Conflicting reports and surgeon opinions have contributed to a long-standing debate regarding the merits of the intact canal wall versus canal wall down approach to cholesteatoma. The objective of this analysis was to identify and synthesize available data concerning rates of recidivism after the two primary types of cholesteatoma surgery. PubMed, Cochrane Collaboration, and Google Scholar searches were performed and articles filtered based on predetermined exclusion criteria. Individually reported rates of recurrent and residual disease were extracted and recorded. Meta-analysis demonstrated a relative risk of 2.87 with a confidence interval of 2.45–3.37, confirming a significantly increased incidence of postoperative cholesteatoma when using an intact canal wall approach rather than a canal wall down approach. Next, rates of recidivism following the typical two-stage intact canal wall operation were compared with a single-stage canal wall down operation and found to be similar. In conclusion, we advocate that greater consideration should be given to the canal wall down procedure in initial surgical management and identify the need for further exploration of rates of recidivism after staged or second-look procedures.
Using administrative data, this study demonstrates a baseline glioma surgery 30-day readmission rate of 13.2% in California for patients who are initially discharged home. This paper highlights the medical histories, perioperative complications, and patient demographic groups that are at an increased risk for readmission within 30 days of home discharge. An analysis of conditions present on readmission that were not present at the index surgical admission, such as infection and seizures, suggests that some readmissions may be preventable. Discharge planning strategies aimed at reducing readmission rates in neurosurgical practice should focus on patient groups at high risk for readmission and comprehensive discharge planning protocols should be implemented to specifically target the mitigation of potentially preventable conditions that are highly associated with readmission.
Object There is limited information on the relationship between patient age and the clinical benefit of resection in patients with glioblastoma. The purpose of this study was to use a population-based database to determine whether patient age influences the frequency that gross-total resection (GTR) is performed, and also whether GTR is associated with survival difference in different age groups. Methods The authors identified 20,705 adult patients with glioblastoma in the Surveillance, Epidemiology, and End Results (SEER) registry (1998–2009). Surgical practice patterns were defined by the categories of no surgery, subtotal resection (STR), and GTR. Kaplan-Meier and multivariate Cox regression analyses were used to assess the pattern of surgical practice and overall survival. Results The frequency that GTR was achieved in patients with glioblastoma decreased in a stepwise manner as a function of patient age (from 36% [age 18–44 years] to 24% [age ≥ 75]; p < 0.001). For all age groups, glioblastoma patients who were selected for and underwent GTR showed a 2- to 3-month improvement in overall survival (p < 0.001) relative to those who underwent STR. These trends remained true after a multivariate analysis that incorporated variables including ethnicity, sex, year of diagnosis, tumor size, tumor location, and radiotherapy status. Conclusions Gross-total resection is associated with improved overall survival, even in elderly patients with glioblastoma. As such, surgical decisions should be individually tailored to the patient rather than an adherence to age as the sole clinical determinant.
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