Toyama分型在颈段椎管内哑铃形肿瘤手术入路选择中的应用

目的 探讨Toyama分型在颈段椎管内哑铃形肿瘤手术入路选择中的应用效果。方法 回顾性分析2011年1月至2019年12月显微手术治疗的21例颈段椎管内哑铃形肿瘤的临床资料,依据Toyama分型计划手术入路。结果 肿瘤全切除18例,次全切除3例。术中均未发生椎动脉损伤。术后发生脑脊液漏并感染5例,行腰大池置管及抗感染治疗后痊愈;术后出现相应神经根支配区麻木感1例,自行缓解。术后随访1~3年,平均21个月;肿瘤全切除的病人无肿瘤复发;1例次全切除病人局部复发1例;21例均未发生脊柱畸形。结论 Toyama分型几乎囊括了所有颈段椎管内哑铃形肿瘤,详细描述了各亚型的影像学表现,对于手术入路的选择具有较大的指导意义。     

Prevalence of dementia subtypes in United States Medicare fee-for-service beneficiaries, 2011–2013

Introduction

Rapid growth of the older adult population requires greater epidemiologic characterization of dementia. We developed national prevalence estimates of diagnosed dementia and subtypes in the highest risk United States (US) population.

Executive function,episodic memory,and Medicare expenditures

Introduction

We examined the relationship between health care expenditures and cognition, focusing on differences across cognitive systems defined by global cognition, executive function, or episodic memory.

Clinical correlates,outcomes and healthcare costs associated with early mechanical ventilation after kidney transplantation

Background

Information is lacking on the frequency, clinical implications, and costs of respiratory failure requiring mechanical ventilation after kidney transplantation.

Methods

US Renal Data System records for Medicare-insured kidney transplant recipients (1995 to 2007; n = 88,392) were examined to identify post-transplantation mechanical ventilation from billing claims within 30 days after transplantation.

Results

Post-transplantation mechanical ventilation was required among 2.1% of the cohort. Independent correlates of early mechanical ventilation included recipient age, low body mass index, coronary artery disease, and cerebrovascular disease. Post-transplantation mechanical ventilation was twice as likely with delayed graft function (adjusted odds ratio, 2.13; P < .001) and 35% lower among recipients of living versus deceased donor allografts. Patients needing early mechanical ventilation experienced 5-fold higher 1-year mortality, as well as significantly higher Medicare costs during the transplant hospitalization and first post-transplantation year.

Conclusions

Recognition of patients at risk for post-transplantation respiratory failure may help direct protocols for reducing the incidence and consequences of this complication.     

Has Removal From the Inpatient-Only List Increased Complications After Outpatient Total Knee Arthroplasty?

BackgroundOn 1/1/2018, the Centers for Medicare and Medicaid Services removed total knee arthroplasty (TKA) from the Inpatient-Only (IPO) list. This change allowed expansion of outpatient TKA, potentially to include older, more frail patients at greater risk for perioperative complications. The purpose of this study was to evaluate the impact of removing TKA from the IPO list on early complications.MethodsPatients undergoing TKA in the National Surgical Quality Improvement Program database were identified using CPT code 27447. Only cases with length of stay of zero days were included. Rates of 30-day complications, readmissions, and reoperation were compared before and after TKA was removed from the IPO list (2015-2017 vs 2018). The analysis was performed both with and without propensity score matching.Results212,313 patients underwent TKA during the study period. 2466 (1.5%) were outpatient TKA in 2015-2017 and 3189 (5.6%) in 2018. After propensity matching, there were 2458 patients in each cohort. Rates of total 30-day complications were significantly lower in 2018 (3.7%) than the years TKA remained on the IPO (4.5%, P = .04). Similarly, rates of any reoperation decreased from 1.2% during 2015-2017 to 0.6% in 2018 (P = .03). There were no significant changes in rates of readmission (2.5% vs 2.2%, P = .5) or wound complications (0.8% vs 0.8%, P = 1.0).ConclusionRemoval of TKA from the IPO list did not result in an increase in complications or readmissions. These data suggest, despite the regulatory change, surgeons have continued to exercise sound judgment as to what patients can safely undergo outpatient TKA.     

Trends in Diagnostic Imaging Medicare Reimbursements: 2007 to 2019

PurposeThe aim of this study was to evaluate recent trends in Medicare reimbursement rates for various imaging studies.MethodsCommon diagnostic radiologic studies were selected across multiple imaging modalities: bone densitometry, CT, CT angiography, mammography, MR angiography, MRI, nuclear medicine, radiography, and ultrasound. The Physician Fee Schedule Look-Up Tool from CMS was queried for Current Procedural Terminology codes to extract reimbursement data. All monetary data were adjusted for inflation to 2019 US dollars. The compound annual growth rate, average annual change, and total percentage change in reimbursement were calculated on the basis of these adjusted trends.ResultsInflation-adjusted Medicare reimbursement for all imaging modalities decreased between 2007 and 2019. The greatest mean decrease in reimbursement rates was observed for MRI (−$52.08), and the largest decrease in total percentage change was seen for bone densitometry (−70.5%). Nuclear medicine demonstrated the smallest mean decreases in both annual change (−$0.32) and total percentage change (−4.28%).ConclusionsThis study examined Medicare reimbursements for radiologic studies from 2007 to 2019. After accounting for inflation, reimbursement rates were shown to decline for all studies across all imaging modalities except for individual studies in nuclear medicine, radiography, and ultrasound. Further investigation is encouraged to properly model future trends in reimbursement rates.     

Effect of Risk Acceptance for Bundled Care Payments on Clinical Outcomes in a High-Volume Total Joint Arthroplasty Practice After Implementation of a Standardized Clinical Pathway

Background

The Bundled Payments for Care Improvement (BPCI) initiative and the Arkansas Payment Improvement (API) initiative seek to incentivize reduced costs and improved outcomes compared with the previous fee-for-service model. Before participation, our practice initiated a standardized clinical pathway (CP) to reduce length of stay (LOS), readmissions, and discharge to postacute care facilities.

Facteurs influençant le choix de la dialyse péritonéale : le point de vue des patients et des néphrologues

PurposeTo identify factors related to the choice of peritoneal dialysis as a first dialysis technique: the viewpoint of patients and viewpoint of nephrologists.MethodsA retrospective multicenter study, type case-control was conducted in patients starting dialysis between 2010 and 2014 in 4 dialysis facilities in the PACA region. Nephrologists take care of patients included in the study were also interviewed. Data were collected using two standardized questionnaires: One for the patient and one for the nephrologists and using the French REIN registry.ResultsOne hundred and fifty patients were interviewed, the average age was 63.7 years. The medical contraindication for PD was present in 26.7%. Among patients eligible for both dialysis techniques, 46.7% had a preference for DP, 31.8% for HD and 21.5% did not have any preference. Patient preference is strongly influenced by information and the duration of predialysis nephrologist care (referral of nephrologist). The main factors related to personal choice of peritoneal dialysis are autonomy and desire for autonomy. Emergency dialysis influences negatively the choice of the PD.ConclusionA third of eligible patients for the 2 techniques could and wanted to be on PD. The limitations for PD are mainly related to professional practices. Better information could increase the utilization of PD to 32%.