Inderpreet Bhatti - Academia.edu (original) (raw)
Papers by Inderpreet Bhatti
Journal of Spine & Neurosurgery, Jul 29, 2016
Intra-operative MRI (ioMRI) may be used to optimize tumor resection. Utilization of this technolo... more Intra-operative MRI (ioMRI) may be used to optimize tumor resection. Utilization of this technology allows for the removal of residual tumor mass following initial tumor removal, maximizing the extent of resection. This, in turn, has been shown to lead to improved outcomes. Individual studies have examined the impact of ioMRI on the rate of extended resection, but a comprehensive review of this topic is needed. A literature review of the MEDLINE, EMBASE, CENTRAL, and Google Scholar databases revealed 12 eligible studies. This included 804 primary operations and 238 extended resections based on ioMRI findings. Use of ioMRI led to extended tumor resection in 13.3-54.8% of patients (mean 37.3%). Stratification by tumor type showed additional resection occurred, on average, in 39.1% of glioma resections (range 13.3-70.0%), 23.5% of pituitary tumor resections (range 13.3-33.7%), and 35.0% of nonspecific tumor resections (range 17.5-40%). Tumor type (glioma vs. pituitary) did not significantly influence the rate of further excision following ioMRI (p=0.309). There was no difference in secondary resection rate between studies limited to pediatric patients and those including adults (p=0.646). Thus, the use of intra-operative MRI frequently results in further resection of tumors. It is primarily used for the resection of gliomas and pituitary tumors. Tumor type does not appear to be a significant contributing factor to the rate of secondary tumor removal. Limited evidence suggests that extended resection may translate into improved clinical outcomes and mortality rates. However, results have not been unanimous, while clinical effect sizes have often been modest.
World Neurosurgery, Jun 1, 2017
Objective: To characterize cranioplasty complications and costs at a population level using a lon... more Objective: To characterize cranioplasty complications and costs at a population level using a longitudinal national claims database. Methods: We identified cranioplasty patients between 2007-2014 in the MarketScan national database. We evaluated age, autograft usage, cranioplasty size, and cranioplasty timing on postoperative outcomes. We further analyzed associated costs. A subset analysis of adult cranioplasty patients with emergent indications, including stroke and trauma, was also performed. Results: We identified 8,275 patients (mean 44.0±20.0 years, 45.2% male) consisting of 13.8% pediatric (<18 years), 76.0% adults (18-64 years), and 10.2% elderly adults (>65 years). Overall complication rate was 36.6%, mortality rate 0.5%, and 30-day readmission rate 12.0%. Elderly patients had the highest complication rate (p<0.0001). Overall, large cranioplasties (>5 cm) saw higher complication rates than small cranioplasties (≤5 cm, p=0.047). In those with emergent indications only(N=1,282), size did not influence complications-though large cranioplasties showed higher infection risk (p=0.02). Overall, autograft use did not affect outcomes, but was associated with higher complication risk-including infections-in the subset with only emergent indications (p<0.001, p=0.001). Late (>90 days) cranioplasty timing had higher complication rates in both the overall cohort and subset with emergent indications (p<0.001, p<0.001). Index costs of care were mainly driven by hospital payments in both the overall cohort and those with emergent indications. Conclusions: We found a high complication rate associated with cranioplasty in the U.S.A. Older age, large cranioplasties, and delayed cranioplasties increased complication risk overall. Among those with only emergent indications, complications were associated with a delayed time to cranioplasty and autograft usage.
Clinical spine surgery, Dec 1, 2017
Objective: To quantify the longitudinal economic impact of venous thromboembolism (VTE) complicat... more Objective: To quantify the longitudinal economic impact of venous thromboembolism (VTE) complications in spinal fusion patients. Summary of Background Data: VTE is a rare and serious complication that may occur after spine surgery. The long-term socioeconomic impact understanding of these events has been limited by small sample sizes and a lack of longitudinal followup. We provide a comparative economic outcomes analysis of these complications. Methods: We identified 204,308 patients undergoing spinal fusion procedures in a national billing claims database (Market-Scan) between 2006 and 2010. Cohorts were balanced using 50:1 propensity score matching and outcome measures compared at 6, 12, and 18 months postoperation. Results: A total of 1196 (0.6%) patients developed postoperative VTE, predominantly occurring following lumbar fusion (69.7%). Postoperative VTE patients demonstrated an increase in hospital length of stay (7.8 vs. 3.3 d, P < 0.001) and a decreased likelihood of being discharged home (71% vs. 85%, P < 0.001). A 26,306increaseintotalhospitalpayments(P<0.001)wasobserved,withadisproportionateincreaseseeninhospitalpayments(26,306 increase in total hospital payments (P < 0.001) was observed, with a disproportionate increase seen in hospital payments (26,306increaseintotalhospitalpayments(P<0.001)wasobserved,withadisproportionateincreaseseeninhospitalpayments(22,103, P < 0.001), relative to physician payments ($1766, P = 0.001). At 6, 12, and 18 months postfusion, increased rates of readmission and follow-up clinic visits were observed. Delayed readmissions were associated with decreased length of stay (3.6 vs. 4.6 d, P < 0.
