Length of Stay Beyond Medical Readiness in a Neurosurgical Patient Population and Associated Healthcare Costs.


BACKGROUND:Length of stay beyond medical readiness (LOS-BMR) leads to increased expenses and higher morbidity related to hospital-acquired conditions. OBJECTIVE:To determine the proportion of admitted neurosurgical patients who have LOS-BMR and associated risk factors and costs. METHODS:We performed a prospective, cohort analysis of all neurosurgical patients admitted to our institution over 5 mo. LOS-BMR was assessed daily by the attending neurosurgeon and neuro-intensivist with a standardized criterion. Univariate and multivariate logistic regressions were performed. RESULTS:Of the 884 patients admitted, 229 (25.9%) had a LOS-BMR. The average LOS-BMR was 2.7 ± 3.1 d at an average daily cost of $9 148.28 ± $12 983.10, which resulted in a total cost of $2 076 659.32 over the 5-mo period. Patients with LOS-BMR were significantly more likely to be older and to have hemiplegia, dementia, liver disease, renal disease, and diabetes mellitus. Patients with a LOS-BMR were significantly more likely to be discharged to a subacute rehabilitation/skilled nursing facility (40.2% vs 4.1%) or an acute/inpatient rehabilitation facility (22.7% vs 1.7%, P < .0001). Patients with Medicare insurance were more likely to have a LOS-BMR, whereas patients with private insurance were less likely (P = .048). CONCLUSION:The most common reason for LOS-BMR was inefficient discharge of patients to rehabilitation and nursing facilities secondary to unavailability of beds at discharge locations, insurance clearance delays, and family-related issues.






Linzey JR,Foshee R,Moriguchi F,Adapa AR,Koduri S,Kahn EN,Williamson CA,Sheehan K,Rajajee V,Thompson BG,Muraszko KM,Pandey AS




Has Abstract


2020-12-28 00:00:00








  • Cells transfected with the basic fibroblast growth factor gene fused to a signal sequence are invasive in vitro and in situ in the brain.

    abstract::Invasiveness is a critical event in the development of malignancy in brain tumors. A potential molecular mediator is basic fibroblast growth factor (bFGF). NIH-3T3 cells transfected with the bFGF gene fused with a signal peptide sequence (signal peptide bFGF) acquire an invasive phenotype as measured by in vitro assay...


    pub_type: 杂志文章


    authors: Gately S,Tsanaclis AM,Takano S,Klagsbrun M,Brem S

    更新日期:1995-04-01 00:00:00

  • Pediatric pituitary tumors.

    abstract::This retrospective review of pediatric patients with pituitary tumors causing onset of symptoms by 17 years of age was done to define their pathological distribution, clinical presentation, treatment, and prognosis. Eighteen patients were evaluated and treated from 1979 to 1989. Five had Cushing's disease and 13 had p...


    pub_type: 杂志文章


    authors: Haddad SF,VanGilder JC,Menezes AH

    更新日期:1991-10-01 00:00:00

  • Deep venous thrombosis and thromboembolism in patients with cervical spinal cord injuries.

    abstract:STANDARDS:Prophylactic treatment of thromboembolism in patients with severe motor deficits due to spinal cord injury is recommended. The use of low-molecular-weight heparins, rotating beds, adjusted dose heparin, or a combination of modalities is recommended as a prophylactic treatment strategy. Low-dose heparin in com...


    pub_type: 杂志文章,评审


    authors: Hadley MN,Walters BC,Grabb PA,Oyesiku NM,Przybylski GJ,Resnick DK,Ryken TC

    更新日期:2002-03-01 00:00:00

  • Suppression of splenic natural killer cell activity in rats with brain tumors.

    abstract::After inoculating 9L glioma cells into the brains or into subcutaneous regions of the back of rats, we investigated splenic natural killer (NK) cell activity for 3 weeks using a 4-hour 51Cr release assay. Only rats with brain tumors showed decreased splenic NK cell activity. The spleens of these rats were morphologica...


