The impact of long-term corticosteroid use on acute postoperative complications following lumbar decompression surgery

BackgroundCorticosteroids have a negative impact on the human immune system’s ability to function at an optimal level. Studies have shown that patients on long-term corticosteroids have higher infection rates. However, the rates of infection and other complications following lumbar decompression surgery remains under-investigated. The aim of our study was to determine the impact of preoperative long-term corticosteroid usage on acute, 30-day postoperative complications in a subset of patients undergoing lumbar spine decompression surgery, without fusion or instrumentation. We hypothesize that patients on long-term corticosteroids will have higher rates of infection and other postoperative complications after undergoing lumbar decompression surgery of the spine.MethodsA retrospective cohort study was conducted using data collected from the National Surgical Quality Improvement Program database data from 2005 to 2016. Lumbar decompression surgeries, including discectomies, laminectomies, and others were identified using CPT codes. Chi-square analysis was used to evaluate differences among the corticosteroid and non-corticosteroid groups for demographics, preoperative comorbidities, and postoperative complications. Logistic regression analysis was done to determine if long-term corticosteroid use predicts incidence of postoperative infections following adjustment.Results26,734 subjects met inclusion criteria. A total of 1044 patients (3.9%) were on long-term corticosteroids prior to surgical intervention, and 25,690 patients (96.1%) were not on long-term corticosteroids. Patients on long-term corticosteroids were more likely to be older (p < 0.001), female (p < 0.001), nonsmokers (p < 0.001), and have a higher American Society of Anesthesiologist class (p < 0.001). Multivariate analysis demonstrated that long-term corticosteroid usage was associated with increased overall complications (odds ratio [OR]: 1.543; p < 0.001), and an independent risk factor for the development of minor complications (OR: 1.808; p < 0.001), urinary tract infection (OR: 2.033; p = 0.002), extended length of stay (OR: 1.244; p = 0.039), thromboembolic complications (OR: 1.919; p = 0.023), and sepsis complications (OR: 2.032; p = 0.024).ConclusionLong-term corticosteroid usage is associated with a significant increased risk of acute postoperative complication development, including urinary tract infection, sepsis and septic shock, thromboembolic complications, and extended length of hospital stay, but not with superficial or deep infection in patients undergoing lumbar decompression procedures. Spine surgeons should remain vigilant regarding postoperative complications in patients on long-term corticosteroids, especially as it relates to UTI and propensity to decompensate into sepsis or septic shock. Thromboembolic risk attenuation is also imperative in this patient group during the postoperative period and the surgeon should weigh the risks and benefits of more intensive anticoagulation measures.     

新型冠状病毒肺炎疫情期间一线护士心理健康状况调查

目的探讨突发新型冠状病毒肺炎疫情期间护士心理健康状况,为采取针对性措施促进护士心理健康提供参考。方法在突发新型冠状病毒肺炎疫情期间,采用心理健康状况量表、社会支持及应对方式量表对175名一线护士进行调查。结果护士躯体化、焦虑得分显著高于常模(均P0.01)。护士心理健康与社会支持、应对方式具有显著相关性(均P0.01)。结论突发新型冠状病毒肺炎疫情期间临床护士躯体化与焦虑评分较高,发挥社会支持、应对方式的正向作用有利于改善护士的心理健康状态。     

The seasonal and monthly distribution of body limbs affected by burns in paediatric patients in southeast Turkey

Studies on the frequency of burned limbs according to season and months are limited. The burning of some body limbs, especially in some months, shows that the causes of burns are different, and knowing the reasons is important for providing preventive measures. The aims of this study were to determine the distribution rate of child burns by months and seasons and to contribute to preventive measures by determining the distribution of the burning of body limbs by months. We retrospectively evaluated 419 paediatric patients (0‐17 years of age) who were hospitalised in the burn unit between 1 May 2017 and 1 November 2018. The demographic characteristics of the patients were recorded according to age, gender, months, and seasons of the patients admitted; cause of burns; degree of burns; total body surface area; and burning regions. The distribution of burns by months was established as being mainly in May to October. As for the distribution of the patients according to the seasons, it was found that it was most common in summer, 122 (29.1%), and in the autumn season as well, it was 122 (29.1%). While body burns increased in the summer‐autumn seasons (P < .023), genital area burns were the lowest in winter and were the highest in summer and autumn seasons. Genital site burns increased statistically in September, October, and November (P < .010). Burn traumas are observed to be more frequent in some seasons and months. The environments where individuals live, forms of life, forms of warming, areas of interest, and sociocultural and economic levels are the causes of this variability.     

