The LACE + index as a predictor of 90-day urologic surgery outcomes.

PURPOSE: This study assessed the ability of the LACE + [Length of stay, Acuity of admission, Charlson Comorbidity Index (CCI) score, and Emergency department visits in the past 6 months] index to predict adverse outcomes after urologic surgery. METHODS: LACE + scores were retrospectively calculated for all consecutive patients (n = 9824) who received urologic surgery at one multi-center health system over 2 years (2016-2018). Coarsened exact matching was employed to sort patient data before analysis; matching criteria included duration of surgery, BMI, and race among others. Outcomes including unplanned hospital readmission, emergency room visits, and reoperation were compared for patients with different LACE + quartiles. RESULTS: 722 patients were matched between Q1 and Q4; 1120 patients were matched between Q2 and Q4; 2550 patients were matched between Q3 and Q4. Higher LACE + score significantly predicted readmission within 90 days (90D) of discharge for Q1 vs Q4 and Q2 vs Q4. Increased LACE + score also significantly predicted 90D emergency room visits for Q1 vs Q4, Q2 vs Q4, and Q3 vs Q4. LACE + score was also significantly predictive of 90D reoperation for Q1 vs Q4. LACE + score did not predict 90D reoperation for Q2 vs Q4 or Q3 vs Q4 or 90D readmission for Q3 vs. Q4. CONCLUSION: These results suggest that LACE + may be a suitable prediction model for important patient outcomes after urologic surgery.

Temporal expression of Laminin-111 in the developing rat larynx.

Laminin-111 is a basement membrane protein that participates in motor innervation and reinnervation. During axonal pathfinding, laminin-111 interacts with netrin-1 (NTN1) and changes its attractant growth cone properties into repulsion. While previous models of recurrent laryngeal nerve (RLN) transection show increased Laminin-111 and NTN1 production after injury, developmental expression in the larynx has not been defined. This study investigates the expression of laminin-111 in laryngeal muscles during primary laryngeal innervation of Sprague Dawley rats. Adult larynges and embryos were sectioned for immunohistochemistry with ßIII-Tubulin, laminin subunit α-1 (LAMA1), NTN1, and α-bungarotoxin. Sections were processed for single-molecule inexpensive RNA fluorescence in situ hybridization analysis of LAMA1 mRNA. LAMA1 expression increased in all intrinsic laryngeal muscles, except the medial thyroarytenoid (MTA), at E20.5. At E20.5 there was increased expression in the lateral thyroarytenoid (LTA) and posterior cricoarytenoid (PCA) compared to the MTA. NTN1 upregulation was limited to the LTA and lateral cricoarytenoid (LCA) at E16.5 without any increase in the MTA or PCA. LAMA1 and NTN1 expression did not strictly follow expected patterns relative to the known timing of innervation and does not appear to be acting similarly to its role following RLN injury. These differences between developmental and post-injury innervation provide targets for investigations of therapeutics after nerve injury.

Composite Score for Outcome Prediction in Gynecologic Surgery Patients.

BACKGROUND: The LACE+ index is a well-studied metric that compacts patient data in an effort to assess readmission risk. PURPOSE: Assess the capacity of LACE+ scores for predicting short-term undesirable outcomes in an entire single-center population of patients undergoing gynecologic surgery. IMPORTANCE AND RELEVANCE TO HEALTHCARE QUALITY: Proactive identification of high-risk patients, with tools such as the LACE+ index, may serve as the first step toward appropriately engaging resources for reducing readmissions. METHODS: This study was a retrospective analysis that used coarsened exact matching. All gynecologic surgery cases over 2 years within a single health system (n = 12,225) were included for analysis. Outcomes of interest were unplanned readmission, emergency room (ER) evaluation, and return to surgery. Composite LACE+ scores were separated into quartiles and matched. For outcome comparison, matched patients were assessed by LACE+ quartile, using Q4 as the reference group. RESULTS: Increasing LACE+ score reflected a higher rate of readmission (p = .003, p = .001) and visits to the ER at 30 postoperative days (p < .001). CONCLUSION: The data presented here suggest that LACE+ index is a viable metric for patient outcome prediction following gynecologic surgery.

