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Research paper thumbnail of Longitudinal Trends of Patient Demographics and Morbidity of Different Approaches in Lumbar Interbody Fusion: An Analysis Using the American College of Surgeons National Surgical Quality Improvement Program Database

World Neurosurgery

STUDY DESIGN Retrospective observational population-based study OBJECTIVES: Aims of this study we... more STUDY DESIGN Retrospective observational population-based study OBJECTIVES: Aims of this study were to determine the time trend of demographics, complications, and outcomes for patients undergoing posterior/transforaminal (PLIF/TLIF) or anterior/lateral lumbar interbody fusion (ALIF/LLIF) and to compare the differences in the time trends between both procedures. METHODS The ACS-NSQIP database was queried for patients undergoing PLIF/TLIF and ALIF/LLIF procedures. Outcomes were analyzed for differences between two time periods in the PLIF/TLIF and ALIF/LLIF cohorts separately (2009-2013 and 2015-2019). Longitudinal time trends of the two procedures were determined by difference-in-differences (DID) analysis. Statistical significance was defined as p<0.05. RESULTS For both approaches, there was an increase in age and ASA class over time, accompanied by a significant decrease in blood transfusions and morbidity. The DID analysis showed a greater change in age (DID:-1.8%; p<0.001) and more patients rated ASA class 3 (DID: -2.4%; p=0.033) in the ALIF/LLIF patients compared to PLIF/TLIF. Length of stay (LOS) declined significantly over time in both cohorts, with a greater reduction observed for patients who underwent ALIF/LLIF compared to PLIF/TLIF (DID: 0.2%; p=0.014). There were no changes in readmission rates over time in either cohort (PLIF/TLIF DID: 0.6%; p=0.080; ALIF/LLIF DID: -0.2%; p=0.696). CONCLUSIONS Time trends for PLIF/TLIF and ALIF/LIIF showed a significant increase in the number of older patients with complex medical status undergoing surgery. Despite these trends, there were decreases in overall postoperative morbidity, incidence of blood transfusion, and LOS, without increasing readmission. These results suggest general improvement in surgical and perioperative management of lumbar fusion over time with greater gains found in ALIF/LLIF specific care compared to PLIF/TLIF.

Research paper thumbnail of Effect of Increasing Stent Length on 3-Year Clinical Outcomes in Women Undergoing Percutaneous Coronary Intervention With New-Generation Drug-Eluting Stents: Patient-Level Pooled Analysis of Randomized Trials From the WIN-DES Initiative

JACC. Cardiovascular interventions, Jan 8, 2018

The aim of this study was to examine whether stent length per patient and stent length per lesion... more The aim of this study was to examine whether stent length per patient and stent length per lesion are negative markers for 3-year outcomes in women following percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (DES). In the era of advanced stent technologies, whether stent length remains a correlate of adverse outcomes is unclear. Women treated with new-generation DES in 14 randomized trials from the WIN-DES (Women in Innovation and Drug-Eluting Stents) pooled database were evaluated. Total stent length per patient, which was available in 5,403 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 24 mm; quartile 3, 24 to 36 mm; quartile 4, ≥36 mm), and stent length per lesion, which was available in 5,232 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 20 mm; quartile 3, 20 to 27 mm; quartile 4, ≥27 mm) were analyzed in quartiles. The primary endpoint was 3-year major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardia...

Research paper thumbnail of Interobserver Variability in CT and MR Staging of Lung Cancer

Journal of Computer Assisted Tomography, 1993

Our goal was to assess the interobserver variability in staging non-small cell lung cancer using ... more Our goal was to assess the interobserver variability in staging non-small cell lung cancer using CT and MRI. As part of the Radiologic Diagnostic Oncology Group (RDOG) study of lung cancer staging, the CT and MR examinations of 40 patients suspected of having non-small cell bronchogenic carcinoma were blindly interpreted by four expert observers. The primary tumor and lymph node stages in the 40 study subjects were similar to the final proportions reported in the RDOG study. Assessed abnormalities included the presence of a lung nodule, chest wall invasion, mediastinal invasion, bronchial involvement, lymph node metastasis in specific node stations, and T and N classifications. Percent agreement and kappa-values were calculated for each of these determinations. Depending on the finding assessed and the method of analysis, average agreement rates ranged from 58 to 90% for CT and from 61 to 96% for MRI. Average kappa-values were largely between 0.40 and 0.60 when dichotomous analysis was used; weighted kappa-values were similar. With a single exception, no significant differences were found for kappa-values calculated for CT and MRI. Although interobserver agreement rates are good for determining T and N classification in patients with lung cancer, variability in image interpretation is frequent, even among experienced observers.