Journal of Clinical Neuroscience, Dec 1, 2016
Intra-operative MRI (ioMRI) may be used to optimize tumor resection. Utilization of this technolo... more Intra-operative MRI (ioMRI) may be used to optimize tumor resection. Utilization of this technology allows for the removal of residual tumor mass following initial tumor removal, maximizing the extent of resection. This, in turn, has been shown to lead to improved outcomes. Individual studies have examined the impact of ioMRI on the rate of extended resection, but a comprehensive review of this topic is needed. A literature review of the MEDLINE, EMBASE, CENTRAL, and Google Scholar databases revealed 12 eligible studies. This included 804 primary operations and 238 extended resections based on ioMRI findings. Use of ioMRI led to extended tumor resection in 13.3-54.8% of patients (mean 37.3%). Stratification by tumor type showed additional resection occurred, on average, in 39.1% of glioma resections (range 13.3-70.0%), 23.5% of pituitary tumor resections (range 13.3-33.7%), and 35.0% of nonspecific tumor resections (range 17.5-40%). Tumor type (glioma vs. pituitary) did not significantly influence the rate of further excision following ioMRI (p=0.309). There was no difference in secondary resection rate between studies limited to pediatric patients and those including adults (p=0.646). Thus, the use of intra-operative MRI frequently results in further resection of tumors. It is primarily used for the resection of gliomas and pituitary tumors. Tumor type does not appear to be a significant contributing factor to the rate of secondary tumor removal. Limited evidence suggests that extended resection may translate into improved clinical outcomes and mortality rates. However, results have not been unanimous, while clinical effect sizes have often been modest.
World Neurosurgery, Dec 1, 2015
Introduction Spine surgeries performed in the United States have increased in both number and com... more Introduction Spine surgeries performed in the United States have increased in both number and complexity over the last two decades (40). The mean total hospital cost of spinal fusions alone have increased 3.3-fold between 1998 and 2008 (40). Lumbar spine surgeries, including fusions, discectomies, and laminectomies, have experienced the most dramatic growth (50). Lumbar fusions account for a majority of this development, with a 142% reported increase from 1998-2008 (40). Postoperative visual loss (POVL) may occur after lumbar spine surgery. Though POVL can occur after all types of nonocular surgeries with an estimated incidence of 0.0008% to 0.002% in the general surgical population, the incidence of POVL after spine surgery is significantly greater, ranging from 0.09% to 0.20% (4,37,42,47). An analysis of published case reports indicates a growing association between POVL and lumbar surgery (20). This accompanies the national estimates of POVL incidence in 0.138% of posterior lumbar fusions and 0.094% of anterior lumbar fusions from 1993-2002 (37). The devastating and often irreversible effects of POVL make it imperative to further investigate its potential risk factors. Moreover, postoperative complications incur large costs. Both major and minor complications after spine surgery increase total health care costs substantially (52). For patients with POVL, a population-based study of spinal fusions from 2002 to 2009 found a twofold increase in hospital costs (33).
