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OBJECTIVE: Anterior approaches to the lumbar spine have been used extensively for various indications but they are also associated with unique complications and have been linked with higher incisional morbidity.This study aimsto evaluate incisional morbidity related to anterior lumbar surgeries and to assess how incisional outcomes correlate with patient and surgery-related factors. METHODS: Patients ≥18 years old and with planned anterior lumbar fusions from L1 to S1 were prospectively enrolled. Follow-up ended at two years, and patients who did not complete the follow-up were excluded. Incision was assessed for general appearance, width, color, cross-hatching, hypertrophy, and pain by using a validated scoring system and a visual analog scale (VAS). Patient and surgery-related factors were analyzed for possible correlations with complications or wound-related parameters. RESULTS: A total of 205 patients with a mean age of 54.4 ± 11.5 were included. Significant improvements were seen in color, hypertrophy, pain, and appearance of the incision. At two years, the mean patient-based VAS for appearance was 8.6 while surgeon-based VAS was 8.8. The total rate of complications was 9%, with no incisional hernia or bulging. No significant relation was found between incision-related parameters and the demographic and surgical variables. CONCLUSION: This study reports acceptable cosmetic results and no chronic pain after anterior lumbar surgery, which is contrary to previous reports. Together with a low total rate of complications, anterior approaches are safe when carefully executed, and have low morbidity.
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Malignant struma ovarii is an exceedingly rare pathology with a paucity of established criteria regarding management and surveillance with recommendations largely based on case reports and retrospective data. Many authors have supported stratification of malignant struma ovarii into low vs high-risk disease with more conservative management reserved for those deemed low-risk. Here we present a unique case of recurrent metastatic malignant struma ovarii after surveillance was undertaken in the setting of initially low-risk disease.
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BACKGROUND & AIMS: Peritoneal carcinomatosis (PC) is treated by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Timely postoperative nutrition is required to reduce the risk of malnutrition and other complications; thus the present study aims to evaluate factors that may impact dietary progression following CRS/HIPEC treatment. METHODS: Forty-two patients undergoing CRS/HIPEC at a tertiary hospital were audited between April 2019 and August 2020. Patients were classified into two groups: fast dietary progression (FDP) and slow dietary progression (SDP), based on commencement of a full fluid diet (FF) within 7 days or after 7 days postoperatively. Between-group differences in patient characteristics, surgical factors and postoperative complications were evaluated statistically (significant at p < 0.05). RESULTS: FDP and SDP groups comprised of 22 (52%) and 20 (40%) patients, respectively. A FF diet was established on a median of 7 (4.25-9.75) days, but not before day 2. Nineteen of the 31 (61.3%) patients receiving parenteral nutrition (PN) were in the SDP group (p = 0.009). The SDP group had longer surgery duration (p = 0.05), more gastrointestinal anastomoses (GIAs) (p = 0.02), more enterotomies (p = 0.008), higher rates of prolonged ileus (p = 0.007), longer duration to first bowel motion (p = 0.002), more returns to theatre (p = 0.03), higher Clavien Dindo scores ≥ IIIb (p = 0.01) and longer postoperative length-of-stay (p = 0.001), compared to the FDP group. CONCLUSIONS: Postoperative complications were associated with SDP in PC patients undergoing CRS/HIPEC. Strategies that aim to limit SDP through timely commencement of nutrition, including PN, are important to improve postoperative outcomes in this patient group.
