•Risk factors for inpatient VTE are different from those diagnosed post-discharge.•Patients with EBL> 500cc, corpectomies, osteotomies and foraminotomies have higher rates of post-discharge ...VTE.•Spinal fractures is a risk factor for inpatient VTE.
retrospective chart review.
We aimed to determine the perioperative risk factors that lead to inpatient or post-discharge venous thromboembolism (VTE) events after spinal surgery.
While many studies relate the risk factors in a post-surgical setting to the incidence of VTE, this study aims to separate these VTE into inpatient and post-discharge categories to examine timing and risk factors.
We analyzed 6869 patients from 2009 to 2015 using Current Procedural Technology codes from a single tertiary academic institution. Patients were stratified based on occurrence and setting of VTE then controlled for perioperative characteristics with exclusion criteria being patients undergoing minor spine surgeries or secondary procedures.
In 170 VTE events, these factors were associated with increased risk for: Inpatient DVT only: IVC filter (OR 6.380 3.414−11.924), longer length of hospital stay (OR 1.083 1.047−1.120), a prior history of DVT (OR 3.640 1.931−6.856). Post-discharge DVT only: history of PE (OR 45.142 6.785−300.351), having a corpectomy (OR 26.670 3.477−204.548), and having an osteotomy (OR 18.877 1.129−315.534). Inpatient PE only: surgery >4 h (OR 30.820, p < 0.001), fracture (OR 6.913, p = 0.004), IVC filter (OR 3.135, p = 0.029). Post-discharge PE only: corpectomy (OR 541.271, p = 0.009), foraminotomy (OR 40.137, p = 0.013), EBL > 500cc (OR 2467.798, p = 0.002). Time to onset of VTE events was significantly longer for patients undergoing osteotomy (7.43 days) than for patients with fracture (4.28 days), which is consistent with our findings that fracture was an independent predictor of inpatient VTE, and osteotomy was an independent predictor of post-discharge VTE (p = 0.018).
Time-to-VTE varies between types of surgeries. Some risk factors are independently associated with VTE at all times during the 30-day postoperative period, while other factors are only associated with either inpatient or post-discharge VTE. Those patients with high-risk features for post-discharge VTE merit increased study for thromboprophylaxis management.
•Postoperative surgical site infection after posterior spinal fusion was examined.•Machine learning and artificial intelligence were used to create a model.•The model had high predictive ...value.•Factors protective against infection were identified.•Machine learning and artificial intelligence should be employed in clinical decision making.
Machine Learning and Artificial Intelligence (AI) are rapidly growing in capability and increasingly applied to model outcomes and complications within medicine. In spinal surgery, post-operative surgical site infections (SSIs) are a rare, yet morbid complication. This paper applied AI to predict SSIs after posterior spinal fusions.
4046 posterior spinal fusions were identified at a single academic center. A Deep Neural Network DNN classification model was trained using 35 unique input variables The model was trained and tested using cross-validation, in which the data were randomly partitioned into training n = 3034 and testing n = 1012 datasets. Stepwise multivariate regression was further used to identify actual model weights based on predictions from our trained model.
The overall rate of infection was 1.5 %. The mean area under the curve (AUC), representing the accuracy of the model, across all 300 iterations was 0.775 (95 % CI 0.767,0.782) with a median AUC of 0.787. The positive predictive value (PPV), representing how well the model predicted SSI when a patient had SSI, over all predictions was 92.56 % with a negative predictive value (NPV), representing how well the model predicted absence of SSI when a patient did not have SSI, of 98.45 %. In analyzing relative model weights, the five highest weighted variables were Congestive Heart Failure, Chronic Pulmonary Failure, Hemiplegia/Paraplegia, Multilevel Fusion and Cerebrovascular Disease respectively. Notable factors that were protective against infection were ICU Admission, Increasing Charlson Comorbidity Score, Race (White), and being male. Minimally invasive surgery (MIS) was also determined to be mildly protective.
Machine learning and artificial intelligence are relevant and impressive tools that should be employed in the clinical decision making for patients. The variables with the largest model weights were primarily comorbidity related with the exception of multilevel fusion. Further study is needed, however, in order to draw any definitive conclusions.
Clinical trials require significant resources, but benefits are only realized after trial completion and dissemination of results. We comprehensively assessed early discontinuation, registry results ...reporting, and publication by trial sponsor and subspecialty in urology trials.
We assessed trial registrations from 2007 to 2019 on ClinicalTrials.gov and publication data from PubMed®/MEDLINE®. Associations between sponsor or subspecialty with early discontinuation were assessed using Cox proportional hazards and results reporting or publication with logistic regression at 3 years after completion.
Of 8,636 trials 3,541 (41.0%) were completed and 999 (11.6%) were discontinued. Of completed trials 26.9% reported results and 21.6% were published. Sponsors included academic institutions (53.1%), industry (37.1%) and the U.S. government (9.8%). Academic-sponsored (adjusted HR 0.81, 95% CI 0.69-0.96, p=0.012) and government-sponsored trials (adjusted HR 0.62, 95% CI 0.49-0.78, p <0.001) were less likely than industry to discontinue early. Government-sponsored trials were more likely to report (adjusted OR 1.72, 95% CI 1.17-2.54, p=0.006) and publish (adjusted OR 1.89, 95% CI 1.23-2.89, p=0.004). Academic-sponsored trials were less likely to report (adjusted OR 0.65, CI:0.48-0.88, p=0.006) but more likely to publish (adjusted OR 1.72, 95% CI 1.25-2.37, p <0.001). These outcomes were similar across subspecialties. However, endourology was more likely to discontinue early (adjusted HR 2.00, 95% CI 1.53-2.95, p <0.001), general urology was more likely to report results (adjusted OR 1.54, 95% CI 1.13-2.11, p=0.006) and andrology was less likely to publish (adjusted OR 0.53, 95% CI 0.35-0.81, p=0.003).