The relationship between preoperative nutritional state and adverse outcome following abdominal and thoracic surgery in children: Results from the NSQIP database

Introduction

Anthropometric measurements can be used to define pediatric malnutrition. Our study aims to: (1) characterize the preoperative nutritional status of children undergoing abdominal or thoracic surgery, and (2) describe the associations between WHO-defined acute (stunting) and chronic (wasting) undernutrition (Z-scores <?2) and obesity (BMI Z-scores > + 2) with 30-day postoperative outcomes.

The 22-Modifier in Reimbursement for Orthopedic Procedures: Hip Arthroplasty and Obesity Are Worth the Effort

Background

Orthopedic surgeons utilize the 22-modifier when billing for complex procedures under the American Medical Association's Current Procedural Terminology (CPT) for reasons such as excessive blood loss, anatomic abnormality, and morbid obesity, cases that would ideally be reimbursed at a higher rate to compensate for additional physician work and time. We investigated how the 22-modifier affects physician reimbursement in knee and hip arthroplasty.

2005～2007年临湘市双洲村血吸虫病疫情监测

2005～2007年临湘市双洲村血吸虫病疫情监测表明,人群血吸虫感染率下降明显,但感染性钉螺持续存在,须采取以传染源控制为主的综合防治策略。     

Practical model description of peripheral neural excitation in cochlear implant recipients: 3. ECAP during bursts and loudness as function of burst duration

In this, the third paper of the series, the loudness of low-rate bursts of electrical pulses was measured as a function of the burst duration, in subjects implanted with the Nucleus^® 24 cochlear implant system (three with straight and two with Contour™ electrode arrays). In order to help distinguish between the contributions of peripheral and more central effects, the ECAP was recorded to the individual pulses comprising the bursts, using the Neural Response Telemetry™ (NRT™) system. At a pulse rate of 250 pulses/s, the ECAP amplitude did not decrease greatly during the bursts: the mean reduction factor was 0.89. The time-constant for summation of the loudness contributions from the pulses comprising a burst was found to be larger than that associated with normal hearing. In addition, the first pulse of a pulse train was found to contribute much more to the overall loudness than did the subsequent pulses, although a corresponding difference was not observed in the ECAP recordings. These results establish a necessary connection between the essentially single-pulse model, developed in the fourth and fifth papers of the series, and the psychophysical data for pulse bursts, but they also have broader implications.     

某社区中学生心理健康状况及其影响因素调查

目的了解影响中学生心理状况的因素，为开展心理咨询和治疗提供基础资料。方法采用SCL-90症状自评量表测评和自行设计的问卷调查。结果成绩为上游、中游和下游各组学生在恐怖和精神病性两项因子上的分值，差异有统计学意义（P〈0．05）；有烦恼各项因子的分值均较无烦恼的分值高；对异性有好感组和没有好感组以及对异性无所谓组之间比较，在总分、强迫症状、人际关系敏感、敌对、偏执、精神病性、其他因子以及总均分上，差异均有统计学意义（P〈0．05），而在躯体化、抑郁、恐怖因子上，差异无统计学意义（P〈0．05）；学习有意义组和无意义组以及无所谓组比较，学习有意义组各项因子的分值均低于无意义组和无所谓组；经常上网组和偶尔上网组以及不上网组之间，在敌对和其他因子的分值上，差异均有统计学意义（P〈0．05）。结论在正视中学生心理问题的同时应加强对中学生青春期心理健康教育，正确处理学习与交友关系，减少青春期的心理冲突。社区卫生服务人员应积极发挥专业指导作用，开展心理咨询，切实减少学生心理问题的发生。     

农村医疗设备现状与发展前景

简述了农村医疗设备的现状以及发展的前景，分析了当前存在的问题，综合国家政策，提出了未来农村医疗设备良性发展的几点建议，希望对农村医疗的健康发展有所促进。     

当前社会环境下医院公关策略的研究

文章对现阶段医院面临社会困境的原因进行了研究,探讨了应用公关策略提升医院形象的理论依据和实施途径,为改善医院生存环境、建立和谐医患关系提出了新方法。