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STUDY DESIGN: Retrospective observational cohort. OBJECTIVES: This study explores the impact of Intraoperative hypotension (IOH)on post-op complications for major thoracolumbar spine fusion procedures. SUMMARY OF BACKGROUND DATA: IOH with mean arterial pressure (MAP) < 65 mmHg is associated with post-op acute kidney injury (AKI) in general surgery. In spinal deformity surgery, IOH is a contributing factor to MEP changes and spinal cord dysfunction with deformity correction. METHODS: 539 thoracolumbar fusion cases, > 6 surgical levels and > 3 hours duration were identified. Anesthetic/surgical data included OR time, fluid volume, blood loss, blood product replacement and use of vasopressors. Arterial-line based MAP data was collected at 1 min intervals. Cummulative duration of MAP < 65 mmHg was recorded. IOH within the first hour of surgery vs. the entire case was determined. Post-op course and complications including SSI, GI complications, pulmonary complications, MI, DVT, PE, AKI and encephalopathy were noted. Cumulative complications were grouped as none, 1-2 complications, or >3 complications. RESULTS: There was a significant association between occurrence of complications and duration of IOH within the first hour of surgery (8.2 vs. 5.6 min, P<0.001) and across the entire procedure (28.1 vs. 19.3 min, P=0.008). This association persisted for individual major complications including SSI, acute respiratory failure, PE, ileus requiring NGT and post-operative cognitive dysfunction. Comparison of patients with 0 vs. 1-2 vs. 3 or more complications demonstrated that patients with 3 or more complications had a longer duration of IOH in the first hour of the surgery and that patients who had no complications received less vasopressor than patients who had 1-2 or 3 or more complications. CONCLUSION: This study identifies duration of IOH during the first hour of surgery as a previously unrecognized modifiable risk associated with major complications for multi-level lumbar fusion surgery.
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OBJECTIVE: Peripheral regional anesthesia is proposed to enhance recovery. We sought to evaluate the efficacy of bilateral continuous erector spinae plane blocks (B-ESpB) for postoperative analgesia and the impact on recovery in children undergoing cardiac surgery. METHODS: Patients aged 2 through 17 years undergoing cardiac surgery in the enhanced recovery after cardiac surgery program were prospectively enrolled to receive B-ESpB at the end of the procedure, with continuous infusions via catheters postoperatively. Participants wore an activity monitor until discharge. B-ESpB patients were retrospectively matched with control patients in the enhanced recovery after cardiac surgery program. Outcomes of the matched clusters were compared using exact conditional logistic regression and generalized linear modeling. RESULTS: Forty patients receiving B-ESpB were matched to 78 controls. There were no major complications from the B-ESpB or infusions, and operating room time was longer by a median of 31 minutes. While blocks were infusing, patients with B-ESpB received fewer opioids in oral morphine equivalents than controls at 24 hours (0.60 ± 0.06 vs 0.78 ± 0.04 mg/kg; P = .02) and 48 hours (1.13 ± 0.08 vs 1.35 ± 0.06 mg/kg; P = .04), respectively. Both groups had low median pain scores per 12-hour period. There was no difference in early mobilization, length of stay, or complications. CONCLUSIONS: B-ESpBs are safe in children undergoing cardiac surgery. When performed as part of a multimodal pain strategy in an enhanced recovery after cardiac surgery program, pediatric patients with B-ESpB experience good pain control and require fewer opioids in the first 48 hours.
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Media and research reports have highlighted the disproportionate burden of home and family responsibilities shouldered by women and mothers due to COVID-19-related school/childcare shutdowns. This cross-sectional study extends this line of inquiry to emerging adults. Our study of 329 diverse emerging adults suggests that young women took on more home/family responsibilities than young men amidst the pandemic, and that these duties were associated with symptoms of depression. However, results also indicate that emerging adults who reported greater home/family responsibilities amidst the pandemic also experienced more quality family time, suggesting that pandemic-related challenges may have also been accompanied by opportunities for family connection. Contrary to previous research that has shown home/family responsibilities to be concentrated by SES and race/ethnicity, we found that participants uniformly endorsed COVID-19-related impacts on home/family responsibilities across these demographic distinctions. This could reflect the ubiquity of COVID-19's impact; across race/ethnicity and class-but differentially by gender-young adults faced significant challenges in taking on new home/family roles.