Prediction of Adverse Outcomes Within 90 Days of Surgery in a Heterogeneous Orthopedic Surgery Population.

INTRODUCTION: The LACE+ index has been shown to predict readmissions; however, LACE+ has not been validated for extended postoperative outcomes in an orthopedic surgery population. The purpose of this study is to examine whether LACE+ scores predict unplanned readmissions and adverse outcomes following orthopedic surgery. Use of the LACE1 index to proactively identify at-risk patients may enable actions to reduce preventable readmissions. METHODS: LACE+ scores were retrospectively calculated at the time of discharge for all consecutive orthopedic surgery patients (n = 18,893) at a multicenter health system over 3 years (2016-2018). Coarsened exact matching was used to match patients based on characteristics not assessed in the LACE+ index. Outcome differences between matched patients in different LACE quartiles (i.e. Q4 vs. Q3, Q2, and Q1) were analyzed. RESULTS: Higher LACE+ scores significantly predicted readmission and emergency department visits within 90 days of discharge and for 30-90 days after discharge for all studied quartiles. Higher LACE+ scores also significantly predicted reoperations, but only between Q4 and Q3 quartiles. CONCLUSIONS: The results suggest that the LACE+ risk-prediction tool may accurately predict patients with a high likelihood of adverse outcomes after a broad array of orthopedic procedures.

Primary Orbital Melanoma: An Investigation of a Rare Malignancy Using the National Cancer Database.

OBJECTIVES: Primary orbital melanoma (POM) is a rare disease with limited data on survival and best treatment practices. Here we utilize the National Cancer Database (NCDB) to determine the overall survival (OS) and covariates that influence mortality. STUDY DESIGN: Retrospective cohort study. METHODS: All patients diagnosed with POM from 2004 to 2016 were identified in the NCDB. Patient and oncologic data were analyzed using the Kaplan-Meier method and multivariate models for the primary outcome of OS. RESULTS: A total of 129 patients were identified. Median OS was 36.9 months (95% confidence interval [CI] 24.1-78.7 months) with mean 5-year survival of 42.0% (CI 33.2%-53.2%). Treatments received included surgery alone (43.4%), radiation alone (23.3%), and surgery followed by radiation (20.2%). The multivariate model demonstrated an increased risk of death associated with age over 80 years (hazard ratio [HR] 3.41, CI 1.31-8.86, P = .012), a Charlson-Deyo comorbidity score of 2 or greater (HR 5.30, CI 1.87-15.03, P = .002), and no treatment (HR 2.28, CI 1.03-5.06, P = .042). For every 1 cm increase in tumor size, there was an increased risk of death (HR 1.06, CI 1.00-1.13, P = .039). When compared to surgery alone, no other treatment modality had an effect on OS. CONCLUSIONS: This study leveraged multiyear data from the NCDB to provide prognostic and demographic information on the largest known cohort of POM cases. Increased age, increased comorbidities, not receiving treatment, and larger tumor size were associated with increased mortality. There was no clear survival advantage for specific treatments. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1790-1797, 2021.

Short-Term Impact of Bracing in Multi-Level Posterior Lumbar Spinal Fusion.

BACKGROUND: Clinical practice in postoperative bracing after posterior lumbar spine fusion (PLF) is inconsistent between providers. This paper attempts to assess the effect of bracing on short-term outcomes related to safety, quality of care, and direct costs. METHODS: Retrospective cohort analysis of consecutive patients undergoing multilevel PLF with or without bracing (2013-2017) was undertaken (n = 980). Patient demographics and comorbidities were analyzed. Outcomes assessed included length of stay (LOS), discharge disposition, quality-adjusted life years (QALY), surgical-site infection (SSI), total cost, readmission within 30 days, and emergency department (ED) evaluation within 30 days. RESULTS: Amongst the study population, 936 were braced and 44 were not braced. There was no difference between the braced and unbraced cohorts regarding LOS (P = .106), discharge disposition (P = .898), 30-day readmission (P = .434), and 30-day ED evaluation (P = 1.000). There was also no difference in total cost (P = .230) or QALY gain (P = .740). The results indicate a significantly lower likelihood of SSI in the braced population (1.50% versus 6.82%, odds ratio = 0.208, 95% confidence interval = 0.057-0.751, P = .037). There was no difference in relevant comorbidities (P = .259-1.000), although the braced cohort was older than the unbraced cohort (63 versus 56 y, P = .003). CONCLUSION: Bracing following multilevel posterior lumbar fixation does not alter short-term postoperative course or reduce the risk for early adverse events. Cost analysis show no difference in direct costs between the 2 treatment approaches. Short-term data suggest that removal of bracing from the postoperative regimen for PLF will not result in increased adverse outcomes.