American Journal of Gastroenterology, 2021
World Neurosurgery, 2017
Objective: To characterize cranioplasty complications and costs at a population level using a lon... more Objective: To characterize cranioplasty complications and costs at a population level using a longitudinal national claims database. Methods: We identified cranioplasty patients between 2007-2014 in the MarketScan national database. We evaluated age, autograft usage, cranioplasty size, and cranioplasty timing on postoperative outcomes. We further analyzed associated costs. A subset analysis of adult cranioplasty patients with emergent indications, including stroke and trauma, was also performed. Results: We identified 8,275 patients (mean 44.0±20.0 years, 45.2% male) consisting of 13.8% pediatric (<18 years), 76.0% adults (18-64 years), and 10.2% elderly adults (>65 years). Overall complication rate was 36.6%, mortality rate 0.5%, and 30-day readmission rate 12.0%. Elderly patients had the highest complication rate (p<0.0001). Overall, large cranioplasties (>5 cm) saw higher complication rates than small cranioplasties (≤5 cm, p=0.047). In those with emergent indications only(N=1,282), size did not influence complications-though large cranioplasties showed higher infection risk (p=0.02). Overall, autograft use did not affect outcomes, but was associated with higher complication risk-including infections-in the subset with only emergent indications (p<0.001, p=0.001). Late (>90 days) cranioplasty timing had higher complication rates in both the overall cohort and subset with emergent indications (p<0.001, p<0.001). Index costs of care were mainly driven by hospital payments in both the overall cohort and those with emergent indications. Conclusions: We found a high complication rate associated with cranioplasty in the U.S.A. Older age, large cranioplasties, and delayed cranioplasties increased complication risk overall. Among those with only emergent indications, complications were associated with a delayed time to cranioplasty and autograft usage.
Journal of Clinical Neuroscience, 2016
Intra-operative MRI (ioMRI) may be used to optimize tumor resection. Utilization of this technolo... more Intra-operative MRI (ioMRI) may be used to optimize tumor resection. Utilization of this technology allows for the removal of residual tumor mass following initial tumor removal, maximizing the extent of resection. This, in turn, has been shown to lead to improved outcomes. Individual studies have examined the impact of ioMRI on the rate of extended resection, but a comprehensive review of this topic is needed. A literature review of the MEDLINE, EMBASE, CENTRAL, and Google Scholar databases revealed 12 eligible studies. This included 804 primary operations and 238 extended resections based on ioMRI findings. Use of ioMRI led to extended tumor resection in 13.3-54.8% of patients (mean 37.3%). Stratification by tumor type showed additional resection occurred, on average, in 39.1% of glioma resections (range 13.3-70.0%), 23.5% of pituitary tumor resections (range 13.3-33.7%), and 35.0% of nonspecific tumor resections (range 17.5-40%). Tumor type (glioma vs. pituitary) did not significantly influence the rate of further excision following ioMRI (p=0.309). There was no difference in secondary resection rate between studies limited to pediatric patients and those including adults (p=0.646). Thus, the use of intra-operative MRI frequently results in further resection of tumors. It is primarily used for the resection of gliomas and pituitary tumors. Tumor type does not appear to be a significant contributing factor to the rate of secondary tumor removal. Limited evidence suggests that extended resection may translate into improved clinical outcomes and mortality rates. However, results have not been unanimous, while clinical effect sizes have often been modest.
World Neurosurgery, 2015
Introduction Spine surgeries performed in the United States have increased in both number and com... more Introduction Spine surgeries performed in the United States have increased in both number and complexity over the last two decades (40). The mean total hospital cost of spinal fusions alone have increased 3.3-fold between 1998 and 2008 (40). Lumbar spine surgeries, including fusions, discectomies, and laminectomies, have experienced the most dramatic growth (50). Lumbar fusions account for a majority of this development, with a 142% reported increase from 1998-2008 (40). Postoperative visual loss (POVL) may occur after lumbar spine surgery. Though POVL can occur after all types of nonocular surgeries with an estimated incidence of 0.0008% to 0.002% in the general surgical population, the incidence of POVL after spine surgery is significantly greater, ranging from 0.09% to 0.20% (4,37,42,47). An analysis of published case reports indicates a growing association between POVL and lumbar surgery (20). This accompanies the national estimates of POVL incidence in 0.138% of posterior lumbar fusions and 0.094% of anterior lumbar fusions from 1993-2002 (37). The devastating and often irreversible effects of POVL make it imperative to further investigate its potential risk factors. Moreover, postoperative complications incur large costs. Both major and minor complications after spine surgery increase total health care costs substantially (52). For patients with POVL, a population-based study of spinal fusions from 2002 to 2009 found a twofold increase in hospital costs (33).