Research paper thumbnail of MR Imaging and Sonography of Early Prostatic Cancer: Pathologic and Imaging Features That Influence Identification and Diagnosis

OBJECTIVE. The purpose of this study was to correlate findings at MR imaging and transrectal sono... more OBJECTIVE. The purpose of this study was to correlate findings at MR imaging and transrectal sonography with histopathologic findings after surgery in patients with prostatic cancer, to identify the pathologic characteristics of prostatic cancer that improved detection with MR imaging and transrectal sonography, and to identify the imaging characteristics that correlated with detection of true cancers. MATERIALS AND METHODS. Data

Research paper thumbnail of MR imaging and sonography of early prostatic cancer: pathologic and imaging features that influence identification and diagnosis

American Journal of Roentgenology, 1994

Research paper thumbnail of Interobserver Variability in CT and MR Staging of Lung Cancer

Journal of Computer Assisted Tomography, 1993

Our goal was to assess the interobserver variability in staging non-small cell lung cancer using ... more Our goal was to assess the interobserver variability in staging non-small cell lung cancer using CT and MRI. As part of the Radiologic Diagnostic Oncology Group (RDOG) study of lung cancer staging, the CT and MR examinations of 40 patients suspected of having non-small cell bronchogenic carcinoma were blindly interpreted by four expert observers. The primary tumor and lymph node stages in the 40 study subjects were similar to the final proportions reported in the RDOG study. Assessed abnormalities included the presence of a lung nodule, chest wall invasion, mediastinal invasion, bronchial involvement, lymph node metastasis in specific node stations, and T and N classifications. Percent agreement and kappa-values were calculated for each of these determinations. Depending on the finding assessed and the method of analysis, average agreement rates ranged from 58 to 90% for CT and from 61 to 96% for MRI. Average kappa-values were largely between 0.40 and 0.60 when dichotomous analysis was used; weighted kappa-values were similar. With a single exception, no significant differences were found for kappa-values calculated for CT and MRI. Although interobserver agreement rates are good for determining T and N classification in patients with lung cancer, variability in image interpretation is frequent, even among experienced observers.

Research paper thumbnail of Longitudinal Trends of Patient Demographics and Morbidity of Different Approaches in Lumbar Interbody Fusion: An Analysis Using the American College of Surgeons National Surgical Quality Improvement Program Database

World Neurosurgery

STUDY DESIGN Retrospective observational population-based study OBJECTIVES: Aims of this study we... more STUDY DESIGN Retrospective observational population-based study OBJECTIVES: Aims of this study were to determine the time trend of demographics, complications, and outcomes for patients undergoing posterior/transforaminal (PLIF/TLIF) or anterior/lateral lumbar interbody fusion (ALIF/LLIF) and to compare the differences in the time trends between both procedures. METHODS The ACS-NSQIP database was queried for patients undergoing PLIF/TLIF and ALIF/LLIF procedures. Outcomes were analyzed for differences between two time periods in the PLIF/TLIF and ALIF/LLIF cohorts separately (2009-2013 and 2015-2019). Longitudinal time trends of the two procedures were determined by difference-in-differences (DID) analysis. Statistical significance was defined as p<0.05. RESULTS For both approaches, there was an increase in age and ASA class over time, accompanied by a significant decrease in blood transfusions and morbidity. The DID analysis showed a greater change in age (DID:-1.8%; p<0.001) and more patients rated ASA class 3 (DID: -2.4%; p=0.033) in the ALIF/LLIF patients compared to PLIF/TLIF. Length of stay (LOS) declined significantly over time in both cohorts, with a greater reduction observed for patients who underwent ALIF/LLIF compared to PLIF/TLIF (DID: 0.2%; p=0.014). There were no changes in readmission rates over time in either cohort (PLIF/TLIF DID: 0.6%; p=0.080; ALIF/LLIF DID: -0.2%; p=0.696). CONCLUSIONS Time trends for PLIF/TLIF and ALIF/LIIF showed a significant increase in the number of older patients with complex medical status undergoing surgery. Despite these trends, there were decreases in overall postoperative morbidity, incidence of blood transfusion, and LOS, without increasing readmission. These results suggest general improvement in surgical and perioperative management of lumbar fusion over time with greater gains found in ALIF/LLIF specific care compared to PLIF/TLIF.