Predictive index for 90-day postoperative outcomes following gynecologic surgery.

OBJECTIVES: Assessment of the potential of LACE+ index scores in patients undergoing gynecologic surgery to predict short-term undesirable outcomes. STUDY DESIGN: Retrospective study over a 2-year time period (2016-2018). METHODS: Coarsened exact matching was used to assess the predictive capacity of the LACE+ index among all gynecologic surgery cases over a 2-year period (2016-2018) at 1 health system (N = 12,225). Study subjects were matched on characteristics not assessed by LACE+, including race and duration of surgery. For comparison of outcomes, LACE+ score was divided into quartiles and otherwise matched populations were compared in reference to LACE+ quartile (Q): Q4 vs Q1, Q4 vs Q2, Q4 vs Q3. RESULTS: A total of 1715 patients were matched for Q1 to Q4, 1951 patients were matched for Q2 to Q4, and 1822 patients were matched for Q3 to Q4. Escalating LACE+ score significantly predicted increased readmission, reoperation, and emergency department (ED) visits from 30 to 90 postoperative days as well as readmission, reoperation, and ED visits from 0 to 90 postoperative days. CONCLUSIONS: The results of this study suggest that the LACE+ index is suitable as a prediction model for important patient outcomes in a gynecologic surgery population.

Composite score for prediction of 30-day orthopedic surgery outcomes.

The LACE+ (Length of stay, Acuity of admission, Charlson Comorbidity Index score, and Emergency department visits in the past 6 months) risk-prediction tool has never been tested in an orthopedic surgery population. LACE+ may help physicians more effectively identify and support high-risk orthopedics patients after hospital discharge. LACE+ scores were retrospectively calculated for all consecutive orthopedic surgery patients (n = 18 893) at a multi-center health system over 3 years (2016-2018). Coarsened exact matching was employed to create "matched" study groups with different LACE+ score quartiles (Q1, Q2, Q3, Q4). Outcomes were compared between quartiles. In all, 1444 patients were matched between Q1 and Q4 (n = 2888); 2079 patients between Q2 and Q4 (n = 4158); 3032 patients between Q3 and Q4 (n = 6064). Higher LACE+ scores significantly predicted 30D readmission risk for Q4 vs Q1 and Q4 vs Q3 (P < .001). Larger LACE+ scores also significantly predicted 30D risk of ED visits for Q4 vs Q1, Q4 vs Q2, and Q4 vs Q3 (P < .001). Increased LACE+ score also significantly predicted 30D risk of reoperation for Q4 vs Q1 (P = .018), Q4 vs Q2 (P < .001), and Q4 vs Q3 (P < .001).

Evaluation of the LACE+ Index for Short-term Cardiac Surgery Outcomes: A Coarsened Exact Match Study.