Sponsor type is significantly associated with trial completion and dissemination. Government-sponsored trials had the best performance, while industry and academic-sponsored trials lagged in completion and results reporting, respectively. Subspecialty played a lesser role. Lack of dissemination remains a problem for urology trials.
•Case volume of posterior lumbar fusion incased from 0.02% of NSQIP cases in 2006 to 0.82%.•A readmission rate of about 5% per year did no vary significantly across study period.•Reoperation had ...associated significantly with age and BMI.•Surgical site infections were listed as the most common cause of both readmission and reoperation.
The primary goal of this study is to determine trends in patient 30-day postoperative readmission and reoperation following elective posterior lumbar fusion (PLF) between 2006–2016.
We retrospectively identified patients in the ACS-NSQIP database who underwent elective, non-emergent PLF from 2006 to 2016. Descriptive statistical and time trend analyses were performed on demographic, comorbidities, perioperative, and outcome variables. Primary outcomes were reoperation and readmission within 30 days and secondary outcomes were medical and surgical complications reported within 30 days of the operation. Linear and binary logistic regression were performed to adjust for patient specific confounders.
A total of 26,265 patients underwent elective PLF over the study period. Overall case volume increased from 0.02 % (n = 27) of all total cases in ACS-NSQIP in 2006 to 0.82 % (n = 8228) in 2016. Mean age increased from 51.22 SE: 2.77 in 2006 to 60.57 SE: 0.14 in 2016 (p < 0.001). For comorbidities, there was a decrease in smokers and increase in hypertension requiring medication and ASA Class 3. A readmission rate of around 5% per year did not vary significantly over the study period (p = 0.531). Unplanned reoperations declined from 7.4 % in 2006 to 3.1 % in 2016, but the overall trend from 2006 to 2016 was not statistically significant (p = 0.139). Reoperation demonstrated a significant association between age and BMI, but did not vary with admission year. Surgical site infections followed by hematomas and seromas were listed as the most common cause of both readmission and reoperation in PLF patients.
Since the establishment of the ACS-NSQIP database, reoperation rates due to complications declined after 2006 and remained relatively stable. Readmissions were added as a variable in 2011 and had no significant changes over time.
Inflammatory bowel disease (IBD) has been implicated as a risk factor for prostate cancer, however, the mechanism of how IBD leads to prostate tumorigenesis is not known. Here, we investigated ...whether chronic intestinal inflammation leads to pro-inflammatory changes associated with tumorigenesis in the prostate.
Using clinical samples of men with IBD who underwent prostatectomy, we analyzed whether prostate tumors had differences in lymphocyte infiltrate compared to non-IBD controls. In a mouse model of chemically-induced intestinal inflammation, we investigated whether chronic intestinal inflammation could be transferred to the wild-type mouse prostate. In addition, mouse prostates were evaluated for activation of pro-oncogenic signaling and genomic instability.
A higher proportion of men with IBD had T and B lymphocyte infiltration within prostate tumors. Mice with chronic colitis showed significant increases in prostatic CD45 + leukocyte infiltration and elevation of three pro-inflammatory cytokines-TIMP-1, CCL5, and CXCL1 and activation of AKT and NF-kB signaling pathways. Lastly, mice with chronic colitis had greater prostatic oxidative stress/DNA damage, and prostate epithelial cells had undergone cell cycle arrest.
These data suggest chronic intestinal inflammation is associated with an inflammatory-rich, pro-tumorigenic prostatic phenotype which may explain how gut inflammation fosters prostate cancer development in men with IBD.
This study focused on the effect that professional learning communities (PLCs) organized to follow a cycle of inquiry centered upon math instruction can have on the early implementation of a new ...curriculum and student performance in math. It examined the following research questions: 1) To what extent does work done in PLC groups around implementing a new math curriculum transfer to improved instructional practice in classrooms during math? 2) To what extent does revised instructional practice in math during early implementation of a new curriculum influence student performance? The study was conducted in a small, rural elementary school in Massachusetts, and the participants included six kindergarten through fifth grade teachers who implemented the new math curriculum and participated in weekly PLC meetings throughout the process. The study followed a mixed methods approach including classroom observations, observations conducted during PLC meetings, teacher interviews, teacher self-assessments of their PLCs using the Teacher Collaboration Assessment Rubric (Woodland, 2016), and comparative analyses of student performance on iReady, a normed math assessment, given during the school year prior to this study and during the this study. Results from this research found that in order to be most effective, teacher teams should be given adequate time to acquaint themselves with a new curriculum’s methodology and materials, and that the focus of teacher teams during the initial stage of a curriculum roll-out should reflect that priority. In this way, the evolution of the efficacy of PLCs can be aligned with teachers’ understanding of the nuances of a curriculum. This study also found that adopting a rich math curriculum that embraces best practices can increase students’ conceptual knowledge according to their teachers; can help teachers feel that they are meeting their students’ needs better; and can provide teachers with the platform to dive deeper into concepts through pointed questions and prompts. Additionally, this study corroborated research finding both that a collaborative selection process of new curricula and a platform on which to compare experience in the early stages of implementation served as a liberating force among teachers, with several reporting that they felt that they were given “permission to teach.” Teachers reported feeling empowered to experiment and adapt instruction in ways that reflected best practices and served their students- partially because the curriculum embraced those methods, and partially because they received encouragement and comradery from their colleagues. While student growth rates during the timeframe of this study were lower than the year prior to implementation, this likely reflects the novelty of the curriculum and teachers’ experience of needing to familiarize themselves with the change, a phenomenon that has been widely documented in educational change research.
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