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OBJECTIVE: We describe the incidence of, and identify the risk factors for, a medial breach of the pedicle wall during robotic-assisted cortical bone trajectory (RA-CBT) screw insertion. METHODS: We analyzed a consecutive series of adult patients who underwent RA-CBT screw placement from January 2019 to July 2022. To assess the pedicle wall medial breach, postoperative computed tomography (CT) images were analyzed. Patient demographic data and screw data were compared between patients with and without a medial breach. The Hounsfield units (HUs) on the L1 midvertebral axial CT scan was used to evaluate bone quality. RESULTS: Of 784 CBT screws in 145 patients, 30 (3.8%) had a medial breach in 23 patients (15.9%). One screw was grade 2, and the others were grade 1. Patients with a medial breach had a lower HU value compared with the patients without a medial breach (123.3 vs. 150.5; P = 0.027). A medial breach was more common in the right than left side (5.5% vs. 2.0%; P = 0.014). More than one half of the screws with a medial breach were found in the upper instrumented vertebra (UIV) compared with the middle construct or lowest instrumented vertebra (6.7% vs. 1.3% vs. 2.7%; P = 0.003). Binary logistic regression showed that low HU values, right-sided screw placement, and UIV were associated with a medial breach. No patients returned to the operating room for screw malposition. No differences were found in the clinical outcomes between patients with and without a medial breach. CONCLUSIONS: The incidence of pedicle wall medial breach was 3.8% of RA-CBT screws in the postoperative CT images. A low HU value measured in the L1 axial image, right-sided screw placement, and UIV were associated with an increased risk of medial breach for RA-CBT screw placement.
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Tornillos Pediculares , Procedimientos Quirúrgicos Robotizados , Fusión Vertebral , Adulto , Humanos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Procedimientos Quirúrgicos Robotizados/métodos , Tornillos Pediculares/efectos adversos , Hueso Cortical/diagnóstico por imagen , Hueso Cortical/cirugía , Factores de Riesgo , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/cirugía , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodos , Estudios RetrospectivosRESUMEN
INTRODUCTION: As college students navigate new developmental milestones, many families rely on digital technology to stay connected and aid in the transition to adulthood. Digital location tracking apps allow for parental monitoring in new ways that may have implications for youth development. Although recent research has begun to examine prevalence and motivations for digital location tracking in adolescence, we know little about how and why families continue to track into the transition to college, and how this may relate to perceptions of helicopter and autonomy supportive parenting. METHODS: In a cross-sectional study of 706 community college and 4-year university students in the Southeastern United States, we describe prevalence and sociodemographic differences in parent/caregiver digital location tracking of their college student children, and how this may be associated with perceptions of helicopter parenting and parent/caregiver autonomy support. RESULTS: Findings suggest that digital location tracking is a fairly common practice among college students, with nearly half of the sample endorsing currently or previously being digitally location tracked by their parent/caregiver. Younger, White, and higher socioeconomic status students were more likely to be tracked. Those students who were currently being digitally location tracked tended to perceive their primary parent/caregiver as engaging in more helicopter parenting and as less supportive of their autonomy. CONCLUSIONS: This brief report provides preliminary insight into parent/caregiver digital location tracking of their college student children. It is our hope that future research will further examine how digital location tracking may be helping or hindering attainment of developmental milestones in the digital age.
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Estudiantes , Humanos , Femenino , Masculino , Estudios Transversales , Estudiantes/psicología , Estudiantes/estadística & datos numéricos , Adolescente , Adulto Joven , Responsabilidad Parental/psicología , Universidades , Relaciones Padres-Hijo , Padres/psicología , Cuidadores/psicología , Sudeste de Estados Unidos , Adulto , Aplicaciones MóvilesRESUMEN
STUDY DESIGN: Retrospective chart review. OBJECTIVE: To provide reference values for Hounsfield unit (HU) measured on computed tomography (CT) scans of children and adolescents. SUMMARY OF BACKGROUND DATA: Spine surgeons increasingly use HU on spine CT as a measure of bone mineral density (BMD). This has not been described in children and adolescents. PATIENTS AND METHODS: Pediatric patients who had a spine CT between 2012 and 2022 were identified. Patients who had more than 1 comorbidity or were syndromic were excluded. Using the bone window, 3 axial images (cephalad, middle, and caudal) of each vertebra were selected. In each axial view, the HU was measured using a "region of interest" (ROI) that included the total cancellous bone area and an ROI excluding the radiolucency present in the posterior vertebral body ("total" vs . "limited"). HU values were compared between total and limited areas and between the axial images at the cephalad, middle, and caudal levels. Each age category data were estimated and stratified. RESULTS: A total of 144 patients (79 females and 65 males) from 2 to 17 years old were included. Mean limited HU was consistently lower than total HU across all images and lumbar levels except for L1. Limited HU taken mid-vertebral body was also consistently lower than those taken cephalad or caudad. Mean limited HU across all ages including all levels was 227 ± 50 (range: 109-357). Stratifying by age showed a gradual decrease in BMD from age 2 to 10 followed by an increase. CONCLUSIONS: This is the first study to measure HU on lumbar CTs in children and adolescents. The technique of measuring BMD in adults should be modified in children by using an ROI that excludes the rarefaction present in the posterior vertebral body. Further studies are needed to evaluate the age-dependent changes in BMD seen in this study.
