In this analysis of female patients with breast cancer treated with anthracycline chemotherapy, statin use was associated with a lower risk for incident HF. This finding is consistent with prior animal studies and warrants further investigation through prospective randomized clinical trials.

Background-Chemotherapy with trastuzumab and anthracycline is associated with incident heart failure (HF) in patients with breast cancer. We hypothesized that continuous incidental use of β-blocker agents (BB) was protective against HF in patients without established structural heart disease who were receiving trastuzumab and anthracycline. Methods and Results-We identified 920 consecutive patients with breast cancer (age 52.3±11.0 years) with normal ejection fraction before receiving trastuzumab and anthracycline therapy at our institution between 2005 and 2010. Using a propensity score and a greedy 5 to 1 digit-matching algorithm, 106 of these patients on continuous BB during cancer treatment were matched with 212 patients from the same pool with similar characteristics but not on continuous BB. During a median follow-up of 3.2±2.0 years, 32 incident HF admissions were identified in these 318 patients with breast cancer, whereas 28 cancer-related (noncardiac) deaths occurred before any incident HF. Cumulative incidence regression models and cause-specific hazards of new HF events were estimated from competing risk Cox models of time-dependent covariates. Although trastuzumab therapy showed significant association with incident HF, independent of anthracycline-related cardiotoxicity (hazard ratio, 9.0; 95% confidence interval, 3.0-27.0; P<0.0001), continuous use of BB was associated with lower risk of new HF events (hazard ratio, 0.2; 95% confidence interval, 0.1-0.5; P=0.003). Conclusions-Coincidental, continuous use of BB is associated with lower incidence of HF in patients with breast cancer and normal baseline ejection fraction in a competing risk framework, and after matching for demographics, clinical, and cancer-related treatment characteristics. Prospective randomized clinical trials to validate these findings are warranted. (Circ Heart Fail. 2013;6:420-426.)

Insufficient sleep may lead to adverse health effects, influencing body weight. This study quantified the prevalence of short sleep and the association between sleep duration and overweight in a sample of suburban students. Cross-sectional study was conducted in 2004, involving 529 students from Bay High School, Bay Village, OH, USA, using self-administered questionnaires assessing lifestyle and sleep behaviors. Students with a body mass index Z Score >85th percentile for sex and age were deemed overweight. Ninety percent of students reported average sleep time less than 8 h on school nights, with 19% reported less than 6 h of sleep per night. Twenty percent of the sample were overweight. Overweight was significantly associated with the male gender, increased caffeine consumption, and short sleep duration. Compared with students sleeping >8 h, the age and gender-adjusted odds ratio of overweight was 8.53 (95% CI: 2.26, 32.14) for those with <5 h sleep (P = 0.0036); 2.79 (1.03, 7.55) for those with 5-6 h sleep; 2.81 (1.14, 6.91) for those with 6-7 h sleep; and 1.29 (0.52, 3.26) for those with 7-8 h sleep. Short sleep duration was common and associated with overweight with evidence of a "dose-response" relationship. These results confirm a high prevalence of short sleep among suburban high school students and provide additional support suggesting significant association between short sleeping hours and overweight.

comorbidities, preop labs. SSI was defined as infection within 90 days of surgery, as per the Centers for Disease Control. Results: In total, 255 patients with CP were identified. Of these, 146 (57%) were male and 109 (43%) were female. The mean age at surgery was 14.5 years. The overall SSI risk was 11.7%. Regression analysis showed that ambulatory status (OR 5.0, p<0.05), bowel incontinence (OR 3.7, p<0.05), Cobb angle >90° (OR 1.5, p<0.05), behavioral disorder/delay (OR 1.1), revision surgery (OR 1.1), and hemoglobin<14 g/dL (OR 1.1) were prognostic of SSI. The RSS model predicted SSI risk of 0.88% when none of these factors were present, and 23.3% when all factors were present. The predictive ability of the RSS was 71%, which demonstrates good discriminatory ability. Conclusions/Significance: This study shows that patients with CP experience high risk of SSI (11.7%) subsequent to spinal surgery. A RSS to predict the probability of SSI developing within 90 days after spinal surgery was created. The CP RSS is a significant addition to a surgeon's arsenal for predicting SSI risk following spine surgery. It facilitates perioperative planning discussions among the clinical team as well as between patient and family members. It allows for fair comparisons of surgical outcomes among different medical centers , based on patients' risk factors. By identifying patients with high risk of SSI, preoperative optimization can help reduce SSI incidence. This has the potential to improve patient outcomes, reduce health care costs associated with SSI, and serves as a stepping stone for future research. Background and Objective(s): Spinal fusion for patients with cerebral palsy is time-consuming, expensive and associated with a high complication rate in comparison to spinal fusion in the idiopathic population. The purpose of this study was to evaluate outcomes and associated costs for spinal fusion performed by two attending co-surgeons versus a single attending surgeon with a surgical trainee acting as surgical assistant. Study Design: A retrospective cohort study was completed. Study Participants & Setting: A consecutive series of all children with a diagnosis of cerebral palsy who underwent posterior spinal fusion at a tertiary care pediatric hospital between 2011 and 2015 was reviewed. All patients who were fused from T1/ 2 to the pelvis with a unit rod and sublaminar wires performed by a single surgeon were eligible for and included in analysis. Materials/Methods: From this cohort, two cohorts were identified those in which a co-surgeon was utilized and those in which an orthopaedic trainee assisted. Statistical analysis was completed using independent t-tests and chi-square tests. A team of expert stakeholders created detailed process maps, determined space and product costs and calculated personnel

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All levels of anemia were significantly associated with prolonged length of hospitalization and poorer operative or 30-day outcomes in patients undergoing elective spine surgery. Our findings, using a large multi-institutional sample of prospectively collected data, suggests that anemia should be regarded as an independent risk factor for perioperative and postoperative complications that deserves attention prior to elective spine surgery.

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ObjectThe utility of preoperative hemostasis screening to predict complications is uncertain. The authors quantified the screening rate in US neurosurgery patients and evaluated the ability of abnormal test results as compared with history-based risk factors to predict hemostasis-related and general outcomes.MethodsEleven thousand eight hundred four adult neurosurgery patients were identified in the 2006–2009 American College of Surgeons National Surgical Quality Improvement Program database. Multivariate logistic regression modeled the ability of hemostatic tests and patient history to predict outcomes, that is, intra- and postoperative red blood cell [RBC] transfusion, return to the operating room [OR], and 30-day mortality. Sensitivity analyses were conducted using patient subgroups by procedure.ResultsMost patients underwent all 3 hemostatic tests (platelet count, prothrombin time/international normalized ratio [INR], activated partial thromboplastin time), but few had any of the outcomes of interest. The number of screening tests undergone was significantly associated with intraoperative RBC transfusion, a return to the OR, and mortality; an abnormal INR was associated with postoperative RBC transfusion. However, all tests had low sensitivity (0.09–0.2) and platelet count had low specificity (0.04–0.05). The association between patient history and each outcome was approximately the same across all tests, with higher sensitivity but lower specificity. Combining abnormal tests with patient history accounted for 50% of the mortality and 33% of each of the other outcomes.ConclusionsThis is the first study focused on assessing preoperative hemostasis screening as compared with patient history in a large multicenter sample of adult neurosurgery patients to predict hemostasis-related outcomes. Patient history was as predictive as laboratory testing for all outcomes, with higher sensitivity. Routine laboratory screening appears to have limited utility. Testing limited to neurosurgical patients with a positive history would save an estimated $81,942,000 annually.