Journal of Clinical Neuroscience, 2012
Chordomas are rare, malignant bone tumors of the axial skeleton, occurring particularly at the cr... more Chordomas are rare, malignant bone tumors of the axial skeleton, occurring particularly at the cranial base or in the sacro-coccygeal region. Although slow growing, chordomas are locally aggressive and challenging to treat. We evaluate the outcomes of skull base and spinal chordomas in 20 patients treated with CyberKnife (CK) stereotactic radiosurgery (SRS) (Accuray, Sunnyvale, CA, USA) between 1994 and 2010 at Stanford Hospital. There were 12 males and eight females (10-78 years; median age: 51.5 years). Eleven patients received CK as primary adjuvant therapy and nine patients received CK for multiple recurrences. The average tumor volume treated was 16.1 cm 3 (2.4-45.9 cm 3), with a mean marginal dose of 32.5 Gy (18-50 Gy). Median follow-up was 34 months (2-131 months). Overall, tumor control was achieved in 11 patients (55%), with eight patients showing tumor size reduction. However, nine patients showed progression and eventually succumbed to the disease (mean time from CK to death was 26.3 months). Of the patients treated with CK as the primary adjuvant therapy, 81.8% had stable or improved outcomes. Only 28.6% of those treated with CK for recurrences had stable or improved outcomes. The overall Kaplan-Meyer survival at five years from the first CK treatment was 52.5%. Moderate tumor control rates can be achieved with few complications with CK SRS. Poor control is associated with complex multiple surgical resections, long delay between initial resection and CK therapy, and recurrently aggressive disease uncontrolled by prior radiation.
Clinical spine surgery, Jan 12, 2016
Propensity score matched retrospective study using a nationwide longitudinal database. To quantif... more Propensity score matched retrospective study using a nationwide longitudinal database. To quantify the longitudinal economic impact of venous thromboembolism (VTE) complications in spinal fusion patients. VTE is a rare and serious complication that may occur after spine surgery. The long-term socioeconomic impact understanding of these events has been limited by small sample sizes and a lack of longitudinal follow-up. We provide a comparative economic outcomes analysis of these complications. We identified 204,308 patients undergoing spinal fusion procedures in a national billing claims database (MarketScan) between 2006 and 2010. Cohorts were balanced using 50:1 propensity score matching and outcome measures compared at 6, 12, and 18 months postoperation. A total of 1196 (0.6%) patients developed postoperative VTE, predominantly occurring following lumbar fusion (69.7%). Postoperative VTE patients demonstrated an increase in hospital length of stay (7.8 vs. 3.3 d, P<0.001) and a...
Journal of Spine & Neurosurgery, Jul 29, 2016
Intra-operative MRI (ioMRI) may be used to optimize tumor resection. Utilization of this technolo... more Intra-operative MRI (ioMRI) may be used to optimize tumor resection. Utilization of this technology allows for the removal of residual tumor mass following initial tumor removal, maximizing the extent of resection. This, in turn, has been shown to lead to improved outcomes. Individual studies have examined the impact of ioMRI on the rate of extended resection, but a comprehensive review of this topic is needed. A literature review of the MEDLINE, EMBASE, CENTRAL, and Google Scholar databases revealed 12 eligible studies. This included 804 primary operations and 238 extended resections based on ioMRI findings. Use of ioMRI led to extended tumor resection in 13.3-54.8% of patients (mean 37.3%). Stratification by tumor type showed additional resection occurred, on average, in 39.1% of glioma resections (range 13.3-70.0%), 23.5% of pituitary tumor resections (range 13.3-33.7%), and 35.0% of nonspecific tumor resections (range 17.5-40%). Tumor type (glioma vs. pituitary) did not significantly influence the rate of further excision following ioMRI (p=0.309). There was no difference in secondary resection rate between studies limited to pediatric patients and those including adults (p=0.646). Thus, the use of intra-operative MRI frequently results in further resection of tumors. It is primarily used for the resection of gliomas and pituitary tumors. Tumor type does not appear to be a significant contributing factor to the rate of secondary tumor removal. Limited evidence suggests that extended resection may translate into improved clinical outcomes and mortality rates. However, results have not been unanimous, while clinical effect sizes have often been modest.