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Densidad Ósea , Osteoporosis , Adulto , Masculino , Femenino , Humanos , Adolescente , Niño , Preescolar , Estudios Retrospectivos , Vértebras Lumbares , Tomografía Computarizada por Rayos X/métodos , Absorciometría de Fotón/métodosRESUMEN
BACKGROUND CONTEXT: Circumferential lumbar fusions (cLFs) are becoming more common with increasing and more minimally invasive anterior access techniques. Staging allows reassessment of indirect decompression and alignment prior to the posterior approach, and optimization of OR time management. Safety of staging has been well documented in deformity surgery but has yet to be delineated in less extensive, degenerative cLFs. PURPOSE: The purpose of this study is to compare perioperative complications and outcomes between staged versus single-anesthetic circumferential fusions in the lumbar spine. STUDY DESIGN: Propensity-matched comparative observational cohort. PATIENT SAMPLE: Patients who underwent cLFs for lumbar degenerative disease. OUTCOME MEASURES: In-hospital, 30-day, 90-day, and 1-year complications. METHODS: From 123 patients undergoing single-anesthetic and 154 patients undergoing staged cLF, 95 patients in each group were propensity-matched based on age, sex, BMI, ASA score, smoking, revision, and number of levels. We compared perioperative, 30-day, 90-day, and 1-year complications between the two cohorts. RESULTS: Mean days between stages was 1.58. Single-anesthetic cLF had longer total surgery time (304 vs 240 minutes, p<.001) but shorter total PACU total time (133 vs 196 minutes, p<.001). However, there was no difference in total anesthesia time (368 vs 374 minutes, p=.661) and total EBL (357 vs 320cc, p=.313). Intraoperative complications were nine incidental durotomies in the single-anesthetic and one iliac vein injury in the staged group (9% vs 1%, p=.018). There was no difference of in-hospital (38 vs 31, p=.291), 30-day (16 vs 23, p=.281), 90-day (10 vs 15, p=.391), 1-year complications (9 vs 12, p=.644), and overall cumulative 1-year complications (54 vs 56, p=.883) between the two cohorts. CONCLUSIONS: There is a decrease in total surgical time and intraoperative complications during staged compared with single-anesthetic cLF with no difference in in-hospital, 30-day, 90-day, and 1-year complications between approaches.
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Anestésicos , Fusión Vertebral , Humanos , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Vértebras Lumbares/cirugía , Complicaciones Intraoperatorias/epidemiología , Complicaciones Intraoperatorias/etiología , Fusión Vertebral/efectos adversos , Fusión Vertebral/métodos , Estudios de Cohortes , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Conditions affecting the hypothalamic-pituitary-adrenal (HPA) axis are common in dogs. Testing the function of the HPA axis includes measurement of endogenous adrenocorticotropic hormone (eACTH) and performance of an adrenocorticotropic hormone (ACTH) stimulation test. Trazodone is commonly administered to dogs to decrease stress. In humans, trazodone significantly decreases plasma cortisol concentration via alpha-1 adrenergic activity. OBJECTIVES: Determine the influence of trazodone on eACTH and serum cortisol concentrations in healthy dogs. ANIMALS: Fourteen healthy, adult, companion dogs. METHODS: Prospective, randomized placebo-controlled study. Trazodone (8-10 mg/kg) or placebo was administered PO 1 hour before eACTH measurement and ACTH stimulation testing. After a ≥7-day wash-out period, dogs received the opposite treatment. Differences in eACTH, pre- and post-ACTH stimulation cortisol concentrations, and delta (difference between pre- and post-ACTH) cortisol concentrations were analyzed using a paired t or signed-rank test with a P < .05 significance level. RESULTS: The eACTH concentrations were not significantly different (P = .23) between treatments. Similarly, no significant differences were found in the pre-ACTH cortisol concentrations between treatments (P = .40). Post-ACTH cortisol concentrations (P = .05) and delta cortisol concentrations (P = .04) were significantly lower when the dogs were treated with trazodone. CONCLUSIONS: Preliminary data suggest trazodone administration dampens the adrenocortical response to stimulation in healthy dogs. If similar effects are found in dogs with adrenal disease, the use of trazodone may affect diagnosis and clinical decision making in these populations.
