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Results for “Surgical outcome”

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At least 19 recordsLinked to original sources

PubMed1992

Response to steroid and duration of radicular pain as predictors of surgical outcome.

Prolonged structural compromise of spinal nerve roots can lead to chronic changes that surgical decompression might not be able to reverse. In this study, it was hypothesized that if there were a reversible structural pain component, a steroid injected into the patient's symptomatic nerve root should provide temporary pain relief and that these patients should have a favorable surgical outcome. It also was hypothesized that duration of radicular symptoms would correlate inversely with surgical outcome. For postoperative relief of radicular pain, the results showed that patients with pain lasting less than 1 year had a positive surgical result (89%), regardless of response to steroid. Patients with pain lasting more than 1 year and who have had a positive response to steroid injected into the symptomatic nerve root (roots) had a positive surgical outcome of 85%. Patients who did not respond to the steroid and had pain for more than 1 year (95%) generally had a poor surgical outcome. Although the poor outcome in the last group might be explained in some cases by an inadequate structural correction, inadequate stabilization, or functional reasons, the majority of these failures represented irreversible changes in the neural structures.

Betamethasone↗

PubMed1991

Temporal lobe surgery for epilepsy: neuropsychological variables related to surgical outcome.

A retrospective study of 383 patients who had undergone either left or right anterior temporal lobectomy (varying with respect to the amount of hippocampus excised) revealed that there were no significant differences in surgical outcome between those patients having a large and those patients having a small hippocampal removal. Although left temporal-lobe excisions were significantly smaller than right temporal-lobe excisions, both medially and laterally, patients with left temporal-lobe removals had an overall better surgical outcome. Patients in the successful surgical-outcome group did better than the unsuccessful surgical-outcome group on a variety of cognitive measures, including tests of intelligence, delayed verbal memory, and verbal fluency. The results suggest that, for many patients with medically intractable epilepsy, an anterior temporal lobectomy including the amygdala may suffice to reduce their seizure frequency.

Adolescent↗

PubMed2026

Longitudinal functional trajectory and surgical outcomes after intracranial meningioma resection: implications for surgical decision-making in older patients.

OBJECTIVE: As the population ages, meningiomas are increasingly encountered in older patients, yet longitudinal functional outcomes following surgery across age groups remain incompletely characterized. This study evaluated age-related differences in clinical and tumor characteristics, functional trajectory, and surgical outcomes. METHODS: This was a retrospective cohort study of 396 consecutive patients who underwent surgery for intracranial meningiomas at a single academic center between January 2023 and September 2025. Patients were stratified into 5 age groups (< 65, 65-69, 70-74, 75-79, and ≥ 80 years). Neurological deficits and Karnofsky Performance Status (KPS) were assessed preoperatively, at discharge, and at last follow-up. Logistic regression analyses identified predictors of prolonged length of stay (LOS) (> 5 days) and poor functional outcome at discharge (KPS < 80). RESULTS: Older patients presented with greater comorbidity burden, larger tumors, and lower preoperative KPS (all p < 0.05), while gross-total resection was achieved at comparable rates across all age groups (p = 0.504). A clinically meaningful inflection point was observed around age 75 years, with KPS < 80 at discharge rising from 7.4% and 9.7% in the < 65-year and 70- to 74-year subgroups and to 36.2% and 57.1% in the 75- to 79-year and ≥ 80-year subgroups (p < 0.001), and median LOS increased from 4 days in the younger groups to 9 and 7 days in the 75- to 79-year and ≥ 80-year groups (p < 0.001). However, recovery rates among patients who experienced functional decline at discharge were comparable across age strata. On multivariable analysis, independent predictors of prolonged LOS were age ≥ 75 years (OR 2.31, p = 0.019), diabetes mellitus (OR 2.85, p = 0.004), posterior fossa location (OR 2.1, p = 0.008), tumor diameter (OR 1.33, p < 0.001), postoperative edema (OR 2.58, p = 0.015), and neurosurgical complications (OR 3.18, p = 0.002). Independent predictors of poor functional outcome at discharge were age ≥ 75 years (OR 5.84, p < 0.001), lower preoperative KPS (OR 2.8, p < 0.001), posterior fossa location (OR 3.72, p = 0.003), neurosurgical complications (OR 3.56, p = 0.008), and recurrent meningioma (OR 2.89, p = 0.025). Among 70 endoscopic endonasal approach patients, higher preoperative deficit burden and subtotal resection rates were observed compared to open craniotomy, though overall functional outcomes were comparable. CONCLUSIONS: Surgical risk in meningioma resection increases from age 75 years onwards, yet recovery capacity following initial functional decline remains similar across all age groups. Preoperative functional status, tumor location, comorbidity burden, and recurrence history should guide surgical decision-making rather than age alone.

Humans↗

PubMedDate not supplied

Diagnostic arthroscopy and longitudinal open lateral release. A four year follow-up study to determine predictors of surgical outcome.

