World Neurosurg
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Diversity, equity, and inclusion within the healthcare workforce are conducive to providing culturally competent care. However, few existing studies have assessed the level of racial and ethnic diversity among resident physicians and residency applicants. Our objective was to provide a comparative analysis of the trends in racial and ethnic representation within different subspecialties in medicine. ⋯ Among the surveyed specialties, neurosurgery demonstrated the greatest disparity between the percentage of Black/African-American residency applicants and current residents. To further drive progress in this domain, we advocate for a series of initiatives designed to increase underrepresented minority participation in neurosurgery practice and scholarship.
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Predicting patient needs for extended care after spinal fusion remains challenging. The Risk Assessment and Prediction Tool (RAPT) was externally developed to predict discharge disposition after nonspine orthopedic surgery but remains scarcely used in neurosurgery. The present study is the first to use coarsened exact matching-which incorporated patient characteristics known to independently affect outcomes-for 1:1 matching across a large population of single-level, posterior lumbar fusions, to isolate the predictive value of preoperative RAPT score on postoperative discharge disposition. ⋯ The RAPT score, captured in preoperative evaluations, can be highly predictive of discharge disposition following single-level, posterior lumbar fusion.
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To characterize the volume dependence of both facilities and surgeons on postoperative complications after lumbar fusion and characterize the role of socioeconomic status. ⋯ Both high-volume facilities and high-volume surgeons show lower rates of complications and readmission. There are significant socioeconomic disparities regarding which patients can access high-volume surgeons.
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Basilar invagination usually shows a decrease of clivus axis angle (CAA), which could give rise to progressive neural compression. Exploring a safe and effective fixation technique to achieve atlantoaxial stability and neural decompression remains necessary. In this study, we introduce a modified posterior C1-C2 distraction and fixation technique by which we obtained indirect ventral neural decompression and atlantoaxial stability in a series of patients with decreased CAA. ⋯ Indirect ventral brainstem decompression by posterior C1-C2 distraction and fixation is a safe and effective technique for treatment of basilar invagination.
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Studies about the transradial technique and experience with this approach abound in the neurointerventional literature, but studies focusing on patient perspectives and preferences with respect to transfemoral or transradial access are scarce. ⋯ Most patients preferred the transradial approach. Evaluating the reasons behind their preference can help operators to better understand patient perspectives and improve quality of care.