BACKGROUND: The potential of length of stay, acuity of admission, Charlson Comorbidity Index score, and emergency department visits in the past 6 months (LACE+) scores in patients undergoing cardiac surgery to predict short-term undesirable outcomes was examined. METHODS: Coarsened exact matching was used to assess the predictive capacity of the LACE+ index among all cardiac surgery cases over a 2-year period (2016-2018) at 1 health system (n = 4001). Study subjects were matched according to characteristics not assessed by LACE+, including duration of surgery, wound class, body mass index, insurance type, median household income, and race. For a comparison of outcomes, LACE score was divided into quartiles and otherwise matched populations were compared in reference to LACE quartile (Q): Q4 versus Q1, Q4 versus Q2, and Q4 versus Q3. RESULTS: Escalating LACE+ score significantly predicted increased readmission (6.99% versus 25.92% for Q1 versus Q4, 12.79% versus 26.74% for Q2 versus Q4, and 20.52% versus 27.66% for Q3 versus Q4, respectively; P < .001, P < .001, and P = .003), reoperation (2.39% versus 7.73% for Q1 versus Q4, and 4.33% versus 7.67% for Q2 versus Q4, respectively; P < .001 and P = .015, respectively), and emergency room visits at 30 days after surgery (6.64% versus 13.65% for Q1 versus Q4, and 11.20% versus 14.84% for Q2 versus Q4, respectively; P < .001 and P = .041, respectively) as well as readmission, reoperation, and emergency room visits from 30 to 90 days and 0 to 90 days after surgery. Increasing LACE score predicted higher rates of death during follow-up within 30 and 90 postoperative days (P < .001). CONCLUSIONS: The LACE+ index may be suitable as a prediction model for important patient outcomes in a cardiac surgery population.

The Utility of Cervical Spine Bracing As a Postoperative Adjunct to Multilevel Anterior Cervical Spine Surgery.

BACKGROUND: Use of cervical bracing/collar subsequent to anterior cervical spine discectomy and fusion (ACDF) is variable. Outcomes data regarding bracing after ACDF are limited. Here, we study the impact of bracing on short-term outcomes related to safety, quality of care, and direct costs in multilevel ACDF. METHODS: Retrospective cohort analyses of all consecutive patients undergoing multilevel ACDF with or without bracing from 2013 to 2017 was undertaken (n = 616). Patient demographics and comorbidities were analyzed. Tests of independence and logistic regressions were used to assess differences in length of stay (LOS), discharge disposition (home, assisted rehabilitation facility [ARF], or skilled nursing facility [SNF]), quality-adjusted life year (QALY), direct cost, readmission within 30 days, and emergency room (ER) visits within 30 days. RESULTS: Amongst the study population, 553 were braced and 63 were not braced. There was no difference in comorbidities (P > .05) such as obesity, smoking, chronic obstructive pulmonary disease, hypertension, coronary artery disease, congestive heart failure, and problem list number. A significant difference in American Society of Anesthesiologists (ASA) score was found, with more ASA 2 patients in the braced cohort and more ASA 3 patients in the unbraced cohort (P = .007). LOS was extended for the unbraced group (median 156.9 ± 211.4 versus 86.67 ± 130.6 h, P = .003), and ER visits within 30 days were 0.21 times less likely in the braced group (P = .006). There was no difference in readmission (P = .181), QALY gain (P = .968), and direct costs (P = .689). CONCLUSION: Bracing following multilevel cervical fixation does not alter short-term postoperative course or reduce the risk for early adverse outcomes in a significant manner.

LACE+ index as a predictor of 90-day plastic surgery outcomes.

OBJECTIVES: This study used coarsened exact matching to assess the ability of the LACE+ index to predict adverse outcomes after plastic surgery. STUDY DESIGN: Two-year retrospective study (2016-2018). METHODS: LACE+ scores were retrospectively calculated for all patients undergoing plastic surgery at a multicenter health system (N = 5744). Coarsened exact matching was performed to sort patient data before analysis. Outcomes including unplanned hospital readmission, emergency department visits, and reoperation were compared for patients in different LACE+ score quartiles (Q1, Q2, Q3, Q4). RESULTS: A total of 2970 patient procedures were matched during coarsened exact matching. Increased LACE+ score significantly predicted readmission within 90 days of discharge for Q4 versus Q1 (6.28% vs 1.91%; P = .003), Q4 versus Q2 (12.30% vs 5.56%; P <.001), and Q4 versus Q3 (13.84% vs 7.33%; P <.001). Increased LACE+ score also significantly predicted emergency department visits within 90 days for Q4 versus Q1 (9.29% vs 3.01%; P <.001), Q4 versus Q2 (11.31% vs 3.57%; P <.001), and Q4 versus Q3 (13.70% vs 8.48%; P = .003). Higher LACE+ score also significantly predicted secondary reoperation within 90 days for Q4 versus Q1 (3.83% vs 1.37%; P = .035), Q4 versus Q2 (5.95% vs 3.37%; P = .042), and Q4 versus Q3 (7.50% vs 3.26%; P <.001). CONCLUSIONS: The results of this study demonstrate that the LACE+ index may be suitable as a prediction model for patient outcomes in a plastic surgery population.

