ABSTRACT
STUDY DESIGN: Prospective observational trial in a community hospital setting. OBJECTIVES: To examine the effect on patient-reported outcome of a clinical practice, namely, decrease in hospital length of stay for single-level lumbar microdiscectomy. SUMMARY OF BACKGROUND DATA: Health care reform and the economic demands of managed care have created increasing pressure to manage health care resources more effectively. Spine surgery is one of the most common surgeries. METHODS: Starting in October 1993, length of stay for patients undergoing lumbar microdiscectomy was decreased at the study institution. Patients completed questionnaires (SF-36) before surgery and 3 months after surgery that assessed health status, back-related functional status, and treatment satisfaction. Comparisons were made between the intervention group and a historical control group and between 1-day and 2-day patients. RESULTS: SF-36 scores 3 months after surgery approximated age and sex norms of five of the eight SF-36 scales and improved significantly on the remaining three scales. The physical functioning and general health scores were significantly better for the 1-day than the 2-day patients. Patient satisfaction was similar in all groups. Hospital charges for the 1-day patients were $781 less per patient than for the 2-day patients. CONCLUSIONS: Hospital length of stay for lumbar microdiscectomy can be decreased without adverse effect on short-term patient self-reported health status or satisfaction and with lower hospital charges. This model assesses the effect of efficient management of health care resources on patient-perceived quality and satisfaction.
Subject(s)
Length of Stay/economics , Low Back Pain/economics , Low Back Pain/surgery , Lumbar Vertebrae/surgery , Adult , Diskectomy , Female , Health Care Costs , Hospitals, Community , Humans , Male , Managed Care Programs/economics , Managed Care Programs/standards , Middle Aged , Patient Satisfaction , Prospective Studies , Treatment OutcomeSubject(s)
Dimethyl Sulfoxide/therapeutic use , Intracranial Pressure/drug effects , Adolescent , Adult , Brain Concussion/drug therapy , Cerebral Hemorrhage/drug therapy , Child, Preschool , Diuresis/drug effects , Encephalitis/drug therapy , Female , Hematoma/drug therapy , Herpes Simplex/drug therapy , Humans , Male , Middle AgedABSTRACT
We studied the neuropsychologic effect of the superficial temporal artery to middle cerebral artery bypass procedure. Nineteen patients with disease (12 surgical and 7 medical therapy) of the anterior carotid circulation were evaluated by neuropsychologic tests with an average test-retest interval of 8 weeks. The 12 surgical and 7 medical patients were comparable in age, education, and preoperative test scores. All surgical patients achieved patency of anastomosis. Both groups improved on some measures and there were no significant differences between groups over time. No patients have deteriorated. The results were compatible with either a spontaneous remission or a practice effect interpretation.
Subject(s)
Cerebral Revascularization , Cerebrovascular Disorders/surgery , Ischemic Attack, Transient/surgery , Mental Processes , Cerebrovascular Disorders/psychology , Humans , Ischemic Attack, Transient/psychology , Memory , Motor Skills , Verbal BehaviorABSTRACT
The authors report two cases of transient ischemic attacks (TIA's) involving the brain stem. The TIA's were due to microemboli that originated from a carotid bifurcation atherosclerotic plaque and travelled through a persistent trigeminal artery.
Subject(s)
Brain Stem/blood supply , Cerebral Arteries/abnormalities , Intracranial Embolism and Thrombosis/complications , Animals , Humans , Intracranial Arteriosclerosis/complications , Ischemic Attack, Transient/etiology , Male , Middle Aged , RabbitsABSTRACT
Two cases of dysphagia secondary to anterior cervical osteophytes were successfully treated at the University of Oregon Medical School by surgical excision of the osteophytes. In both cases the cervical osteophytes caused mechanical obstruction to deglutition by esophageal compression. Postoperative x-ray examination confirmed relief of obstruction. Related cases, clinical features, diagnostic steps, and possible mechanisms are discussed.
