Abstract:
BACKGROUND:Multiple nationwide outcome registries are utilized for quality benchmarking between institutions and individual surgeons. OBJECTIVE:To evaluate whether nationwide quality of care programs in the United Kingdom and United States can measure differences in neurosurgical quality. METHODS:This prospective observational study comprised 418 consecutive adult patients undergoing elective craniotomy at Helsinki University Hospital between December 7, 2011 and December 31, 2012.We recorded outcome event rates and categorized them according to British Neurosurgical National Audit Programme (NNAP), American National Surgical Quality Improvement Program (NSQIP), and American National Neurosurgery Quality and Outcomes Database (N2QOD) to assess the applicability of these programs for quality benchmarking and estimated sample sizes required for reliable quality comparisons. RESULTS:The rate of in-hospital major and minor morbidity was 18.7% and 38.0%, respectively, and 30-d mortality rate was 2.4%. The NSQIP criteria identified 96.2% of major but only 38.4% of minor complications. N2QOD performed better, but almost one-fourth (23.2%) of all patients with adverse outcomes, mostly minor, went unnoticed. For NNAP, a sample size of over 4200 patients per surgeon is required to detect a 50.0% increase in mortality rates between surgeons. The sample size required for reliable comparisons between the rates of complications exceeds 600 patients per center per year. CONCLUSION:The implemented benchmarking programs in the United Kingdom and United States fail to identify a considerable number of complications in a high-volume center. Health care policy makers should be cautious as outcome comparisons between most centers and individual surgeons are questionable if based on the programs.
journal_name
Neurosurgeryjournal_title
Neurosurgeryauthors
Reponen E,Tuominen H,Korja Mdoi
10.1093/neuros/nyy380subject
Has Abstractpub_date
2019-10-01 00:00:00pages
500-507issue
4eissn
0148-396Xissn
1524-4040pii
5084855journal_volume
85pub_type
杂志文章相关文献
NEUROSURGERY文献大全abstract:OBJECTIVE:We report the long-term follow-up of 31 patients with cavernous sinus meningiomas who were treated either with surgery and radiotherapy (RT) or with RT alone. This retrospective review was undertaken to compare long-term efficacy and morbidity of RT with or without previous surgery versus complete, aggressive...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-200102000-00006
更新日期:2001-02-01 00:00:00
abstract::A striking and diffuse hemangiomatous architecture was identified by microscopic examination of bone specimens obtained at cranial synostectomy and from the craniofacial area of a young boy with Kleeblättschadel deformity and Crouzon's syndrome. A retrospective review of the histopathological appearance of bone specim...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-198503000-00019
更新日期:1985-03-01 00:00:00
abstract:OBJECTIVE:Despite advances in surgical techniques in the management of the brain abscess, long-term antibiotics are as crucial to cure as the initial surgical procedure itself. This study was designed to evaluate the effect of adjuvant hyperbaric oxygen (HBO) therapy on the duration of antibiotic treatment. METHODS:Be...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000316257.21478.5b
更新日期:2008-02-01 00:00:00
abstract:OBJECTIVE:To define and discuss elements of the escalation in scientific data availability and their importance to neurosurgery. METHODS:This multifactorial essay describes the evolution of communication methodologies, the information revolution, and the advent and effect of Internet communication with its potential e...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:
更新日期:2000-01-01 00:00:00
abstract::Coronary thrombolysis with streptokinase or tissue plasminogen activator is useful for the treatment of acute myocardial infarction in selected patients. This treatment is associated with local hemorrhagic complications and age-related cerebral hemorrhage. Coronary thrombolysis is contraindicated in patients with tran...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-199209000-00025
更新日期:1992-09-01 00:00:00
abstract:OBJECTIVE:Carotid endarterectomy with a patch graft (Patch CEA) has been our standard treatment for patients with carotid artery stenosis, but carotid artery stenting (CAS) has emerged as an alternative. The purpose of this study was to compare the postoperative changes in the configurations and the flow velocities of ...
journal_title:Neurosurgery
pub_type: 临床试验,杂志文章
doi:10.1227/01.NEU.0000358952.12917.DF
更新日期:2009-11-01 00:00:00
abstract:Background and importance:Pilocytic astrocytoma (PA) is among the most common of the central nervous system gliomas in the pediatric population; however, it is uncommon in adults. PAs of the spinal cord in adults are even rarer, with only a few cases found in the literature. We report here the first case in the literat...