World Neurosurgery, Jun 1, 2017
Objective: To characterize cranioplasty complications and costs at a population level using a lon... more Objective: To characterize cranioplasty complications and costs at a population level using a longitudinal national claims database. Methods: We identified cranioplasty patients between 2007-2014 in the MarketScan national database. We evaluated age, autograft usage, cranioplasty size, and cranioplasty timing on postoperative outcomes. We further analyzed associated costs. A subset analysis of adult cranioplasty patients with emergent indications, including stroke and trauma, was also performed. Results: We identified 8,275 patients (mean 44.0±20.0 years, 45.2% male) consisting of 13.8% pediatric (<18 years), 76.0% adults (18-64 years), and 10.2% elderly adults (>65 years). Overall complication rate was 36.6%, mortality rate 0.5%, and 30-day readmission rate 12.0%. Elderly patients had the highest complication rate (p<0.0001). Overall, large cranioplasties (>5 cm) saw higher complication rates than small cranioplasties (≤5 cm, p=0.047). In those with emergent indications only(N=1,282), size did not influence complications-though large cranioplasties showed higher infection risk (p=0.02). Overall, autograft use did not affect outcomes, but was associated with higher complication risk-including infections-in the subset with only emergent indications (p<0.001, p=0.001). Late (>90 days) cranioplasty timing had higher complication rates in both the overall cohort and subset with emergent indications (p<0.001, p<0.001). Index costs of care were mainly driven by hospital payments in both the overall cohort and those with emergent indications. Conclusions: We found a high complication rate associated with cranioplasty in the U.S.A. Older age, large cranioplasties, and delayed cranioplasties increased complication risk overall. Among those with only emergent indications, complications were associated with a delayed time to cranioplasty and autograft usage.
Clinical spine surgery, Dec 1, 2017
Objective: To quantify the longitudinal economic impact of venous thromboembolism (VTE) complicat... more Objective: To quantify the longitudinal economic impact of venous thromboembolism (VTE) complications in spinal fusion patients. Summary of Background Data: VTE is a rare and serious complication that may occur after spine surgery. The long-term socioeconomic impact understanding of these events has been limited by small sample sizes and a lack of longitudinal followup. We provide a comparative economic outcomes analysis of these complications. Methods: We identified 204,308 patients undergoing spinal fusion procedures in a national billing claims database (Market-Scan) between 2006 and 2010. Cohorts were balanced using 50:1 propensity score matching and outcome measures compared at 6, 12, and 18 months postoperation. Results: A total of 1196 (0.6%) patients developed postoperative VTE, predominantly occurring following lumbar fusion (69.7%). Postoperative VTE patients demonstrated an increase in hospital length of stay (7.8 vs. 3.3 d, P < 0.001) and a decreased likelihood of being discharged home (71% vs. 85%, P < 0.001). A 26,306increaseintotalhospitalpayments(P<0.001)wasobserved,withadisproportionateincreaseseeninhospitalpayments(26,306 increase in total hospital payments (P < 0.001) was observed, with a disproportionate increase seen in hospital payments (26,306increaseintotalhospitalpayments(P<0.001)wasobserved,withadisproportionateincreaseseeninhospitalpayments(22,103, P < 0.001), relative to physician payments ($1766, P = 0.001). At 6, 12, and 18 months postfusion, increased rates of readmission and follow-up clinic visits were observed. Delayed readmissions were associated with decreased length of stay (3.6 vs. 4.6 d, P < 0.
Journal of Clinical Neuroscience, Dec 1, 2016
Intra-operative MRI (ioMRI) may be used to optimize tumor resection. Utilization of this technolo... more Intra-operative MRI (ioMRI) may be used to optimize tumor resection. Utilization of this technology allows for the removal of residual tumor mass following initial tumor removal, maximizing the extent of resection. This, in turn, has been shown to lead to improved outcomes. Individual studies have examined the impact of ioMRI on the rate of extended resection, but a comprehensive review of this topic is needed. A literature review of the MEDLINE, EMBASE, CENTRAL, and Google Scholar databases revealed 12 eligible studies. This included 804 primary operations and 238 extended resections based on ioMRI findings. Use of ioMRI led to extended tumor resection in 13.3-54.8% of patients (mean 37.3%). Stratification by tumor type showed additional resection occurred, on average, in 39.1% of glioma resections (range 13.3-70.0%), 23.5% of pituitary tumor resections (range 13.3-33.7%), and 35.0% of nonspecific tumor resections (range 17.5-40%). Tumor type (glioma vs. pituitary) did not significantly influence the rate of further excision following ioMRI (p=0.309). There was no difference in secondary resection rate between studies limited to pediatric patients and those including adults (p=0.646). Thus, the use of intra-operative MRI frequently results in further resection of tumors. It is primarily used for the resection of gliomas and pituitary tumors. Tumor type does not appear to be a significant contributing factor to the rate of secondary tumor removal. Limited evidence suggests that extended resection may translate into improved clinical outcomes and mortality rates. However, results have not been unanimous, while clinical effect sizes have often been modest.