Predicting short-term outcomes following supratentorial tumor surgery.

OBJECTIVES: The LACE+ index risk prediction tool has not been successfully used to predict short-term outcomes after neurosurgery. This study assessed the ability of LACE+ to predict 30-day (30D) adverse outcomes after supratentorial brain tumor surgery. PATIENTS AND METHODS: LACE+ scores were retrospectively calculated for consecutive patients (n = 624) who received surgery for supratentorial tumors at one multi-center health system (2017-2019). Coarsened exact matching was employed to control for confounding variables. Outcomes including unplanned hospital readmission, emergency department visits, and death were compared for patients with different LACE+ score quartiles (Q1, Q2, Q3, Q4). RESULTS: 134 patients were matched between Q1 and Q4; 152 patients between Q2 and Q4; 192 patients between Q3 and Q4. LACE+ score was not found to predict readmission within 30D of discharge for Q1 vs Q4 (p = 0.239), Q2 vs Q4 (p = 0.336), or Q3 vs Q4 (p = 0.739). LACE + score also did not predict 30D risk of emergency department visits for Q1 vs Q4 (p = 0.210), Q2 vs Q4 (p = 0.839), or Q3 vs Q4 (p = 0.167). LACE + did predict death within 30D of surgery for Q3 vs Q4 (1.04 % vs 7.29 %, p = 0.039), but not for Q1 vs Q4 (p = 0.625) or Q2 vs Q4 (p = 0.125). CONCLUSION: LACE + may not be suitable for characterizing short-term risk of certain perioperative events in a patient population undergoing supratentorial brain tumor surgery.

The LACE+ Index as a Predictor of 90-Day Supratentorial Tumor Surgery Outcomes.

BACKGROUND: The LACE+ (Length of stay, Acuity of admission, Charlson Comorbidity Index [CCI] score, and Emergency department [ED] visits in the past 6 mo) index risk-prediction tool has never been successfully tested in a neurosurgery population. OBJECTIVE: To assess the ability of LACE+ to predict adverse outcomes after supratentorial brain tumor surgery. METHODS: LACE+ scores were retrospectively calculated for all patients (n = 624) who underwent surgery for supratentorial tumors at the University of Pennsylvania Health System (2017-2019). Confounding variables were controlled with coarsened exact matching. The frequency of unplanned hospital readmission, ED visits, and death was compared for patients with different LACE+ score quartiles (Q1, Q2, Q3, and Q4). RESULTS: A total of 134 patients were matched between Q1 and Q4; 152 patients were matched between Q2 and Q4; and 192 patients were matched between Q3 and Q4. Patients with higher LACE+ scores were significantly more likely to be readmitted within 90 d (90D) of discharge for Q1 vs Q4 (21.88% vs 46.88%, P = .005) and Q2 vs Q4 (27.03% vs 55.41%, P = .001). Patients with larger LACE+ scores also had significantly increased risk of 90D ED visits for Q1 vs Q4 (13.33% vs 30.00%, P = .027) and Q2 vs Q4 (22.54% vs 39.44%, P = .039). LACE+ score also correlated with death within 90D of surgery for Q2 vs Q4 (2.63% vs 15.79%, P = .003) and with death at any point after surgery/during follow-up for Q1 vs Q4 (7.46% vs 28.36%, P = .002), Q2 vs Q4 (15.79% vs 31.58%, P = .011), and Q3 vs Q4 (18.75% vs 31.25%, P = .047). CONCLUSION: LACE+ may be suitable for characterizing risk of certain perioperative events in a patient population undergoing supratentorial brain tumor resection.