Research paper thumbnail of Effect of Increasing Stent Length on 3-Year Clinical Outcomes in Women Undergoing Percutaneous Coronary Intervention With New-Generation Drug-Eluting Stents: Patient-Level Pooled Analysis of Randomized Trials From the WIN-DES Initiative

JACC. Cardiovascular interventions, Jan 8, 2018

The aim of this study was to examine whether stent length per patient and stent length per lesion... more The aim of this study was to examine whether stent length per patient and stent length per lesion are negative markers for 3-year outcomes in women following percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (DES). In the era of advanced stent technologies, whether stent length remains a correlate of adverse outcomes is unclear. Women treated with new-generation DES in 14 randomized trials from the WIN-DES (Women in Innovation and Drug-Eluting Stents) pooled database were evaluated. Total stent length per patient, which was available in 5,403 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 24 mm; quartile 3, 24 to 36 mm; quartile 4, ≥36 mm), and stent length per lesion, which was available in 5,232 women (quartile 1, 8 to 18 mm; quartile 2, 18 to 20 mm; quartile 3, 20 to 27 mm; quartile 4, ≥27 mm) were analyzed in quartiles. The primary endpoint was 3-year major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardia...

Research paper thumbnail of Interobserver Variability in CT and MR Staging of Lung Cancer

Journal of Computer Assisted Tomography, 1993

Our goal was to assess the interobserver variability in staging non-small cell lung cancer using ... more Our goal was to assess the interobserver variability in staging non-small cell lung cancer using CT and MRI. As part of the Radiologic Diagnostic Oncology Group (RDOG) study of lung cancer staging, the CT and MR examinations of 40 patients suspected of having non-small cell bronchogenic carcinoma were blindly interpreted by four expert observers. The primary tumor and lymph node stages in the 40 study subjects were similar to the final proportions reported in the RDOG study. Assessed abnormalities included the presence of a lung nodule, chest wall invasion, mediastinal invasion, bronchial involvement, lymph node metastasis in specific node stations, and T and N classifications. Percent agreement and kappa-values were calculated for each of these determinations. Depending on the finding assessed and the method of analysis, average agreement rates ranged from 58 to 90% for CT and from 61 to 96% for MRI. Average kappa-values were largely between 0.40 and 0.60 when dichotomous analysis was used; weighted kappa-values were similar. With a single exception, no significant differences were found for kappa-values calculated for CT and MRI. Although interobserver agreement rates are good for determining T and N classification in patients with lung cancer, variability in image interpretation is frequent, even among experienced observers.

Research paper thumbnail of MR Imaging and Sonography of Early Prostatic Cancer: Pathologic and Imaging Features That Influence Identification and Diagnosis

OBJECTIVE. The purpose of this study was to correlate findings at MR imaging and transrectal sono... more OBJECTIVE. The purpose of this study was to correlate findings at MR imaging and transrectal sonography with histopathologic findings after surgery in patients with prostatic cancer, to identify the pathologic characteristics of prostatic cancer that improved detection with MR imaging and transrectal sonography, and to identify the imaging characteristics that correlated with detection of true cancers. MATERIALS AND METHODS. Data

Research paper thumbnail of MR imaging and sonography of early prostatic cancer: pathologic and imaging features that influence identification and diagnosis

American Journal of Roentgenology, 1994

Research paper thumbnail of Interobserver Variability in CT and MR Staging of Lung Cancer

Journal of Computer Assisted Tomography, 1993

Our goal was to assess the interobserver variability in staging non-small cell lung cancer using ... more Our goal was to assess the interobserver variability in staging non-small cell lung cancer using CT and MRI. As part of the Radiologic Diagnostic Oncology Group (RDOG) study of lung cancer staging, the CT and MR examinations of 40 patients suspected of having non-small cell bronchogenic carcinoma were blindly interpreted by four expert observers. The primary tumor and lymph node stages in the 40 study subjects were similar to the final proportions reported in the RDOG study. Assessed abnormalities included the presence of a lung nodule, chest wall invasion, mediastinal invasion, bronchial involvement, lymph node metastasis in specific node stations, and T and N classifications. Percent agreement and kappa-values were calculated for each of these determinations. Depending on the finding assessed and the method of analysis, average agreement rates ranged from 58 to 90% for CT and from 61 to 96% for MRI. Average kappa-values were largely between 0.40 and 0.60 when dichotomous analysis was used; weighted kappa-values were similar. With a single exception, no significant differences were found for kappa-values calculated for CT and MRI. Although interobserver agreement rates are good for determining T and N classification in patients with lung cancer, variability in image interpretation is frequent, even among experienced observers.