Surgical Complications in Intradural Extramedullary Spinal Cord Tumors - An ACS-NSQIP Analysis of Spinal Cord Level and Malignancy

Bhimani, Abhiraj D.; Denyer, Steven; Esfahani, Darian R.; Zakrzewski, Jack; Aguilar, Tania; Mehta, Ankit I.

doi:10.1016/j.wneu.2018.06.014

Cited by 21 publications

(11 citation statements)

References 16 publications

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“…Different scales have been used in different studies, the most frequent being those by McCormick, Klekamp, Samii, and Frankel [ 5 ], or even the classification of the American Spinal Injury Association [ 24 ]. In addition, the timing of the assessment varied significantly between the studies, with those with a follow-up of days to months [ 24 , 25 ], in contrast to other studies that assessed the clinical picture at discharge, as in our series. Despite the heterogeneity described, both in our series and in other studies analyzed, the clinical stability rate exceeded the rate of improvement, which was higher than the rate of worsening or new deficit.…”

Section: Discussionmentioning

confidence: 83%

Evaluation of Surgically Treated Primary Spinal Cord Tumors in a Single Brazilian Institution: A Case Series Study of 104 Patients

Júnior¹,

Dantas²,

Caires³

et al. 2022

Cureus

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Background: Primary spinal cord tumors are rare and heterogeneous, and their prevalence varies among the studies. Few articles have evaluated the prevalence, characteristics, and histological types of spinal cord tumors in Latin American populations. This study aimed to analyze the histological types and clinical aspects of a series of consecutive patients diagnosed with primary spinal cord tumors who underwent surgical treatment in a single Brazilian institution and to compare them with the literature. Methods: This is a case series study, with retrospective analysis of all consecutive adult patients who underwent surgical treatment for primary spinal cord tumors in a single center between January 1997 and April 2021. Data analyzed included age at surgery, sex, anatomical location, histopathological diagnosis, clinical presentation, and neurological status at discharge. Results: A total of 104 patients (53 women [51.0%]; mean age, 49.0 ± 16.7 years [range, 19-87 years]) were included in the analysis. Among the tumors, 83.7% were benign, and 36.5% involved the thoracic spine; intradural extramedullary lesions comprised 52.9% of the tumors, and the most prevalent were schwannomas (26.9%) and meningiomas (18.3%). Among the patients, 55% and 50% presented with pain and motor deficit, respectively, and the deficit improvement rate was greater than the worsening rate at the immediate postoperative period and discharge. Conclusions: Our series highlights the heterogeneity of primary spinal cord tumors compared to other studies. Further large population studies are necessary to elucidate the epidemiology of this disease.

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Section: Discussionmentioning

confidence: 83%

Evaluation of Surgically Treated Primary Spinal Cord Tumors in a Single Brazilian Institution: A Case Series Study of 104 Patients

Júnior¹,

Dantas²,

Caires³

et al. 2022

Cureus

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“…The concordance probability of the doubly robust CPH regression model on all-cause mortality on PS-matched cohorts was 0.77, indicating good discrimination of the global CPH model. 24 In this model, 3 covariates met the threshold of significance: age at diagnosis, African American race, and receipt of RT, Table 3 and Figure 3. Controlling for other factors, patients who were older were significantly more likely to die from all causes than were younger patients [HR: 1.03, 95% CI: (1.03, 1.05), P < 0.0001], Table 3 and Figure 3.…”

Section: Cox Proportional Hazards Regression Survival Analysismentioning

confidence: 99%

Impact of Racial Disparities on All-Cause Mortality in Patients With Tumors of the Spinal Cord or Spinal Meninges: A Propensity-Score Analysis