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Hidrocortisona , Trazodona , Animales , Perros , Hormona Adrenocorticotrópica/farmacología , Sistema Hipotálamo-Hipofisario , Sistema Hipófiso-Suprarrenal , Estudios Prospectivos , Trazodona/farmacologíaRESUMEN
An 11-year-old boy presented with enlarged and tender cervical lymph nodes that showed areas of central hypodensity and necrosis with histiocytes and an absence of neutrophils. What is your diagnosis?
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Linfadenopatía , Humanos , Niño , Linfadenopatía/diagnóstico , Linfadenopatía/etiología , Ganglios LinfáticosRESUMEN
This study investigated the relationship between the size, condition, year class, family, and sexual maturity of Atlantic salmon (Salmo salar) using data collected in an aquaculture selective breeding programme. Males that were sexually mature at 2 years of age (maiden spawn) have, on average, greater fork length and condition factor (K) at 1 year of age than their immature counterparts. For every 10-mm increase in fork length or 0.1 increase in K at 1 year of age, the odds of sexual maturity at 2 years of age increased by 1.48 or 1.22 times, respectively. Females that were sexually mature at 3 years of age (maiden spawn) have, on average, greater fork length and K at 2 years of age than their immature counterparts. For every 10-mm increase in fork length or 0.1 increase in K at 2 years of age, the odds of sexual maturity at 3 years of age increased by 1.06 or 1.44 times, respectively. The family explained 34.93% of the variation in sexual maturity among 2-year-old males that was not attributable to the average effects of fork length and K at 1 year of age and year class. The proportion of variation in sexual maturity among 3-year-old females explained by the family could not be investigated. These findings suggest that the onset of sexual maturation in Atlantic salmon is conditional on performance (with respect to energy availability) surpassing a threshold, the magnitude of which can vary between families and is determined by a genetic component. This could support the application of genetic selection to promote or inhibit the onset of sexual maturation in farmed stocks.
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Salmo salar , Maduración Sexual , Humanos , Masculino , Femenino , Animales , Maduración Sexual/genética , Salmo salar/genética , AcuiculturaRESUMEN
STUDY DESIGN: Propensity-matched cohort. OBJECTIVE: The aim of this study was to determine if opioid-sparing anesthesia (OSA) reduces in-hospital and 1-year postoperative opioid consumption. SUMMARY OF BACKGROUND DATA: The recent opioid crisis highlights the need to reduce opioid exposure. We developed an OSA protocol for lumbar spinal fusion surgery to mitigate opioid exposure. MATERIALS AND METHODS: Patients undergoing lumbar fusion for degenerative conditions over one to four levels were identified. Patients taking opioids preoperatively were excluded. OSA patients were propensity-matched to non-OSA patients based on age, sex, smoking status, body mass index, American Society of Anesthesiologists grade, and revision versus primary procedure. Standard demographic and surgical data, daily in-hospital opioid consumption, and opioid prescriptions 1 year after surgery were compared. RESULTS: Of 296 OSA patients meeting inclusion criteria, 172 were propensity-matched to non-OSA patients. Demographics were similar between cohorts (OSA: 77 males, mean age=57.69 yr; non-OSA: 67 males, mean age=58.94 yr). OSA patients had lower blood loss (326 mL vs. 399 mL, P =0.014), surgical time (201 vs. 233 min, P <0.001) emergence to extubation time (9.1 vs. 14.2 min, P< 0.001), and recovery room time (119 vs. 140 min, P =0.0.012) compared with non-OSA patients. Fewer OSA patients required nonhome discharge (18 vs. 41, P =0.001) compared with the non-OSA cohort, but no difference in length of stay (90.3 vs. 98.5 h, P =0.204). Daily opioid consumption was lower in the OSA versus the non-OSA cohort from postoperative day 2 (223 vs. 185 morphine milligram equivalents, P =0.017) and maintained each day with lower total consumption (293 vs. 225 morphine milligram equivalents, P =0.003) throughout postoperative day 4. The number of patients with active opioid prescriptions at 1, 3, 6, and 12 months postoperative was statistically fewer in the OSA compared with the non-OSA patients. CONCLUSIONS: OSA for lumbar spinal fusion surgery decreases in-hospital and 1-year postoperative opioid consumption. The minimal use of opioids may also lead to shorter emergence to extubation times, shorter recovery room stays, and fewer discharges to nonhome facilities.
