Neurosurgery
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Surgical site infections (SSI) contribute significantly to patient morbidity and mortality and greatly increase health care costs. It has been postulated that increased traffic through operating rooms (ORs) during procedures increases SSI rates. ⋯ In conclusion, OR traffic can be significantly reduced by using a LT protocol like that used in this study. However, significantly reducing OR traffic does not meaningfully reduce the risk of SSI.
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Several studies have indicated that 30-day morbidity and mortality risk is higher among pediatric and adult patients who are admitted on the weekends. This "weekend effect" has been observed among patients admitted with and for a variety of diagnoses and procedures, respectively, including myocardial infarction, pulmonary embolism, ruptured abdominal aortic aneurysm, stroke, peptic ulcer disease, and pediatric surgery. We sought to compare morbidity and mortality outcomes for emergent pediatric neurosurgical procedures done on the weekend or after-hours with emergent surgical procedures performed during regular weekday "business hours." ⋯ Weekday after-hours and weekend emergent pediatric neurosurgical procedures are associated with significantly increased 30-day morbidity and mortality risk compared with procedures performed during weekday regular hours.
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Over the past decade, new national guidelines and requirements ranging from ACGME mandated duty hour restrictions to the development of The Neurological Surgery Milestone Project have rapidly altered the shape of current neurosurgical education and training. This national survey of neurosurgical residents within all levels of training was performed with support from the Council of State Neurosurgical Societies and the Young Neurosurgeons Committee in an effort to quantify the relative readiness of residents to venture into practice and to understand the socioeconomic issues impacting our field. ⋯ In a national survey of neurosurgical residents, the vast majority of respondents felt their training lacked adequate socioeconomic training. Specific areas of weakness have been identified, and new initiatives are needed within the field of neurosurgical education to fill this void.
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Sacroiliac joint (SIJ) pain is a common cause of lower back and sciatic pain. Nonsurgical treatment often fails to provide pain relief. Minimally invasive SIJ fusion is now available with several devices. To date, no prospective concurrent comparison of SIJ fusion against nonsurgical treatment has been reported. ⋯ This level 1 study demonstrated that SIJ fusion using iFuse implants was more effective than NSM in relieving pain and disability in patients with SIJ dysfunction at 6 months. Twelve-month data will be available and presented at the meeting.