    pub_type: 杂志文章


    authors: Imaya H,Matsuura H,Kudo M,Nakazawa S

    更新日期:1988-07-01 00:00:00

  • Thoracolumbar Injury Classification and Severity Score in Children: A Validity Study.

    abstract:BACKGROUND:The Thoracolumbar Injury Classification and Severity Score (TLICS) has been shown to be a valid tool for assessing the need for surgical intervention in adult patients. There is limited insight into its usefulness in children. OBJECTIVE:To assess the validity of the TLICS system in pediatric patients. METH...


    pub_type: 杂志文章


    authors: Dawkins RL,Miller JH,Menacho ST,Ramadan OI,Lysek MC,Kuhn EN,Tubbs RS,Walker ML,Walters BC,Agee BS,Rozzelle CJ

    更新日期:2019-06-01 00:00:00

  • Extended endoscopic transsphenoidal approach for tuberculum sellae meningiomas.

    abstract:OBJECTIVE:Tuberculum sellae meningiomas are classically removed through several different surgical transcranial approaches, including the pterional transsylvian route. Recently, the indications for the transsphenoidal technique, traditionally proposed only for the treatment of intrasellar lesions, have been extended to...


    pub_type: 杂志文章


    authors: de Divitiis E,Cavallo LM,Esposito F,Stella L,Messina A

    更新日期:2008-06-01 00:00:00

  • A patient with a resistant major depression disorder treated with deep brain stimulation in the inferior thalamic peduncle.

    abstract:OBJECTIVE AND IMPORTANCE:The present report explored the effect of electrical stimulation on the inferior thalamic peduncle in a patient with resistant major depression disorder (MDD). CLINICAL PRESENTATION:This report refers to a 49-year-old woman with a history of recurrent episodes of major depression for 20 years ...


    pub_type: 杂志文章


    authors: Jiménez F,Velasco F,Salin-Pascual R,Hernández JA,Velasco M,Criales JL,Nicolini H

    更新日期:2005-09-01 00:00:00

  • The juxtaposition of a capillary telangiectasia, cavernous malformation, and developmental venous anomaly in the brainstem of a single patient: case report.

    abstract:OBJECTIVE AND IMPORTANCE:Capillary telangiectasias, cavernous malformations, and developmental venous anomalies are all vascular malformations that occur on the capillary-venous side of the cerebral circulation. The associations of capillary telangiectasias with venous malformations, cavernous malformations with venous...


    pub_type: 杂志文章


    authors: Clatterbuck RE,Elmací I,Rigamonti D

    更新日期:2001-11-01 00:00:00

  • Angiographic detection and characterization of "cryptic venous anomalies" associated with spinal cord cavernous malformations using flat-panel catheter angiotomography.

    abstract:BACKGROUND:Spinal cord cavernous malformations (CMs) are associated with 2 types of angiographically occult "cryptic venous anomalies," which differ in location with respect to the spinal cord. The anatomic distinction between superficial and intramedullary is important in that the latter heighten the risks of CM resec...


    pub_type: 杂志文章


    authors: Pearl MS,Chen JX,Gregg L,San Millàn D,Belzberg A,Jallo G,Gailloud P

    更新日期:2012-09-01 00:00:00

  • Continuous assessment of the cerebral vasomotor reactivity in head injury.

    abstract:OBJECTIVE:Cerebrovascular vasomotor reactivity reflects changes in smooth muscle tone in the arterial wall in response to changes in transmural pressure or the concentration of carbon dioxide in blood. We investigated whether slow waves in arterial blood pressure (ABP) and intracranial pressure (ICP) may be used to der...


