis Research Society (SRS). This database was reviewed to assess complication incidence, and to identify factors that were associated with increased complication rates. Methods. The SRS M&M database was queried to identify cases of DS and IS treated between 2004 and 2007. Complications were identified and analyzed based on age, surgical approach, spondylolisthesis type/grade, and history of previous surgery. Age was stratified into 2 categories: > 65 years and ≤ 65 years. Surgical approach was stratified into the following categories: decompression without fusion, anterior, anterior/posterior, posterior without instrumentation, posterior with instrumentation, and interbody fusion. Spondylolisthesis grades were divided into low-grade (Meyerding I and II) versus high-grade (Meyerding III, IV, and V) groups. Both univariate and multivariate analyses were performed. Results. In the 10,242 cases of DS and IS reported, there were 945 complications (9.2%) in 813 patients (7.9%). The most common complications were dural tears, wound infections, implant complications, and neurological complications (range 0.7%-2.1%). The mortality rate was 0.1%. Diagnosis of DS had a significantly higher complication rate (8.5%) when compared with IS (6.6%; p = 0.002). High-grade spondylolisthesis correlated strongly with a higher complication rate (22.9% vs 8.3%, p < 0.0001). Age > 65 years was associated with a significantly higher complication rate (p = 0.02). History of previous surgery and surgical approach were not significantly associated with higher complication rates. On multivariate analysis, only the grade of spondylolisthesis (low vs high) was in the final best-fit model of factors associated with the occurrence of complications (p < 0.0001). Conclusions. The rate of total complications for treatment of DS and IS in this series was 9.2%. The total percentage of patients with complications was 7.9%. On univariate analysis, the complication rate was significantly higher in patients with high-grade spondylolisthesis, a diagnosis of DS, and in older patients. Surgical approach and history of previous surgery were not significantly correlated with increased complication rates. On multivariate analysis, only the grade of spondylolisthesis was significantly associated with the occurrence of complications.

Smith J.S.,University of Virginia | Shaffrey C.I.,University of Virginia | Sansur C.A.,University of Maryland, Baltimore | Berven S.H.,University of California at San Francisco | And 11 more authors.
Spine | Year: 2011

STUDY DESIGN. Retrospective review of a prospectively collected database. OBJECTIVE. Our objective was to assess the rates of postoperative wound infection associated with spine surgery. SUMMARY OF BACKGROUND DATA. Although wound infection after spine surgery remains a common source of morbidity, estimates of its rates of occurrence remain relatively limited. The Scoliosis Research Society prospectively collects morbidity and mortality data from its members, including the occurrence of wound infection. METHODS. The Scoliosis Research Society morbidity and mortality database was queried for all reported spine surgery cases from 2004 to 2007. Cases were stratified based on factors including diagnosis, adult (≥21 years) versus pediatric (<21 years), primary versus revision, use of implants, and whether a minimally invasive approach was used. Superficial, deep, and total infection rates were calculated. RESULTS. In total, 108,419 cases were identified, with an overall total infection rate of 2.1% (superficial = 0.8%, deep = 1.3%). Based on primary diagnosis, total postoperative wound infection rate for adults ranged from 1.4% for degenerative disease to 4.2% for kyphosis. Postoperative wound infection rates for pediatric patients ranged from 0.9% for degenerative disease to 5.4% for kyphosis. Rate of infection was further stratified based on subtype of degenerative disease, type of scoliosis, and type of kyphosis for both adult and pediatric patients. Factors associated with increased rate of infection included revision surgery (P < 0.001), performance of spinal fusion (P < 0.001), and use of implants (P < 0.001). Compared with a traditional open approach, use of a minimally invasive approach was associated with a lower rate of infection for lumbar discectomy (0.4% vs. 1.1%; P < 0.001) and for transforaminal lumbar interbody fusion (1.3% vs. 2.9%; P = 0.005). CONCLUSION. Our data suggest that postsurgical infection, even among skilled spine surgeons, is an inherent potential complication. These data provide general benchmarks of infection rates as a basis for ongoing efforts to improve safety of care. © 2011 Lippincott Williams & Wilkins, Inc.

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