The LACE+ Index as a Predictor of 30-Day Patient Outcomes in a Plastic Surgery Population: A Coarsened Exact Match Study.

BACKGROUND: This study used coarsened exact matching to investigate the effectiveness of the LACE+ index (i.e., length of stay, acuity of admission, Charlson Comorbidity Index, and emergency department visits in the past 6 months) predictive tool in patients undergoing plastic surgery. METHODS: Coarsened exact matching was used to assess the predictive ability of the LACE+ index among plastic surgery patients over a 2-year period (2016 to 2018) at one health system (n = 5744). Subjects were matched on factors not included in the LACE+ index such as duration of surgery, body mass index, and race, among others. Outcomes studied included emergency room visits, hospital readmission, and unplanned return to the operating room. RESULTS: Three hundred sixty-six patients were matched and compared for quarter 1 to quarter 4 (n = 732, a 28.2 percent match rate); 504 patients were matched for quarter 2 to quarter 4 (n = 1008, a 36.7 percent match rate); 615 patients were matched for quarter 3 to quarter 4 (n = 1230, a 44.8 percent match rate). Increased LACE+ score significantly predicted readmission within 30 days for quarter 1 versus quarter 4 (1.09 percent versus 4.37 percent; p = 0.019), quarter 2 versus quarter 4 (3.57 percent versus 7.34 percent; p = 0.008), and quarter 3 versus quarter 4 (5.04 percent versus 8.13 percent; p = 0.028). Higher LACE+ score also significantly predicted 30-day reoperation for quarter 3 versus quarter 4 (1.30 percent versus 3.90 percent; p = 0.003) and emergency room visits within 30 days for quarter 2 versus quarter 4 (3.17 percent versus 6.75 percent; p = 0.008). CONCLUSION: The results of this study demonstrate that the LACE+ index may be suitable as a prediction model for patient outcomes in a plastic surgery population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Undiagnosed Obstructive Sleep Apnea as Predictor of 90-Day Readmission for Brain Tumor Patients.

BACKGROUND: Previously undiagnosed obstructive sleep apnea (OSA) is a known contributor to negative postoperative outcomes. The STOP-Bang questionnaire is a screening tool for OSA that has been validated in both medical and surgical populations. The authors have previously studied this screening tool in a brain tumor population at 30 days. The present study seeks to investigate the effectiveness of this questionnaire, for predicting 90-day readmissions in a population of brain tumor patients with previously undiagnosed OSA. METHODS: Included for analysis were all patients undergoing craniotomy for supratentorial neoplasm at a multihospital, single academic medical center. Data were collected from supratentorial craniotomy cases for which the patient was alive at 90 days after surgery (n = 238). Simple logistic regression analyses were used to assess the ability of the STOP-Bang questionnaire and subsequent single variables to accurately predict patient outcomes at 90 days. RESULTS: The sample included 238 brain tumor admissions, of which 50% were female (n = 119). The average STOP-Bang score was 1.95 ± 1.24 (range 0-7). A 1-unit higher increase in STOP-Bang score accurately predicted 90-day readmissions (odds ratio [OR] = 1.65, P = 0.001), 30- to 90-day emergency department visits (OR = 1.85, P < 0.001), and 30- to 90-day reoperation (OR = 2.32, P < 0.001) with fair accuracy as confirmed by the receiver operating characteristic (C-statistic = 0.65-0.76). However, the STOP-Bang questionnaire did not correlate with home discharge (P = 0.315). CONCLUSIONS: The results of this study suggest that undiagnosed OSA, as evaluated by the STOP-Bang questionnaire, is an effective predictor of readmission risk and health system utilization in a brain tumor craniotomy population with previously undiagnosed OSA.

The LACE+ Index as a Predictor of 30-Day Patient Outcomes in a Urologic Surgery Population: A Coarsened Exact Match Study.

