Subject(s)
Inflammatory Bowel Diseases/epidemiology , Pyoderma Gangrenosum/epidemiology , Socioeconomic Factors , Adolescent , Adult , Black or African American/statistics & numerical data , Age Factors , Aged , Aged, 80 and over , Comorbidity , Cross-Sectional Studies , Female , Humans , Income , Male , Middle Aged , Pyoderma Gangrenosum/ethnology , United States/epidemiology , White People/statistics & numerical data , Young AdultABSTRACT
BACKGROUND CONTEXT: Central cord syndrome (CCS) is a common cause of incomplete spinal cord injury. However, to date, national trends in the management and mortality after CCS are not fully understood. PURPOSE: To analyze how patient, surgical, and institutional factors influence surgical management and mortality after CCS. STUDY DESIGN: A retrospective cohort analysis. PATIENT SAMPLE: The Nationwide Inpatient Sample (NIS) was queried for records of patients with a diagnosis of CCS from 2003 to 2010. OUTCOME MEASURES: They included in hospital mortality and surgical management, including anterior cervical decompression and fusion (ACDF), posterior cervical decompression and fusion (PCDF), and posterior cervical decompression (PCD). METHODS: Using International Classification of Diseases, Ninth Revision, Clinical Modification codes, patient records with a diagnosis of CCS from 2003 to 2010 were selected from the NIS database and sorted by inpatient mortality and surgical management. Demographic information (age, gender, and race) and hospital characteristics were evaluated with χ(2)-tests for categorical variables and t tests for continuous variables. Multivariate logistic regression models controlled for confounding. RESULTS: In this sample of 16,134 patients, a total of 39.7% of patients (6,351) underwent surgery. ACDF was most common (19.4%), followed by PCDF (7.4%) and PCD (6.8%). From 2003 to 2010, surgical management increased by an average of 40% each year. The overall inpatient mortality rate was 2.6%. Increasing age and comorbidities were associated with higher rates of patient mortality and a decreasing surgical rate (p<.01). Hospitals greater than 249 beds (p<.01) and the south (p<.01) were associated with a higher surgical rate. Rural hospitals (p<.01) and people in the second income quartile (p<.01) were associated with higher inpatient mortality. CONCLUSIONS: Elderly patients with medical comorbidities are associated with a lower surgical rate and a higher mortality rate. Surgical management was more prevalent in the south and large hospitals. Mortality was higher in rural hospitals. It is important for surgeons to understand how patient, surgical, and institutional factors influence surgical management and mortality.
Subject(s)
Central Cord Syndrome/surgery , Cervical Vertebrae/surgery , Decompression, Surgical/methods , Spinal Fusion/methods , Adult , Aged , Aged, 80 and over , Cohort Studies , Comorbidity , Decompression, Surgical/mortality , Female , Hospital Mortality , Humans , Logistic Models , Male , Middle Aged , Retrospective Studies , Spinal Fusion/mortalityABSTRACT
OBJECTIVE: Sinemet, a combination drug containing carbidopa and levodopa is considered the gold standard therapy for the treatment of Parkinson's disease (PD). When approved by the Food and Drug Administration (FDA) in 1988, a maximum daily dosage limit of 800 mg (eight tablets) of the 25/100 carbidopa/levodopa formulation was introduced. Overall, the FDA approval was a historic success; however, the pill limit has been hardcoded into many online medical record systems. This study investigates the 800 mg threshold by using a prospectively collected database of patient information. DESIGN: A retrospective cohort study: (Part I) cross-sectional, (Part II) longitudinal. SETTING AND PARTICIPANTS: PD patients at a Movement Disorders Center in a large academic, tertiary medical setting. OUTCOME MEASURES: An analysis was performed using carbidopa/levodopa at dosages below and above the 800 mg threshold. A secondary analysis was then performed using two consecutive clinic visits to determine the effects of crossing the 800 mg threshold. Comparisons were made on standardised scales. RESULTS: There was no significant difference in motor, mood and quality-of-life scores in patients consuming below and above the 800 mg carbidopa/levodopa threshold, though a mild worsening in dyskinesia duration was noted without worsening in dyskinesia pain and disability. In PD patients who crossed the 800 mg threshold between two consecutive clinic visits, a significant improvement in depressive symptoms and quality-of-life measures was demonstrated, and in these patients there was no worsening of motor fluctuations or dyskinesia. CONCLUSIONS: The data suggest that PD patients have the potential for enhanced clinical benefits when eclipsing the 800 mg carbidopa/levodopa threshold. Many patients will likely need to eclipse the 800 mg threshold and pharmacies and insurance companies should be aware of the requirements that may extend beyond approval limits.