Journal of neurosurgery
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Journal of neurosurgery · Mar 2014
Multicenter StudySuboptimal compliance with evidence-based guidelines in patients with traumatic brain injuries.
Evidence-based management (EBM) guidelines for severe traumatic brain injuries (TBIs) were promulgated decades ago. However, the extent of their adoption into bedside clinical practices is not known. The purpose of this study was to measure compliance with EBM guidelines for management of severe TBI and its impact on patient outcome. ⋯ Despite widespread dissemination of EBM guidelines, patients with severe TBI continue to receive inconsistent care. Barriers to adoption of EBM need to be identified and mitigated to improve patient outcomes.
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Journal of neurosurgery · Mar 2014
Clinical TrialStereotactic placement of depth electrodes in medically intractable epilepsy.
Despite its long-reported successful record, with almost 60 years of clinical use, the technical complexity regarding the placement of stereoelectroencephalography (SEEG) depth electrodes may have contributed to the limited widespread application of the technique in centers outside Europe. The authors report on a simplified and novel SEEG surgical technique in the extraoperative mapping of refractory focal epilepsy. ⋯ The authors report on a safe, simplified, and less time-consuming method of SEEG depth electrode implantation, using standard and widely available surgical tools, making the technique a reasonable option for extraoperative monitoring of patients with medically intractable epilepsy in centers lacking the Talairach stereotactic armamentarium.
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Journal of neurosurgery · Mar 2014
Predicting inpatient complications from cerebral aneurysm clipping: the Nationwide Inpatient Sample 2005-2009.
Precise delineation of individualized risks of morbidity and mortality is crucial in decision making in cerebrovascular neurosurgery. The authors attempted to create a predictive model of complications in patients undergoing cerebral aneurysm clipping (CAC). ⋯ The featured model can provide individualized estimates of the risks of postoperative complications based on preoperative conditions and can potentially be used as an adjunct in decision making in cerebrovascular neurosurgery.
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Journal of neurosurgery · Mar 2014
Frequency and predictors of complications in neurological surgery: national trends from 2006 to 2011.
Surgical complications increase the cost of health care worldwide and directly contribute to patient morbidity and mortality. In an effort to mitigate morbidity and incentivize best practices, stakeholders such as health insurers and the US government are linking reimbursement to patient outcomes. In this study the authors analyzed a national database to determine basic metrics of how comorbidities specifically affect the subspecialty of neurosurgery. ⋯ Understanding the landscape of neurosurgical complications will allow better targeting of the most costly and harmful complications of preventive measures. Data from the ACS NSQIP database provide a starting point for developing paradigms of improved care of neurosurgical patients.
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Journal of neurosurgery · Mar 2014
Impact of preoperative anemia on outcomes in patients undergoing elective cranial surgery.
The objective of this study was to assess whether preoperative anemia in patients undergoing elective cranial surgery influences outcomes in the immediate perioperative period (≤ 30 days). ⋯ Anemia is not associated with an overall increased risk for adverse outcomes in patients undergoing elective cranial surgery. However, patients with anemia are more likely to experience prolonged hospitalization postoperatively, resulting in increased resource utilization.