journal_title:Neurosurgery
pub_type: 杂志文章,评审
doi:10.1093/neuros/nyw029
更新日期:2017-02-01 00:00:00
abstract::Intraoperative monitoring with electroencephalography and the use of brain protection with steroids, phenytoin, mannitol, and pentobarbital or etomidate were evaluated in 15 patients undergoing operation for an aneurysm of the upper basilar artery. One patient harbored a basilar trunk aneurysm, 1 an aneurysm of the pr...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-198912000-00008
更新日期:1989-12-01 00:00:00
abstract::While the efficacy of Intravenous tissue plasminogen activator (tPA) is well established, its impact on large vessel occlusion (LVO) is controversial. Whether IV tPA should be bypassed in favor of endovascular thrombectomy (MT) will be addressed. Compelling evidence exists to suggest tPA administration might be bypass...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1093/neuros/nyz083
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVE:It is still debated to what extent intraoperative electrophysiological techniques contribute to the outcome of subthalamic nucleus (STN) deep brain stimulation (DBS). Intraoperative electrophysiological recordings for identification of the STN can be made with one electrode or with multiple, simultaneously im...
journal_title:Neurosurgery
pub_type: 临床试验,杂志文章
doi:10.1227/01.neu.0000303993.82149.98
更新日期:2007-11-01 00:00:00
abstract:OBJECTIVE:We compared long-term seizure outcome and health-related quality of life (HRQoL) of patients who underwent epilepsy surgery and matched medically treated nonsurgical controls with intractable epilepsy. METHODS:Medically treated controls were identified for patients operated on for epilepsy between January 1,...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000315999.58022.1c
更新日期:2008-02-01 00:00:00
abstract:OBJECTIVE:We report a retrospective series of 13 patients who presented with symptoms and signs caused by cervical juxtafacet cysts. Clinical findings, radiographic features, surgical management strategies, and possible causes are reported and discussed. METHODS:We reviewed clinical histories, radiographic studies, su...
journal_title:Neurosurgery
pub_type: 杂志文章,评审
doi:10.1097/00006123-199812000-00058
更新日期:1998-12-01 00:00:00
abstract:BACKGROUND:Robot-assisted stereoelectroencephalography (SEEG) may represent a simplified, precise, and safe alternative to the more traditional SEEG techniques. OBJECTIVE:To report our clinical experience with robotic SEEG implantation and to define its utility in the management of patients with medically refractory e...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/NEU.0000000000001034
更新日期:2016-02-01 00:00:00
abstract::Previous studies have suggested that certain prostanoids are mediators of the pathological features of subarachnoid hemorrhage (SAH) and that a reduced synthesis of prostacyclin in the vessel wall might also contribute to the cerebral vasospasm associated with this malady. The present study was performed, therefore, t...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-198301000-00008
更新日期:1983-01-01 00:00:00
abstract:OBJECTIVE:Cerebellopontine angle (CPA) epidermoids, although of benign nature, are of considerable neurosurgical interest because of their close proximity and adherence to the cranial nerves and the brain stem. We describe our experience and attempt to correlate the final outcomes with the extent of surgical removal. ...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-199701000-00004
更新日期:1997-01-01 00:00:00
abstract::A model of rat arteriovenous fistula (AVF) was created using a proximal common carotid artery to distal external jugular vein anastomosis. Anatomical dissections revealed that the external jugular vein is the primary vessel draining intracranial venous blood. Physiological measurements were made with the AVF open and ...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-199109000-00002
更新日期:1991-09-01 00:00:00
abstract::The effect of mannitol on focal cerebral ischemia in cynomolgus monkeys was studied. After the implantation of a snare ligature about the right middle cerebral artery (MCA) and of deep electrodes for measurement of cerebral blood flow, unanesthetized animals underwent 4-hour MCA occlusion. Ten monkeys were untreated, ...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:
更新日期:1982-10-01 00:00:00
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...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-199702000-00040
更新日期:1997-02-01 00:00:00