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Analgésicos Opioides , Anestesia , Masculino , Humanos , Persona de Mediana Edad , Analgésicos Opioides/uso terapéutico , Estudios de Cohortes , Dolor Postoperatorio/tratamiento farmacológico , Estudios Retrospectivos , Hospitales , Derivados de la MorfinaRESUMEN
The objective of this guideline is to provide up-to-date, evidence-based recommendations for the management of SLE that builds upon the existing treatment guideline for adults living with SLE published in 2017. This will incorporate advances in the assessment, diagnosis, monitoring, non-pharmacological and pharmacological management of SLE. General approaches to management as well as organ-specific treatment, including lupus nephritis and cutaneous lupus, will be covered. This will be the first guideline in SLE using a whole life course approach from childhood through adolescence and adulthood. The guideline will be developed with people with SLE as an important target audience in addition to healthcare professionals. It will include guidance related to emerging approved therapies and account for National Institute for Health and Care Excellence Technology Appraisals, National Health Service England clinical commissioning policies and national guidance relevant to SLE. The guideline will be developed using the methods and rigorous processes outlined in 'Creating Clinical Guidelines: Our Protocol' by the British Society for Rheumatology.
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Background: Perioperative cardiac arrest continues to occur. This study aims to identify risk factors for perioperative cardiac arrest in children presenting for noncardiac surgery and characterise its outcomes. Methods: Using the National Surgical Quality Improvement Program (NSQIP) Pediatric Database 2019 and 2020, 261 276 patients were included. Patients ≥18 yr and cardiac surgical procedures were excluded. Exploratory multivariable analysis was performed to identify independent predictors of perioperative cardiac arrest and associated outcomes. Results: The overall rate of cardiac arrest was 0.1%, with an intraoperative rate of 0.05% and 48-h postoperative rate of 0.06%. Significant risk factors for perioperative cardiac arrest included age <12 months (adjusted odds ratios [aOR] 3.07, P<0.001), American Society of Anesthesiology Physical Status classification (ASA-PS 3 aOR=2.57, P<0.001; ASA-PS 4 aOR=5.27, P<0.001; ASA-PS 5 aOR=13.1, P<0.001), admission through the emergency room (aOR 1.7, P=0.003), inpatient (aOR 2.19, P=0.008), major and severe cardiac disease (aOR 1.58, P=0.008), impaired cognitive status (aOR 1.54, P=0.009), and longer anaesthesia duration (aOR 1.1 per 30 min, P<0.001). Perioperative cardiac arrest was significantly associated with longer hospital length of stay, reoperation, differences in discharge destination, and 30-day mortality. In addition, patients experiencing postoperative cardiac arrest had a significantly higher rate of in-hospital and 30-day mortality than those experiencing intraoperative cardiac arrest. Conclusions: The incidence of cardiac arrest in this study is higher than previously reported. This may be related to selection bias and the rigorous data collection required by NSQIP. Lower 30-day mortality after intraoperative cardiac arrest could be related to prompt recognition and rapid initiation of intraoperative resuscitation. Identification of perioperative risk factors for cardiac arrest is crucial to improve the safety and quality of patient care.
