Cranioplasty outcomes and associated complications: A single-centre observational study.

INTRODUCTION: The resurgence of decompressive craniectomy has led to recent published reviews of the safety of cranioplasties. To date there is a wide range of reported mortality and morbidity. This observational study reports the outcomes of the cranioplasty operations from a single centre and evaluates the factors involved in their management. METHODS: A retrospective search of all theatre logs was performed for the years 2006-2013 inclusive. 88 operations were documented as 'Cranioplasty'. Data collection include patient demographics, type of cranioplasty used, time lapse between decompression and cranioplasty, seniority of the operating surgeon(s), antibiotic regimen and complications. Outcomes were recorded at the three-month follow-up. RESULTS: The overall complication rate was 6.8%. The mean patient age was 36.2 years. 52.2% of patients had decompressive craniectomy for trauma, 11.3% had infectious pathology, 9% had subarachnoid haemorrhage, 9% had tumour with bone infiltration and 3.4% had stroke. 55.7% of patients had cranioplasty within 6 months of craniectomy. 61.3% of cranioplasties were with autologous bone, 20.4% titanium, 10.2% acrylic and 7.9% polyetheretherketone (PEEK). Significant complications included one case of infection, two cases of subgaleal haematoma and one extradural collection. No deaths were noted. No correlation was found between infection and the use of drains. 68.6% of cases were done by either a senior surgeon or a supervised registrar. There was an observable difference in complication rates in relation to the seniority and experience of the operator. However, patient numbers and complications were insufficient to achieve statistical significance. Strict antimicrobial prescribing was observed. CONCLUSION: Some potentially preventable complications have been addressed with a resulting rate of complications lower than other published reports. We use two standard adjuncts: the presence of a senior surgeon and strict antimicrobial regimens. We believe that our results could be transferrable to other units by following similar guidelines.

Patient-reported quality of life and eligibility for cataract surgery: assessing the relationship between ethnicity and 'Impact on Life' questionnaire scores in New Zealand.

AIMS: The 'Impact on Life' (IoL) questionnaire is a patient reported quality-of-life assessment tool used to prioritise cataract surgery in New Zealand (NZ). This study evaluated the association between ethnicity and IoL questionnaire responses. METHODS: This is a retrospective cohort study of patients prioritised for public-funded cataract surgery between November 2014 and March 2019 in New Zealand. Data were extracted from the New Zealand Ministry of Health National Prioritisation Web Service database. Ethnic, demographic and IoL data for all patients who were prioritised for surgery were analysed after controlling for age, gender, visual acuity and cataract type. RESULTS: Of the 58,648 prioritisation events, over the four-and-a-half-year period, 46,352 prioritisation events had documented scores for the IoL questionnaire. The study population had a mean age of 74.4 years and had a female preponderance (74%). The average IoL score was 22.5/36 (SD 7.8). After controlling for age, gender, visual acuity (VA) and cataract type, there was only a marginal difference between Maori and non-Maori IoL scores (22.8/36 vs 22.4/36) despite statistical significance for the difference (p=0.001). Maori and Pacific people presented at a younger age (68.5 years and 66.7 years, respectively) with worse visual acuity than other ethnic groups (mean range 70.1-76.7 years). Mean IoL scores were 23.0/36 for Maori and Pacific people and 22.4/36 for other ethnic groups. CONCLUSIONS: Maori and Pacific people present younger with worse VA and more advanced cataracts at time of surgical prioritisation when compared with other ethnic groups. Despite these differences, after controlling for confounding factors, the mean IoL score did not differ to a level that was clinically significant between different ethnic groups in New Zealand at time of prioritisation for cataract surgery. These results suggest that there are no meaningful ethnic specific differences in patient reported quality of life for patients with cataract in New Zealand after controlling for other factors. Alternatively, the IoL tool may lack the sensitivity to detect meaningful ethnic disparities that may exist for quality of life in this cohort of patients.

Radiographic Features Associated With Increased Surgical Invasiveness in Pyogenic Vertebral Column Osteomyelitis.

