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1.
World Neurosurg ; 160: e471-e480, 2022 04.
Article in English | MEDLINE | ID: mdl-35074543

ABSTRACT

OBJECTIVE: To analyze cervical spine injuries resulting from recreational activity in shallow ocean water amid high-energy breaking waves. METHODS: Single-center 10-year review of patients who sustained cervical injuries at the beach in Long Island, New York, USA. A systematic review following the PRISMA guidelines was also performed. RESULTS: Nineteen patients (age 17-79 years) sustained cervical injury from high-energy breaking waves while in shallow beach water. Six patients dived into a wave; 6 patients were struck by a large wave while standing upright; and 7 tumbled in the waves while engaged in nonspecified recreational activity. All 7 patients with subaxial cervical AO Spine Injury Score (AO-SIS) >10 had cervical spine injury with cord signal change and required operative management. Diving mechanism, AO-SIS >10, and cord signal change all predicted significant disability or death at 12 months (P < 0.01). The present study and 7 additional studies reporting on 534 patients (mean age, 45.4 years) were analyzed. Within the reported literature, most patients (94.2%) sustained a spinal cord injury. On long-term follow-up, an estimated 64.8% of patients had permanent neurologic injury and 12.5% had permanent quadriplegia. CONCLUSIONS: We offer the first description of cervical injuries sustained in water-related recreational activity using the AO-SIS. The morphology of injuries varied significantly and seemed to depend on body position and wave kinetic energy. Patients presenting with cervical injury in this setting and yielding AO-SIS >10 are likely to have poor functional recovery.


Subject(s)
Spinal Cord Injuries , Spinal Fractures , Spinal Injuries , Adolescent , Adult , Aged , Cervical Vertebrae/injuries , Humans , Middle Aged , Retrospective Studies , Spinal Cord Injuries/epidemiology , Spinal Cord Injuries/surgery , Spinal Injuries/surgery , Trauma Centers , Young Adult
2.
J Neurosurg Sci ; 66(5): 391-398, 2022 Oct.
Article in English | MEDLINE | ID: mdl-34313415

ABSTRACT

INTRODUCTION: Enhanced recovery after surgery (ERAS) programs may be implemented to minimize the body's stress response to surgery and enable a safe and timely discharge. Successful implementation involves a multifaceted approach from surgeons, anesthesiologists, nurses, nutritionists, and nonclinical staff. EVIDENCE ACQUISITION: National databases (MEDLINE (PubMed), Cochrane Central, and Google Scholar databases) were searched to identify studies on the clinical implementation of ERAS protocols in neurosurgery. A systematic review was chosen to select studies and pooled data analysis was performed. EVIDENCE SYNTHESIS: Thirty-five studies reported the use of enhanced recovery after surgery (ERAS), with 13 studies on cranial surgery and 22 on spinal surgery. Overall, 27 studies reported length of stay, 10 studies reported differences in opioid use, 21 studies reported either complications, readmission rate, or long term (>30 day) follow-up, 14 studies reported patient feedback, and 10 studies reported cost reduction of ERAS implementation. Findings supported significant reduction in length of stay, opioid use, and costs associated with ERAS regimens. Complications, readmission rates, and follow-up pain scores remained similar in ERAS and control groups. CONCLUSIONS: Our review finds that ERAS regimen implementation can serve an important role in facilitating clinical quality improvement and cost-effective care in all applications related to neurosurgical care and recovery. While application of ERAS in neurological surgery may have an important role in facilitating patient beneficial and cost-effective care, the findings of this review confirm that several challenges remain in select settings and prevent widespread implementation.


Subject(s)
Enhanced Recovery After Surgery , Analgesics, Opioid , Humans , Length of Stay , Neurosurgical Procedures/methods , Patient Discharge , Postoperative Complications/prevention & control
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