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STUDY DESIGN: Retrospective cross-sectional. OBJECTIVES: To determine associations between Hounsfield Units (HU) within a Region of interest (ROI) on CT scans and Dual Energy X-ray Absorptiometry (DEXA) measurements in children and adolescents. SUMMARY OF BACKGROUND DATA: HU on CT scans as a proxy for bone mineral density (BMD) is widely used in adults. However, the utility of CT as a proxy for BMD have not been evaluated in children and adolescents. METHODS: Patients younger than 18 years with a lumbar spine CT scan and a DEXA within 6 months of each other were identified. A ROI was used to measure the HU at each lumbar vertebral body on mid-axial cuts. Charts were reviewed for demographics, medical co-morbidities and DEXA reports. Correlation coefficients were calculated between mean DEXA Z-score and HU value. Patients were also stratified by Z-score (≥ -1.0, between -1.0 and -2.0, and ≤-2.0) and matched by age and BMI to a cohort of healthy children and compared. RESULTS: A moderate correlation between mean DEXA Z-score and mean HU on CT was found (r2=0.42, P<0.001). After matching for age and BMI, 21 patients in each group between the age of 4 and 17 years were analyzed. The mean HU value of the control group was 231.69. When stratified by Z-score (≥ -1.0, between -1.0 and -2.0, and ≤-2.0), the mean HU values were 244.59, 216.50, and 176.54, respectively. Patients with a Z-score of ≤-2.0 had a significantly lower mean HU than age matched controls. CONCLUSIONS: HU on lumbar CT in children and adolescents with DEXA Z-scores less than -2.0, were lower when compared to healthy age and BMI matched controls. This study suggests that HU on opportunistic CT scans of the spine may be used as a reasonable proxy for BMD in the pediatric population.
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Objective: Patients undergoing congenital cardiac surgery require induction of anesthesia. Our objective was to identify the median anesthesia ready time and the predictors of this time. Methods: By using the Society of Thoracic Surgeons Congenital Heart Surgery Database, we identified patients who underwent cardiopulmonary bypass procedures from 2017 to 2021. Univariate and multivariable regression modeling to predict the anesthesia ready time was performed using mixed-effects linear regression. Results: After exclusion of outliers, 44,418 cases were analyzed. The median anesthesia ready time was 51 minutes (interquartile range, 38-66). On multivariable analysis, independent predictors of a longer anesthesia ready time included decreasing weight (0.3 min/10 kg, 95% CI, 0.1-0.6; P = .011), prematurity (1.5 minutes, 95% CI, 0.8-2.2; P < .001), and presence of chromosomal abnormality (3.4 minutes, 95% CI, 1.5-5.2; P < .001). An increase in the duration in anesthesia ready time was seen with increasing Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery mortality category with an additional 7.8 minutes (95% CI, 5.2-10.4; P < .001) for a Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery 5 procedure compared with Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery 1. Emergency versus elective case designation was associated with an anesthesia ready time reduction of 3.6 minutes (95% CI, 1.1-6.1; P = .005), and an afternoon case start was associated with an anesthesia ready time reduction of 4.2 minutes (95% CI, 2.8-5.6; P < .001). The presence of an anesthesia trainee increased the anesthesia ready time by 3.8 minutes (95% CI, 2.6-5.0; P < .001). The presence of an airway in situ decreased the anesthesia ready time by 3.6 minutes (95% CI, 1.6-5.5; P < .001), whereas an in situ arterial line decreased the anesthesia ready time by 7.4 minutes (95% CI, 4.6-10.2; P < .001). Placement of a central venous line increased the anesthesia ready time by 8.5 minutes (95% CI, 5.9-11.1; P < .001). Conclusions: The median anesthesia ready time was 51 minutes. For patients with characteristics associated with prolonged anesthesia ready time, consideration should be given to allocation of additional anesthesia staffing to improve efficiency.