Urinary tract infections in meningioma patients: analysis of risk factors and outcomes.

BACKGROUND: Urinary tract infections (UTIs) account for about 35% of all nosocomial infections and 75% are associated with the use of urethral catheters. AIM: The goal of this study was to evaluate preoperative factors associated with the risk of UTI and to estimate the impact of UTIs on patient outcome and resource utilization. METHODS: Adult meningioma patients treated with craniotomy in US hospitals between 2002 and 2007 were queried from the Nationwide Inpatient Sample (NIS) database. Univariate and multivariate analyses that correct for sample survey design data were used to study the association of perioperative UTIs and outcomes. FINDINGS: In all, 46,344 patients were included. Women comprised the majority (70.0%), had lower mortality (1.2% vs 2.0%), shorter in-hospital stay (6.7 vs 7.5 days), lower hospital charges (US$76,682 vs 87,220) and higher UTI rates (6.3% vs 3.9%) than men. In multivariate analysis, female gender (odds ratio: 2.2; P < 0.0001), older age (1.4; P < 0.001), emergency room admissions (1.8; P < 0.0001), total length of stay (1.08; P < 0.0001), comorbidity score (1.04; P = 0.0147), postoperative fluid abnormalities (1.96; P < 0.0001) and pulmonary complications (1.3; P < 0.0011) were associated with UTI. UTI was associated with an additional 2.3 days of hospital stay and an incremental US$18,920 in hospital charges. CONCLUSIONS: Perioperative UTIs are associated with specific comorbidities and postoperative complications. They significantly increase in-hospital length of stay and costs. Our data emphasize the need to support national efforts that are underway to reduce hospital-acquired UTIs within the neurosurgical population.

Complications and outcomes after spinal cord tumor resection in the United States from 1993 to 2002.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Data on patient outcomes after surgery for spinal cord tumors have been derived from single-institution series. The objective of this study is to report inpatient complications, mortality and outcomes on a national level. SETTING: United States, national inpatient care database. METHODS: The National Inpatient Sample (NIS) was used to identify 19,017 admissions for resection of a spinal cord tumor in the United States from 1993 to 2002. The effects of patient and hospital characteristics on inpatient outcomes were analyzed using logistic regression. RESULTS: The in-hospital mortality rate and the complication rate were 0.55 and 17.5%, respectively. Urinary and renal complications (3.7%), postoperative hemorrhages or hematomas (2.5%) and pulmonary complications (2.4%) were the most common complications reported. A single postoperative complication increased the length of stay by 4 days, increased the mortality rate by sixfold and added over $10,000 to hospital charges. Multivariate analysis showed that complications were more likely in African Americans and patients with multiple comorbidities. The odds of an adverse outcome increased significantly with age greater than 64, multiple comorbidities and postoperative complications. CONCLUSION: A national perspective on inpatient outcomes after resection of spinal cord tumors has been provided. The significant negative impact of postoperative complications on mortality and resource utilization has been demonstrated. We have identified advanced age and multiple comorbidities as risk factors that predict adverse outcome. Furthermore, this study highlights the importance of avoidance, recognition and prompt management of nonneurologic complications.

Distinction between differentiation, cell cycle, and apoptosis signals in PC12 cells by the nerve growth factor mutant delta9/13, which is selective for the p75 neurotrophin receptor.

The common neurotrophin receptor p75(NTR) (low affinity nerve growth factor receptor) participates in the high-affinity binding with the TrkA nerve growth factor (NGF) receptor, may mediate apoptosis, and may signal independently in a cell-specific manner. The potential of p75(NTR) to signal independently of TrkA was investigated with an NGF mutant protein (NGFdelta9/13) that binds poorly to TrkA (Woo et al. [1995] J. Biol. Chem. 270:6278-6285). The NGFdelta9/13 mutant does not activate TrkA autophosphorylation and fails to stimulate the normal NGF-induced growth arrest, demonstrating that TrkA activation is required to arrest PC12 cells at the NGF-activated G1/S cell cycle checkpoint. However, apoptosis is successfully blocked and cell survival is promoted by the NGFdelta9/13 mutant in naive PC12 cells after serum withdrawal, suggesting that p75(NTR) can signal for survival autonomously of TrkA. Annexin V binding, an indication of apoptotic plasma membrane disruption, is inhibited by both NGF and the NGFdelta9/13 mutant after serum deprivation. Both NGF and the NGFdelta9/13 mutant inhibit the rapid apoptotic internucleosomal DNA cleavage of PC12 cells upon serum deprivation. Furthermore, the level of caspase3-like activity that is rapidly activated by serum withdrawal from PC12 cells is reduced by both the NGFdelta9/13 protein and NGF. Finally, upon serum withdrawal, both NGF and the NGFdelta9/13 mutant activate nuclear translocation of the transcriptional factor NF-kappaB (nuclear factor kappaB), a process involved in cell survival. These results are consistent with p75(NTR) inhibition of caspase-mediated apoptosis in PC12 cells. The different physiologic responses elicited by NGFdelta9/13 indicate the potential for individual signaling by the two NGF receptors and also demonstrate the utility of NGF mutants for receptor-selective signal transduction.