Despite institutional variability in antibiotic regimens, meningitis rarely occurs after skull base procedures and seems to be encountered most frequently in open craniofacial surgeries. A systematic review revealed a limited number of published studies, all observational in study design, which precluded a formal meta-analysis. A novel large-scale randomized-controlled clinical trial is needed to evaluate antibiotic selection and need in endoscopic skull base surgery.
e21583 Background: Malignancy is generally considered a poor prognosticator for in-hospital cardiopulmonary arrest. Recent studies have shown that overall survival in those with localized disease and fewer than two comorbidities approximates the general population, likely reflective of advances in cancer treatment and more selective use of cardiopulmonary resuscitation. The present study was conducted to evaluate whether malignancy is an independent risk factor for death before discharge following in-hospital cardiopulmonary arrest. Methods: This single-center retrospective study included consecutive in-hospital cardiac arrests for whom cardiopulmonary resuscitation was attempted between 2011-2015. Patients were identified from an inpatient cardiac arrest registry and excluded if the arrest occurred in the operating room or emergency department prior to admission. Data related to each patient’s oncologic history was obtained via manual chart review by physician investigators. The primary outcome was survival to discharge among patients according to malignancy status. Results: Over the five-year study, 532 patients experienced in-hospital arrest and met inclusion criteria. Fifteen percent (n = 81) had a known cancer diagnosis at the time of arrest; 9% of arrests (n = 46) had a cancer that was considered active (not in remission). One-fourth of all cancer diagnoses at time of arrest were hematologic malignancies. Overall post-arrest survival to discharge was 34%. Survival did not differ significantly for patients with versus without current or prior malignancy (OR 0.69, 95% CI 0.41-1.18; p = 0.17), nor with active malignancy at time of arrest (OR 0.52; 95% CI 0.25-1.07; p = 0.08). The subgroup of patients with hematologic malignancy had significantly lower survival (OR 0.21, 95% CI 0.05-0.91; p = 0.04). Conclusions: Malignancy was not associated with decreased survival to hospital discharge among patients experiencing in-hospital arrest for whom resuscitation was attempted.
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