World Neurosurgery, Dec 1, 2015
Introduction Spine surgeries performed in the United States have increased in both number and com... more Introduction Spine surgeries performed in the United States have increased in both number and complexity over the last two decades (40). The mean total hospital cost of spinal fusions alone have increased 3.3-fold between 1998 and 2008 (40). Lumbar spine surgeries, including fusions, discectomies, and laminectomies, have experienced the most dramatic growth (50). Lumbar fusions account for a majority of this development, with a 142% reported increase from 1998-2008 (40). Postoperative visual loss (POVL) may occur after lumbar spine surgery. Though POVL can occur after all types of nonocular surgeries with an estimated incidence of 0.0008% to 0.002% in the general surgical population, the incidence of POVL after spine surgery is significantly greater, ranging from 0.09% to 0.20% (4,37,42,47). An analysis of published case reports indicates a growing association between POVL and lumbar surgery (20). This accompanies the national estimates of POVL incidence in 0.138% of posterior lumbar fusions and 0.094% of anterior lumbar fusions from 1993-2002 (37). The devastating and often irreversible effects of POVL make it imperative to further investigate its potential risk factors. Moreover, postoperative complications incur large costs. Both major and minor complications after spine surgery increase total health care costs substantially (52). For patients with POVL, a population-based study of spinal fusions from 2002 to 2009 found a twofold increase in hospital costs (33).
American Journal of Gastroenterology, 2021
World Neurosurgery, 2017
Objective: To characterize cranioplasty complications and costs at a population level using a lon... more Objective: To characterize cranioplasty complications and costs at a population level using a longitudinal national claims database. Methods: We identified cranioplasty patients between 2007-2014 in the MarketScan national database. We evaluated age, autograft usage, cranioplasty size, and cranioplasty timing on postoperative outcomes. We further analyzed associated costs. A subset analysis of adult cranioplasty patients with emergent indications, including stroke and trauma, was also performed. Results: We identified 8,275 patients (mean 44.0±20.0 years, 45.2% male) consisting of 13.8% pediatric (<18 years), 76.0% adults (18-64 years), and 10.2% elderly adults (>65 years). Overall complication rate was 36.6%, mortality rate 0.5%, and 30-day readmission rate 12.0%. Elderly patients had the highest complication rate (p<0.0001). Overall, large cranioplasties (>5 cm) saw higher complication rates than small cranioplasties (≤5 cm, p=0.047). In those with emergent indications only(N=1,282), size did not influence complications-though large cranioplasties showed higher infection risk (p=0.02). Overall, autograft use did not affect outcomes, but was associated with higher complication risk-including infections-in the subset with only emergent indications (p<0.001, p=0.001). Late (>90 days) cranioplasty timing had higher complication rates in both the overall cohort and subset with emergent indications (p<0.001, p<0.001). Index costs of care were mainly driven by hospital payments in both the overall cohort and those with emergent indications. Conclusions: We found a high complication rate associated with cranioplasty in the U.S.A. Older age, large cranioplasties, and delayed cranioplasties increased complication risk overall. Among those with only emergent indications, complications were associated with a delayed time to cranioplasty and autograft usage.
Journal of Clinical Neuroscience, 2016
Intra-operative MRI (ioMRI) may be used to optimize tumor resection. Utilization of this technolo... more Intra-operative MRI (ioMRI) may be used to optimize tumor resection. Utilization of this technology allows for the removal of residual tumor mass following initial tumor removal, maximizing the extent of resection. This, in turn, has been shown to lead to improved outcomes. Individual studies have examined the impact of ioMRI on the rate of extended resection, but a comprehensive review of this topic is needed. A literature review of the MEDLINE, EMBASE, CENTRAL, and Google Scholar databases revealed 12 eligible studies. This included 804 primary operations and 238 extended resections based on ioMRI findings. Use of ioMRI led to extended tumor resection in 13.3-54.8% of patients (mean 37.3%). Stratification by tumor type showed additional resection occurred, on average, in 39.1% of glioma resections (range 13.3-70.0%), 23.5% of pituitary tumor resections (range 13.3-33.7%), and 35.0% of nonspecific tumor resections (range 17.5-40%). Tumor type (glioma vs. pituitary) did not significantly influence the rate of further excision following ioMRI (p=0.309). There was no difference in secondary resection rate between studies limited to pediatric patients and those including adults (p=0.646). Thus, the use of intra-operative MRI frequently results in further resection of tumors. It is primarily used for the resection of gliomas and pituitary tumors. Tumor type does not appear to be a significant contributing factor to the rate of secondary tumor removal. Limited evidence suggests that extended resection may translate into improved clinical outcomes and mortality rates. However, results have not been unanimous, while clinical effect sizes have often been modest.