Elsamadicy

Freedman

Koo

et al. 2021

Global Spine Journal

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Study Design: Retrospective cohort study. Objective: The influence that race has on mortality rates in patients with spinal cord tumors is relatively unknown. The aim of this study was to investigate the influence of race on the outcomes of patients with primary malignant or nonmalignant tumors of the spinal cord or spinal meninges. Methods: The Surveillance, Epidemiology, and End Results (SEER) Registry was used to identify all patients with a code for primary malignant or nonmalignant tumor of the spinal cord (C72.0) or spinal meninges (C70.1) from 1973 through 2016. Racial groups (African-American/Black vs. White) were balanced using propensity-score (PS) matching using a non-parsimonious 1:1 nearest neighbor matching algorithm. Overall survival (OS) estimates were obtained using the Kaplan-Meier method and compared across non-PS-matched and PS-matched groups using log-rank tests. Associations of survival with clinical variables was assessed using doubly robust Cox proportional-hazards (CPH) regression analysis. Results: There were a total of 7,498 patients identified with 648 (6.8%) being African American. African-American patients with primary intradural spine tumors were more likely to die of all causes than were White patients in both the non-PS-matched [HR: 1.26, 95% CI: (1.04, 1.51), P = 0.01] and PS-matched cohorts [HR: 1.64, 95% CI: (1.28, 2.11), P < 0.0001]. On multivariate CPH regression analysis age at diagnosis [HR: 1.03, 95% CI: (1.02, 1.05), P < 0.0001], race [HR: 1.82, 95% CI: (1.22, 2.74), P = 0.004), and receipt of RT [HR: 2.62, 95% CI: (1.56, 4.37), P = 0.0002) were all significantly associated with all-cause mortality, when controlling for other demographic, tumor, and treatment variables. Conclusions: Our study provides population-based estimates of the prognosis for patients with primary malignant or nonmalignant tumors of the spinal cord or spinal meninges and suggests that race may impact all-cause mortality.

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“…The ACS-NSQIP is an international database featuring more than 600 institutions used to record an array of standard surgical outcomes with the goal of improving the quality of surgical practice, 12 and it has been used in multiple neurosurgical studies examining surgical outcomes. [13][14][15][16][17][18][19][20] Data in the NSQIP database are acquired directly from patient charts rather than through billing records by specialized data collectors at each institution and subject to regular quality control reviews to ensure site-to-site uniformity. The period of data collection begins before surgery and extends until 30 days after the Fig.…”

Section: Data Acquisition and Patient Selectionmentioning

confidence: 99%

Supratentorial and Infratentorial Approaches to Pineal Surgery: A Database Analysis

et al. 2018

Self Cite

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Objectives Neoplasms involving the pineal gland are rare. When they do occur, tumor resection is anatomically challenging and is traditionally addressed by either a supratentorial or an infratentorial approach. To date, no large, multicenter studies have been performed that systematically analyze outcomes comparing these two approaches. This study aimed to evaluate outcomes for patients undergoing pineal neoplasm resection, comparing supratentorial and infratentorial approaches. Design Retrospective database review. Setting Multi-institutional database. Participants From 2005 to 2016, 60 patients were identified, with 13 undergoing a supratentorial approach and 47 undergoing an infratentorial approach. Main Outcome Measures Patient demographics, comorbidities, and 30-day postoperative outcomes were investigated using the American College of Surgeons National Surgical Quality Improvement Program database. Demographics, readmission, reoperation, and complication rates were analyzed and compared with previous studies. Results Patient demographics were similar between these two groups. The overall complication rates for the supratentorial and infratentorial approaches were 30.8 and 17%, respectively, and the difference was not statistically significant. The most common medical complications encountered were respiratory and hematological. Conclusion As the first multi-institutional database analysis of approaches to the pineal gland, this study provides an analysis of patient demographics, comorbidities, and postoperative complications. After controlling for preoperative risk factors and demographic characteristics, no statistically significant differences in postoperative outcomes were found between infratentorial and supratentorial approaches. The mean readmission, reoperation, and complication rates were found to be 2.1, 8.3, and 20%, respectively. The lack of significant difference between approaches suggests that clinical decision-making should depend upon anatomical considerations and physician preference, although the complications illustrated here may provide some preoperative guidance.

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Surgical Complications in Intradural Extramedullary Spinal Cord Tumors - An ACS-NSQIP Analysis of Spinal Cord Level and Malignancy

Cited by 21 publications

References 16 publications

Evaluation of Surgically Treated Primary Spinal Cord Tumors in a Single Brazilian Institution: A Case Series Study of 104 Patients

Evaluation of Surgically Treated Primary Spinal Cord Tumors in a Single Brazilian Institution: A Case Series Study of 104 Patients

Impact of Racial Disparities on All-Cause Mortality in Patients With Tumors of the Spinal Cord or Spinal Meninges: A Propensity-Score Analysis

Supratentorial and Infratentorial Approaches to Pineal Surgery: A Database Analysis

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