    pub_type: 杂志文章


    authors: Czosnyka M,Smielewski P,Kirkpatrick P,Laing RJ,Menon D,Pickard JD

    更新日期:1997-07-01 00:00:00

  • Potent mimicry of fibronectin-induced intracellular signaling in glioma cells by the homodimeric snake venom disintegrin contortrostatin.

    abstract:OBJECTIVE:The snake venom disintegrin contortrostatin (CN) is able to inhibit tumor progression and angiogenesis in vivo and therefore is of considerable interest as a potential antitumor drug. CN specifically binds to certain integrins on the tumor cell and angiogenic endothelial cell surface and inhibits their intera...


    pub_type: 杂志文章


    authors: Schmitmeier S,Markland FS,Schönthal AH,Chen TC

    更新日期:2005-07-01 00:00:00

  • Pharmacokinetics of intraventricular vancomycin in hydrocephalic rats.

    abstract::An animal model was developed for studying the pharmacokinetics of antibiotics administered intraventricularly in hydrocephalus. Obstructive hydrocephalus was consistently produced in craniectomized adult rats by injecting kaolin into the cisterna magna. After induction of hydrocephalus, vancomycin was injected into t...


    pub_type: 杂志文章


    authors: Howard MA,Grady MS,Park TS,Scheld WM

    更新日期:1986-06-01 00:00:00

  • The treatment of intracranial malignant gliomas using orally administered tamoxifen therapy: preliminary results in a series of "failed" patients.

    abstract::In vitro studies have shown that the nonsteroidal antiestrogen tamoxifen can suppress deoxyribonucleic acid synthesis and cell proliferation in cultured human gliomas. This growth suppression is independent of its antiestrogenic properties. Tamoxifen may act through the inhibition of the enzyme protein kinase C, which...


    pub_type: 杂志文章


    authors: Vertosick FT Jr,Selker RG,Pollack IF,Arena V

    更新日期:1992-06-01 00:00:00

  • Hemifacial spasm caused by contralateral cerebellopontine angle meningioma: case report.

    abstract::A large meningioma in the cerebellopontine angle manifested itself as a contralateral hemifacial spasm. On computed tomographic and magnetic resonance imaging scans, the brain stem was markedly displaced and distorted by the tumor. After total removal of the meningioma, the hemifacial spasm completely disappeared. ...


    pub_type: 杂志文章


    authors: Rhee BA,Kim TS,Kim GK,Leem WL

    更新日期:1995-02-01 00:00:00

  • High-resolution three-dimensional magnetic resonance angiography and three-dimensional spoiled gradient-recalled imaging in the evaluation of neurovascular compression in patients with trigeminal neuralgia: a double-blind pilot study.

    abstract:OBJECTIVE:To assess the value of high-resolution three-dimensional (3D) time-of-flight (TOF) magnetic resonance (MR) angiography and gadolinium (Gad)-enhanced 3D spoiled gradient-recalled imaging in the visualization of neurovascular compression in patients with trigeminal neuralgia. METHODS:Forty-eight patients with ...


    pub_type: 杂志文章


    authors: Anderson VC,Berryhill PC,Sandquist MA,Ciaverella DP,Nesbit GM,Burchiel KJ

    更新日期:2006-04-01 00:00:00

  • Postsurgical Electrical Stimulation Enhances Recovery Following Surgery for Severe Cubital Tunnel Syndrome: A Double-Blind Randomized Controlled Trial.

    abstract:BACKGROUND:Patients with severe cubital tunnel syndrome often have poor functional recovery with conventional surgical treatment. Postsurgical electrical stimulation (PES) has been shown to enhance axonal regeneration in animal and human studies. OBJECTIVE:To determine if PES following surgery for severe cubital tunne...


    pub_type: 杂志文章,随机对照试验


    authors: Power HA,Morhart MJ,Olson JL,Chan KM

    更新日期:2020-06-01 00:00:00

  • Traumatic anterior atlanto-occipital dislocation.