OBJECTIVE: To examine the potential of LACE+ scores, in patients undergoing urologic surgery, to predict short-term undesirable outcomes. METHODS: Coarsened exact matching was used to assess the predictive value of the LACE+ index among all urologic surgery cases over a 2-year period (2016-2018) at 1 health system (n = 9824). Study subjects were matched on characteristics not assessed by LACE+, including duration of surgery and race, among others. For comparison of outcomes, matched populations were compared by LACE+ quartile with Q4 as the referent group: Q4 vs Q1, Q4 vs Q2, Q4 vs Q3. RESULTS: Seven hundred and twenty-two patients were matched for Q1-Q4; 1120 patients were matched for Q2-Q4; 2550 patients were matched for Q3-Q4. Escalating LACE+ score significantly predicted increased readmission (2.86% vs 4.91% for Q2 vs Q4; P = .012) and Emergency Room (ER) visits at 30 days postop (5.69% vs 11.37% for Q1 vs Q4, 4.11% vs 11.45% for Q2 vs Q4, 8.29% vs 13.32% for Q3 vs Q4; P <.001 for all). Increasing LACE score did not predict reoperation within 30 days or rate of death over follow-up within 30 postoperative days. CONCLUSION: The results of this study suggest that the LACE+ index is suitable as a prediction model for important patient outcomes in a urologic surgery population including unanticipated readmission and ER evaluation.

Undiagnosed obstructive sleep apnea as a predictor of 30-day readmission for brain tumor patients.

OBJECTIVE: Obstructive sleep apnea (OSA) is known to be associated with negative outcomes and is underdiagnosed. The STOP-Bang questionnaire is a screening tool for OSA that has been validated in both medical and surgical populations. Given that readmission after surgical intervention is an undesirable event, the authors sought to investigate, among patients not previously diagnosed with OSA, the capacity of the STOP-Bang questionnaire to predict 30-day readmissions following craniotomy for a supratentorial neoplasm. METHODS: For patients undergoing craniotomy for treatment of a supratentorial neoplasm within a multiple-hospital academic medical center, data were captured in a prospective manner via the Neurosurgery Quality Improvement Initiative (NQII) EpiLog tool. Data were collected over a 1-year period for all supratentorial craniotomy cases. An additional criterion for study inclusion was that the patient was alive at 30 postoperative days. Statistical analysis consisted of simple logistic regression, which assessed the ability of the STOP-Bang questionnaire and additional variables to effectively predict outcomes such as 30-day readmission, 30-day emergency department (ED) visit, and 30-day reoperation. The C-statistic was used to represent the receiver operating characteristic (ROC) curve, which analyzes the discrimination of a variable or model. RESULTS: Included in the sample were all admissions for supratentorial neoplasms treated with craniotomy (352 patients), 49.72% (n = 175) of which were female. The average STOP-Bang score was 1.91 ± 1.22 (range 0-7). A 1-unit higher STOP-Bang score accurately predicted 30-day readmissions (OR 1.31, p = 0.017) and 30-day ED visits (OR 1.36, p = 0.016) with fair accuracy as confirmed by the ROC curve (C-statistic 0.60-0.61). The STOP-Bang questionnaire did not correlate with 30-day reoperation (p = 0.805) or home discharge (p = 0.315). CONCLUSIONS: The results of this study suggest that undiagnosed OSA, as assessed via the STOP-Bang questionnaire, is a significant predictor of patient health status and readmission risk in the brain tumor craniotomy population. Further investigations should be undertaken to apply this prediction tool in order to enhance postoperative patient care to reduce the need for unplanned readmissions.

LACE+ Index as Predictor of 30-Day Readmission in Brain Tumor Population.