STUDY DESIGN: Single center retrospective cohort study. OBJECTIVES: Assess the association between well-known radiographic features for spinal instability from the Spinal Instability in Neoplasia Score (SINS) and surgical invasiveness in treating vertebral column osteomyelitis (VCO). This will potentially help surgeons in surgical planning and aid in developing a pathology specific score. METHODS: Patients with VCO were identified from hospital coding. On preoperative computed tomography radiographic features, including spinal alignment, vertebral body collapse, location, type of bone lesion, and posterolateral involvement were assessed and scored 0 (stable) to 15 (highly unstable). Surgical invasiveness was graded as 0 = no surgery, 1 = decompression alone, 2 = shortening or posterior stabilization, or 3 = anterior column reconstruction. RESULTS: A total of 41 patients were included. The mean age of the cohort was 63.3 years (SD 12.0) with male comprising 78%. The mean total radiographic score for the nonsurgical group was 6.39 (3.14) and for the surgical group 10.38 (3.06), P < .001. Spinal alignment, vertebral body collapse, type of bone lesion, and posterolateral involvement correlated with surgical invasiveness (all Ps < .05). Subgroup comparison following analysis of variance showed that only spinal alignment was significantly different between groups 2 and 3. CONCLUSIONS: Our findings show correlation of the radiographic components of the SINS with surgical invasiveness in management of pyogenic VCO-these findings should aid development of an "instability score" in pyogenic VCO. While most radiographic features assessed correlated with surgical invasiveness spinal alignment appears to be the key feature in determining the need for more invasive surgery.

Patient-reported quality of life for cataract surgery: prospective validation of the 'Impact on Life' and Catquest-9SF questionnaires in New Zealand.

AIMS: The 'Impact on Life' (IoL) questionnaire is used to prioritise publicly funded cataract surgery in New Zealand, however, it has not been formally validated for ophthalmic use. The Catquest-9SF questionnaire is widely used to assess vision-related quality of life (VRQoL) but has not been validated in New Zealand. This study evaluates the validity of the IoL and Catquest-9SF questionnaires for measuring VRQoL in New Zealand. METHOD: Formal ethics approval was obtained. Participants completed the IoL and Catquest-9SF questionnaires before and three months after routine cataract surgery. Rasch analysis was used to investigate all qualitative questionnaire responses. Results were correlated with the change in patient visual acuity. RESULTS: There was a 100% response rate at follow-up (41 participants). Disordered probability thresholds were observed for all IoL questions but no Catquest-9SF questions. All IoL questions demonstrated unsatisfactory mean-square fit statistics. Differences in visual acuity following surgery correlated with the change in total F-score for the Catquest-9SF (P=0.04), but not IoL responses (P=0.17). CONCLUSIONS: Disordered probability thresholds, poor question-model fit and correlation with visual acuity changes indicate the current IoL questionnaire is poorly suited for assessment of VRQoL. In contrast, the Catquest-9SF demonstrated credible results for assessment of VRQoL in New Zealand.

Posterior sloping angle as a predictor of contralateral slip in slipped capital femoral epiphysis.

BACKGROUND: Slipped capital femoral epiphysis is a condition with potentially severe complications. Controversy remains as to when to undertake prophylactic pinning. We aimed to assess the utility of the posterior sloping angle as a predictor for contralateral slip in a large, multi-ethnic cohort including Polynesian children with a high incidence of slipped capital femoral epiphysis. METHODS: All patients presenting to our hospital between 2000 and 2009 were identified and records were reviewed to determine demographic data and determine whether they subsequently developed a contralateral slip. The presenting radiographs were reviewed and the posterior sloping angle was measured. Patients with bilateral slips at presentation and those without initial radiographs were excluded. RESULTS: Records and radiographs of 132 patients were analyzed for the posterior sloping angle in the unaffected hip. Forty-two patients who had subsequently developed a contralateral slip had a mean posterior sloping angle (and standard deviation) of 17.2° ± 5.6°, which was significantly higher (p < 0.001) than that of 10.8° ± 4.2° for the ninety patients who had had a unilateral slip. Children who had developed a subsequent contralateral slip were significantly younger (11.1 years) than those who had developed a unilateral slip (12.2 years) (p < 0.001). If a posterior sloping angle of 14° were used as an indication for prophylactic fixation in this population, thirty-five (83.3%) of forty-two contralateral slips would have been prevented, and nineteen (21.1%) of ninety hips would have been pinned unnecessarily. The number needed to treat to prevent one subsequent contralateral slip is 1.79. CONCLUSIONS: To our knowledge, this is the largest study to date that confirms that the posterior sloping angle is a reliable predictor of contralateral slip and can be used to guide prophylactic pinning. The posterior sloping angle is applicable in the high-risk Polynesian population and could be useful in preventing future slips in populations that are difficult to follow up.