    abstract::The five cases of atlanto-occipital dislocation reported in the world literature are reviewed, and four additional cases are presented, including two survivors. The pathological anatomy of this potentially catastrophic injury and its management are briefly discussed. Because immediate recognition of the atlanto-occip...


    pub_type: 杂志文章


    authors: Powers B,Miller MD,Kramer RS,Martinez S,Gehweiler JA Jr

    更新日期:1979-01-01 00:00:00

  • Inflammation and intracranial aneurysms.

    abstract:OBJECTIVE:An intracranial aneurysm is an important acquired cerebrovascular disease that can cause a catastrophic subarachnoid hemorrhage. Despite modern therapy, most patients die or are left disabled as a direct result of a severe initial hemorrhage. The development of more effective treatment strategies depends on u...


    pub_type: 杂志文章


    authors: Chyatte D,Bruno G,Desai S,Todor DR

    更新日期:1999-11-01 00:00:00

  • Familial Predisposition and Differences in Radiographic Patterns in Spontaneous Nonaneurysmal Subarachnoid Hemorrhage.

    abstract:BACKGROUND:Subarachnoid hemorrhage (SAH) from an intracranial aneurysmal rupture is the most common nontraumatic etiology for SAH, but up to 15% of patients with SAH have no identifiable source. OBJECTIVE:To assess familial predisposition to spontaneous nonaneurysmal SAH (naSAH) and to evaluate whether family history ...


    pub_type: 杂志文章


    authors: Lai PMR,Ng I,Gormley WB,Patel NJ,Frerichs KU,Aziz-Sultan MA,Du R

    更新日期:2021-01-13 00:00:00

  • Feasibility, safety, and periprocedural complications associated with endovascular treatment of selected ruptured aneurysms under conscious sedation and local anesthesia.

    abstract:BACKGROUND:Endovascular coil embolization of ruptured aneurysms is performed under general anesthesia at most centers for perceived improved image quality and patient safety. OBJECTIVE:To report the feasibility of and outcomes associated with endovascular treatment of subarachnoid hemorrhage (SAH) patients with ruptur...


    pub_type: 杂志文章


    authors: Kan P,Jahshan S,Yashar P,Orion D,Webb S,Siddiqui AH,Hopkins LN,Levy EI

    更新日期:2013-02-01 00:00:00

  • Surgical complications in patients with Parkinson's disease after posteroventral pallidotomy.

    abstract:OBJECTIVE:To investigate the potential operative morbidity in posteroventral pallidotomy (PVP) for patients with Parkinson's disease. METHODS:We designed a retrospective study that included 796 consecutive patients (mean age, 64.9 yr; male, 559; female, 237) with Parkinson's disease. All PVPs (simultaneous bilateral P...


    pub_type: 杂志文章


    authors: Higuchi Y,Iacono RP

    更新日期:2003-03-01 00:00:00

  • Air sinus wounds: an analysis of 163 consecutive cases incurred in the Korean War, 1950-1952.

    abstract::Review of 1105 records patients with penetrating craniocerebral injuries incurred in the Korean War revealed 163 cases with air sinus wounds, an incidence of 14.8%. The characteristics of these wounds and their surgical management have been described. Foremost among the complications of air sinus wounds are the develo...


    pub_type: 杂志文章


    authors: Arendall RE,Meirowsky AM

    更新日期:1983-10-01 00:00:00

  • Computed tomographic guidance stereotaxis in the management of intracranial mass lesions.

    abstract::A prototype Brown-Roberts-Welles stereotactic instrument has been used as both a diagnostic and a therapeutic surgical adjunct in cases of intracranial mass lesions. Eighty-three procedures (142 point placements) required computerized guidance stereotaxy. The unit accomplished point intracranial access with an accurac...


    pub_type: 杂志文章


    authors: Apuzzo ML,Sabshin JK

    更新日期:1983-03-01 00:00:00

  • Techniques of spinal cord surgery in fetal rats.

