A real-world analysis of hybrid CDA and ACDF compared to multilevel ACDF.

BACKGROUND: Multilevel anterior cervical discectomy and fusion (mACDF) is the gold standard for multilevel spinal disease; although safe and effective, mACDF can limit regular spinal motion and contribute to adjacent segment disease (ASD). Hybrid surgery, composed of ACDF and cervical disc arthroplasty, has the potential to reduce ASD by retaining spinal mobility. This study examined the safety of hybrid surgery by utilizing administrative claims data to compare real-world rates of subsequent surgery and post-procedural hospitalization within populations of patients undergoing hybrid surgery versus mACDF for multilevel spinal disease. METHODS: This observational, retrospective analysis used the MarketScan Commercial and Medicare Database from July 2013 through June 2020. Propensity score matched cohorts of patients who received hybrid surgery or mACDF were established based on the presence of spinal surgery procedure codes in the claims data and followed over a variable post-period. Rates of subsequent surgery and post-procedural hospitalization (30- and 90-day) were compared between hybrid surgery and mACDF cohorts. RESULTS: A total of 430 hybrid surgery patients and 2,136 mACDF patients qualified for the study; average follow-up was approximately 2 years. Similar rates of subsequent surgery (Hybrid: 1.9 surgeries/100 patient-years; mACDF: 1.8 surgeries/100 patient-years) were observed for the two cohorts. Hospitalization rates were also similar across cohorts at 30 days post-procedure (Hybrid: 0.67% hospitalized/patient-year; mACDF: 0.87% hospitalized/patient-year). At 90 days post-procedure, hybrid surgery patients had slightly lower rates of hospitalization compared to mACDF patients (0.23% versus 0.42% hospitalized/patient-year; p < 0.05). CONCLUSIONS: Findings of this real-world, retrospective cohort study confirm prior reports indicating that hybrid surgery is a safe and effective intervention for multilevel spinal disease which demonstrates non-inferiority in relation to the current gold standard mACDF. The use of administrative claims data in this analysis provides a unique perspective allowing the inclusion of a larger, more generalizable population has historically been reported on in small cohort studies.

Early detection of prostate cancer with ultrasound-guided systematic needle biopsy.

INTRODUCTION: Prostate biopsy strategies have greatly evolved over the past 2 decades. METHODS: We performed a literature review which addressed the initial and repeat biopsy schemes, pathologic risk factors for a positive repeat biopsy, and the ideal timing as well as the number of repeat biopsy sessions. RESULTS: Extended biopsy schemes (11-13 cores) should be used at initial and repeat biopsy. In the era of extended biopsy schemes, high-grade prostatic intraepithelial neoplasia no longer represents an independent predictor of prostate cancer on repeat biopsy. Conversely, the risk is appreciably increased with atypical small acinar proliferation, and its presence warrants a repeat biopsy, which may be performed as soon as the pathologic findings of the previous biopsy become available. Second and subsequent repeat biopsies carry a low detection yield. In most instances, the decision regarding the indications and the timing of a third or subsequent biopsy may be made after a 6 to 12 months interval following the repeat biopsy. CONCLUSION: Biopsy strategies and pathologic predictors of an increased risk of prostate cancer have appreciably changed over the past 2 decades.

Exploration of health-related quality of life areas that may distinguish between continent diversion and ileal conduit patients.

OBJECTIVES: We explored the specific impact of urinary diversion type on HRQOL in men after cystectomy for bladder cancer. Our intent was to provide a basis for the development of a diversion-specific instrument. METHODS: We invited 13 ileal conduit and 12 orthotopic urinary diversion (neo-bladder) male patients to several open-ended interviews. We explored HRQOL domains that may have been affected by cystectomy and urinary diversion, and that could then be used to form a basis for a diversion-specific HRQOL measure. RESULTS: The average age of neo-bladder patients was 59 versus 65 years for ileal conduit patients. We identified 10 HRQOL domains, ranging from involuntary urine leakage to dietary modifications, which were recognized as important by ileal conduit and neobladder patients. Within each domain, a sufficient amount of overlap existed to allow developing a measure that might be applied to both groups of patients. CONCLUSIONS: Ten HRQOL domains were identified as important by ileal conduit and neobladder patients. These demonstrated a significant amount of overlap between conduit and neobladder patients. Potentially, these domains could be used to develop scales for distinguishing between conduit and neobladder-specific HRQOL detriments.