World Neurosurgery, 2015
Introduction Spine surgeries performed in the United States have increased in both number and com... more Introduction Spine surgeries performed in the United States have increased in both number and complexity over the last two decades (40). The mean total hospital cost of spinal fusions alone have increased 3.3-fold between 1998 and 2008 (40). Lumbar spine surgeries, including fusions, discectomies, and laminectomies, have experienced the most dramatic growth (50). Lumbar fusions account for a majority of this development, with a 142% reported increase from 1998-2008 (40). Postoperative visual loss (POVL) may occur after lumbar spine surgery. Though POVL can occur after all types of nonocular surgeries with an estimated incidence of 0.0008% to 0.002% in the general surgical population, the incidence of POVL after spine surgery is significantly greater, ranging from 0.09% to 0.20% (4,37,42,47). An analysis of published case reports indicates a growing association between POVL and lumbar surgery (20). This accompanies the national estimates of POVL incidence in 0.138% of posterior lumbar fusions and 0.094% of anterior lumbar fusions from 1993-2002 (37). The devastating and often irreversible effects of POVL make it imperative to further investigate its potential risk factors. Moreover, postoperative complications incur large costs. Both major and minor complications after spine surgery increase total health care costs substantially (52). For patients with POVL, a population-based study of spinal fusions from 2002 to 2009 found a twofold increase in hospital costs (33).
Journal of Clinical Neuroscience, 2012
Chordomas are rare, malignant bone tumors of the axial skeleton, occurring particularly at the cr... more Chordomas are rare, malignant bone tumors of the axial skeleton, occurring particularly at the cranial base or in the sacro-coccygeal region. Although slow growing, chordomas are locally aggressive and challenging to treat. We evaluate the outcomes of skull base and spinal chordomas in 20 patients treated with CyberKnife (CK) stereotactic radiosurgery (SRS) (Accuray, Sunnyvale, CA, USA) between 1994 and 2010 at Stanford Hospital. There were 12 males and eight females (10-78 years; median age: 51.5 years). Eleven patients received CK as primary adjuvant therapy and nine patients received CK for multiple recurrences. The average tumor volume treated was 16.1 cm 3 (2.4-45.9 cm 3), with a mean marginal dose of 32.5 Gy (18-50 Gy). Median follow-up was 34 months (2-131 months). Overall, tumor control was achieved in 11 patients (55%), with eight patients showing tumor size reduction. However, nine patients showed progression and eventually succumbed to the disease (mean time from CK to death was 26.3 months). Of the patients treated with CK as the primary adjuvant therapy, 81.8% had stable or improved outcomes. Only 28.6% of those treated with CK for recurrences had stable or improved outcomes. The overall Kaplan-Meyer survival at five years from the first CK treatment was 52.5%. Moderate tumor control rates can be achieved with few complications with CK SRS. Poor control is associated with complex multiple surgical resections, long delay between initial resection and CK therapy, and recurrently aggressive disease uncontrolled by prior radiation.
Clinical spine surgery, Jan 12, 2016
Propensity score matched retrospective study using a nationwide longitudinal database. To quantif... more Propensity score matched retrospective study using a nationwide longitudinal database. To quantify the longitudinal economic impact of venous thromboembolism (VTE) complications in spinal fusion patients. VTE is a rare and serious complication that may occur after spine surgery. The long-term socioeconomic impact understanding of these events has been limited by small sample sizes and a lack of longitudinal follow-up. We provide a comparative economic outcomes analysis of these complications. We identified 204,308 patients undergoing spinal fusion procedures in a national billing claims database (MarketScan) between 2006 and 2010. Cohorts were balanced using 50:1 propensity score matching and outcome measures compared at 6, 12, and 18 months postoperation. A total of 1196 (0.6%) patients developed postoperative VTE, predominantly occurring following lumbar fusion (69.7%). Postoperative VTE patients demonstrated an increase in hospital length of stay (7.8 vs. 3.3 d, P<0.001) and a...