    abstract::These experiments were done to develop techniques to expose and manipulate the spinal cord in fetal rats, techniques that could be used to study spinal cord regeneration and transplantation. Adequate maternal anesthesia required a mixture of acepromazine-ketamine supplemented by thiopental. Fetal rats were operated on...


    pub_type: 杂志文章


    authors: Albright L

    更新日期:1987-02-01 00:00:00

  • Primary hydatid cyst of sacral spinal canal: case report.

    abstract:OBJECTIVE AND IMPORTANCE:Primary hydatid cysts of the spinal canal are very rare. The patient in the present case presented with lower cauda equina compression caused by a primary solitary hydatid cyst of the sacral spinal canal, which is a remote possibility. To the best of our knowledge, such a case has not been repo...


    pub_type: 杂志文章


    authors: Pandey M,Chaudhari MP

    更新日期:1997-02-01 00:00:00

  • Microsurgical keyhole approach for middle fossa arachnoid cyst fenestration.

    abstract:OBJECTIVE:The optimal surgical treatment for symptomatic temporal arachnoid cysts is controversial. Therapeutic options include cyst shunting, endoscopic fenestration, and craniotomy for fenestration. We reviewed the results for patients who were treated primarily with craniotomy and fenestration at our institution, to...


    pub_type: 杂志文章


    authors: Levy ML,Wang M,Aryan HE,Yoo K,Meltzer H

    更新日期:2003-11-01 00:00:00

  • Boron neutron capture therapy of brain tumors: an emerging therapeutic modality.

    abstract::Boron neutron capture therapy (BNCT) is based on the nuclear reaction that occurs when boron-10, a stable isotope, is irradiated with low-energy thermal neutrons to yield alpha particles and recoiling lithium-7 nuclei. For BNCT to be successful, a large number of 10B atoms must be localized on or preferably within neo...


    pub_type: 杂志文章,评审


    authors: Barth RF,Soloway AH,Goodman JH,Gahbauer RA,Gupta N,Blue TE,Yang W,Tjarks W

    更新日期:1999-03-01 00:00:00

  • Results of nerve transfers to the musculocutaneous and axillary nerves.

    abstract:OBJECTIVE:Nerve transfers in cases of brachial plexus traction injuries with avulsion of spinal nerve roots or irreparable proximal lesions of spinal nerves have been attempted using a variety of donor nerves. The purpose of this study was to analyze the results of nerve transfers to the musculocutaneous and axillary n...


    pub_type: 临床试验,杂志文章,评审


    authors: Samardzić M,Rasulić L,Grujicić D,Milicić B

    更新日期:2000-01-01 00:00:00

  • Intracranial meningiomas in the aged: surgical outcome in the era of computed tomography.

    abstract::Seventy-five patients older than 60 years of age underwent surgical resection of intracranial meningiomas during a 10-year period at a single institution. All patients had a computed tomographic scan preoperatively, and all were followed for at least 3 months postoperatively. There were 50 patients 61 to 70 years of a...


    pub_type: 杂志文章


    authors: Awad IA,Kalfas I,Hahn JF,Little JR

    更新日期:1989-04-01 00:00:00

  • A preliminary study of the prognostic value of proton magnetic resonance spectroscopic imaging in gamma knife radiosurgery of recurrent malignant gliomas.

    abstract:OBJECTIVE:The goal of this study was to investigate the use of proton magnetic resonance spectroscopic imaging as a prognostic indicator in gamma knife radiosurgery of recurrent gliomas. METHODS:Thirty-six patients with recurrent gliomas were studied with proton magnetic resonance spectroscopic imaging at the time of ...


    pub_type: 杂志文章


    authors: Graves EE,Nelson SJ,Vigneron DB,Chin C,Verhey L,McDermott M,Larson D,Sneed PK,Chang S,Prados MD,Lamborn K,Dillon WP

    更新日期:2000-02-01 00:00:00