abstract:OBJECTIVE:For adult meningiomas, the staining index (SI) for the anti-Ki-67 monoclonal antibody MIB-1 is well correlated with histological atypia and tumor recurrence. MIB-1 SIs for meningiomas in the pediatric population have not been previously reported. Meningiomas tend to be more histologically aggressive and to re...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-200103000-00027
更新日期:2001-03-01 00:00:00
abstract:OBJECTIVE:Several studies have shown that human gliomas contain a small population of cells with stem cell-like features. It has been proposed that these "cancer stem cells" may be uniquely responsible for glioma formation and recurrence. However, human gliomas also contain an abundance of cells that closely resemble m...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000316019.28421.95
更新日期:2008-02-01 00:00:00
abstract:OBJECTIVE:Cerebral vasospasm is the leading cause of morbidity and mortality in patients who are hospitalized because of aneurysmal subarachnoid hemorrhage (SAH). Recent work has suggested that activation of the complement cascade contributes to the development of cerebral vasospasm. To further examine this hypothesis,...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-199607000-00028
更新日期:1996-07-01 00:00:00
abstract::We have divided head injury into three categories based on the Glasgow Coma Scale (GCS) (severe, 3-8; moderate, 9-12; and minor, 13-15). In a previous report, we described significant disability after minor head injury. The present report describes 199 patients with moderate head injury, 159 of whom underwent follow-u...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-198209000-00002
更新日期:1982-09-01 00:00:00
abstract:OBJECTIVE:Previous reports identified the presence of traumatic subarachnoid hemorrhage (tSAH) on admission computed tomographic (CT) scans as an independent prognostic factor in worsening outcomes. The mechanism underlying the link between tSAH and prognosis has not been clarified. The aim of this study was to investi...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-200202000-00006
更新日期:2002-02-01 00:00:00
abstract:OBJECTIVE:We describe extensively the multilevel oblique corpectomy technique with its advantages, disadvantages, indications, and biomechanical effects. This procedure is an alternative to the anterior corpectomy. METHODS:Multilevel oblique corpectomy can be indicated in spondylotic myelopathy, whether or not it is a...
journal_title:Neurosurgery
pub_type: 杂志文章,评审
doi:10.1227/01.neu.0000289723.89588.72
更新日期:2007-09-01 00:00:00
abstract::The techniques for the treatment of intracranial arteriovenous fistulae include angiographic balloon occlusion of the fistula as well as direct surgical attack. Regardless of the method, the occurrence of severe hyperemia caused by a lack of autoregulation after obliteration of the fistula remains a significant concer...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-199410000-00033
更新日期:1994-10-01 00:00:00
abstract:OBJECTIVE:Hypomania accounts for approximately 4% to 13% of psychotropic adverse events during subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson's disease. Diffusion of current into the inferior and medial "limbic" STN is often reported to be the cause. We suggest a different explanation, in which th...
journal_title:Neurosurgery
pub_type: 临床试验,杂志文章
doi:10.1227/01.NEU.0000345631.54446.06
更新日期:2009-06-01 00:00:00
abstract::Vittorio Marchi was an Italian neuroscientist who lived during the second half of the 19th century. He is generally remembered for developing a novel staining method to trace the degeneration of nervous fibers in lesions of the central nervous system. This osmium-based method was used worldwide for approximately a cen...
journal_title:Neurosurgery
pub_type: 传,历史文章,杂志文章
doi:10.1227/NEU.0000000000000003
更新日期:2013-11-01 00:00:00
abstract:OBJECTIVE:To evaluate the reclosure-promoting capacity of a neural stem cell line (F3) and a human bone marrow stem cell line (B10) injected into the amniotic cavity of spinal open neural tube defects (ONTDs) of chick embryos of Hamburger and Hamilton stage 18 or 19. METHODS:Fifteen chick embryos that survived the pro...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.NEU.0000371048.76494.0F
更新日期:2010-07-01 00:00:00
abstract:OBJECTIVE:The source of fluid and the mechanism of cyst enlargement in syringomyelia are unknown. It has been demonstrated that cerebrospinal fluid (CSF) normally flows from the subarachnoid space through perivascular spaces and into the spinal cord central canal. The aim of this study was to investigate whether this f...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-199905000-00068
更新日期:1999-05-01 00:00:00
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...
journal_title:Neurosurgery
pub_type: 杂志文章,随机对照试验
doi:10.1093/neuros/nyz322
更新日期:2020-06-01 00:00:00