BACKGROUND: The LACE+ index (Length of stay, Acuity of admission, Charlson Comorbidity Index score, and Emergency department [ED] visits in the past 6 months) is a tool used to predict 30-day readmissions. We sought to examine this predictive tool in patients undergoing brain tumor surgery. METHODS: Admissions and readmissions for patients undergoing craniotomy for supratentorial neoplasm at a single multihospital academic medical center were analyzed. All brain tumor cases for which the patient was alive at 30 days after surgery were included (n = 352). Simple logistic regression analyses were used to assess the ability of the LACE+ index and subsequent single variables to accurately predict the outcome measures of 30-day readmission, reoperation, and ED visit. Analysis of the model's or variable's discrimination was determined by the receiver operating characteristic curve as represented by the C-statistic. RESULTS: The sample included admissions for craniotomy for supratentorial neoplasm (n = 352). Assessment of the LACE+ index demonstrates a 1.02× increased odds of 30-day readmission for every 1-unit increase in LACE+ score (P = 0.031, CI = 1.00-1.03). Despite this, analysis of the receiver operating characteristic curve indicates that LACE+ index has poor specificity in predicting 30-day readmission (C-statistic = 0.58). A 1-unit increase in LACE+ score also predicts a 0.98× reduction in odds of home discharge (P < 0.001, CI = 0.97-0.99, C-statistic = 0.70). But LACE+ index does not predict 30-day reoperation (P = 0.945) or 30-day ED visits (P = 0.218). CONCLUSIONS: The results of this study demonstrate that the LACE+ index is not yet suitable as a prediction model for 30-day readmission in a brain tumor population.

The LACE+ index fails to predict 30-90 day readmission for supratentorial craniotomy patients: A retrospective series of 238 surgical procedures.

OBJECTIVE: The LACE + index (Length of stay, Acuity of admission, Charlson Comorbidity Index (CCI) score, and Emergency department visits in the past 6 months) is a tool utilized to predict 30-90 day readmission and other secondary outcomes. We sought to examine the effectiveness of this predictive tool in patients undergoing brain tumor surgery. PATIENTS AND METHODS: Admissions and readmissions for patients undergoing craniotomy for supratentorial neoplasm at a single, multi-hospital, academic medical center, were analyzed. Key data was prospectively collected with the Neurosurgery Quality Improvement Initiative (NQII)-EpiLog tool. This included all supratentorial craniotomy cases for which the patient was alive at 90 days after surgery (n = 238). Simple logistic regression analyses were used to assess the ability of the LACE + index and subsequent single variables to accurately predict the outcome measures of 30-90 day readmission, 30-90 day emergency department (ED) visit, and 30-90 day reoperation. Analysis of the model's or variable's discrimination was determined by the receiver operating characteristic curve as represented by the C-statistic. RESULTS: The sample included admissions for craniotomy for supratentorial neoplasm (n = 238) from 227 patients, of which 50.00% were female (n = 119). The average LACE + index score was 53.48 ± 16.69 (Range 9-83). The LACE + index did not accurately predict 30-90 day readmissions (P = 0.127), 30-90 day ED visits (P = 0.308), nor reoperations (P = 0.644). ROC confirmed that the LACE + index was little better than random chance at predicting these events in this population (C-statistic = 0.51-0.58). However, a single unit increase in LACE + leads to a 0.97 times reduction in the odds of being discharged home with fair predictive accuracy (P < 0.001, CI = 0.96-0.98, C-statistic = 0.69). CONCLUSION: The results of this study show that the LACE + index is ill-equipped to predict 30-90 day readmissions in the brain tumor population and further analysis of significant covariates or other prediction tools should be undertaken.

Toll-Like Receptor 2 Signaling and Current Approaches for Therapeutic Modulation in Synucleinopathies.

The innate immune response in the central nervous system (CNS) is implicated as both beneficial and detrimental to health. Integral to this process are microglia, the resident immune cells of the CNS. Microglia express a wide variety of pattern-recognition receptors, such as Toll-like receptors, that detect changes in the neural environment. The activation of microglia and the subsequent proinflammatory response has become increasingly relevant to synucleinopathies, including Parkinson's disease the second most prevalent neurodegenerative disease. Within these diseases there is evidence of the accumulation of endogenous α-synuclein that stimulates an inflammatory response from microglia via the Toll-like receptors. There have been recent developments in both new and old pharmacological agents designed to target microglia and curtail the inflammatory environment. This review will aim to delineate the process of microglia-mediated inflammation and new therapeutic avenues to manage the response.