The purpose of this study was as follows: 1) to review our previous findings regarding surgical outcome following open retinacular release but now at a mean followup of 4 years, 2) to test the validity of the correction of patellar "overhang" by Merchant views at 4 years and correlate this with outcome, 3) to correlate arthroscopic findings of lateral overhang, patellofemoral cartilage disease, preoperative Q-angle measurements, and duration of symptoms with outcome at 4 years postrelease. The surgical technique of diagnostic arthroscopy and open longitudinal release has been described previously by the author, emphasizing the specific anatomical structures to be divided. The synovium was never incised and the retinacular structures were freed to allow reduction of the patella medially. Sixty patients comprising 76 knees were reviewed at a mean followup of 4 years postrelease. Followup included evaluation of Merchant views and Q angles, physical examination, and determination of patient satisfaction. Eighty-five percent of the patients followed retained the good to excellent ratings they had at the 2 year followup. "Reduction" of the released patella on Merchant views correlated well with surgical outcome and patient satisfaction in 95% of cases. Residual Merchant view patellar tilt or excessive lateral position correlated well with poor results. Hematoma formation was the leading cause of failure. A severe preoperative Q angle correlated somewhat with results at 4 years but this was not statistically significant. The degree of articular cartilage disease at prerelease arthroscopy did not correlate at all with results at 4 years, nor did the duration of preoperative symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Effects of psychophysical stress on surgical outcome.

The aim was to determine the effects of stress on immune status and surgical outcome in 24 healthy men undergoing hernia repair. Stressful life events over the prior 6 mo and social support was assessed at time of admission. Physiological response to a cold pressor test was measured the day before surgery. Lymphocyte blastogenesis and neutrophil chemotaxis were measured before and 3 and 30 days after surgery in patients and controls. Surgical outcomes were assessed by length of stay, narcotics used, and complications. Data were analyzed in 2 x 2 factorial designs for multivariate analysis of covariance where one factor was life stress and the other was response to the cold pressor. Age and social support were covaried in comparing immune responses before surgery. High responders to life stress had significantly less response to PHA, and high responders to cold pressor stress had lower PWM responses. With preoperative immune status covaried, high responders to cold pressor stress had significantly lower PWM response after surgery, indicating some T-B cell interaction defect and more narcotics and complications. Data suggest that high psychological and physiological stress responses before surgery (that is itself an additional psychophysiologic stressor) lead to poorer outcomes even in otherwise healthy men undergoing relatively simple elective surgical procedures.

Aged↗

PubMed1987

Prolactin-secreting adenomas: the preoperative response to bromocriptine treatment and surgical outcome.

Controversy exists regarding the effects of bromocriptine on the success of transsphenoidal surgery for patients with prolactinomas. Various studies on this drug have reported adverse effects, improvement, and no effect upon the subsequent surgical outcome. The authors have retrospectively reviewed the case histories of 55 patients with immunocytochemically confirmed prolactin-secreting pituitary adenomas operated on by a transsphenoidal approach between 1981 and 1985. All patients had received bromocriptine in a variety of doses and for variable durations prior to surgery. Thirty-nine patients were women and 16 were men, with an age range of 8 to 72 years. Basal prolactin levels prior to bromocriptine treatment ranged from 38 to 100 ng/ml in 11 patients, from 101 to 200 ng/ml in 12, and greater than 200 ng/ml in 29. The "cure" rates were 54%, 58%, and 38%, respectively. Thirty-one patients had microadenomas, with a postoperative cure rate of 68%; 12 had diffuse expansive adenomas, with a 17% cure rate; and 12 had grossly invasive tumors, with a 17% cure rate. A response to preoperative bromocriptine therapy was defined as a return of the basal prolactin level to normal: 18 patients were responders and 29 were hyporesponders; in eight the data were not available. The postoperative cure rate was 50% for the responders and 31% for the hyporesponders. Taking into account the distribution of tumor type, there was no actual difference in outcome between the responder and the hyporesponder groups. The total bromocriptine dose received preoperatively was nearly identical for all groups. No significant differences in the frequency or extent of fibrosis, calcification, or prolactin immunoreactivity were observed in the 55 patients when compared with 26 control prolactinomas not treated with bromocriptine. It is concluded that short-term bromocriptine treatment does not adversely affect surgical outcome in any of the prolactin-secreting adenoma groups, nor does response or lack of response to bromocriptine predict surgical outcome.

Adenoma↗

PubMed1990

Surgical outcome in 435 patients who sustained missile head wounds during the Iran-Iraq War.

Variables important in predicting the final postsurgical outcome of 435 patients who sustained missile head wounds during the Iran-Iraq War were evaluated over a 99-month period. The type of projectile, site of injury, and presence or absence of foreign material did not seem to have a significant effect on the final outcome. Of the patients with a perforating type of injury, 48.8% had a poor surgical outcome as compared with 19.9% with a penetrating type and 15.6% with a tangential type. This difference is statistically significant (chi 2 = 14.7 and 17.1, respectively; p less than 0.001). The most important factor in predicting overall outcome was the Glasgow Coma Scale (GCS) score at the time of admission. Mortality and morbidity contributing to a poor surgical outcome were noted in only 6% of patients with a GCS score at admission of 13 to 15, in 24.6% of those with a GCS score of 9 to 12, in 57% of those with a GCS score of 6 to 8, and in 65% of those with a GCS score of 3 to 5. Of the 71 patients who died, 75% had a score of 3 to 8. Perforating projectiles or those traversing two or more dural compartments were statistically significant in contributing to mortality and morbidity (chi 2 = 17.2; p less than 0.001). The incidence of focal neurological deficit was 100, 90.6, 88, and 52.2% in patients with GCS scores of 3 to 5, 6 to 8, 9 to 12, and 13 to 15, respectively. The two best predictors of mortality in this group of patients were a low GCS score and infection.

Adult↗

PubMed1987

Epidural steroid injection as a predictor of surgical outcome.

The value of patient response to epidural steroid injection as a predictor of surgical outcome was studied. One hundred and eighty-seven patients with clinical signs of root compression underwent lumbar epidural steroid injection. Eighty-five of these patients had been told that an operation on the lumbar spine would be necessary. Over the ensuing one to three years, only 34 of these patients eventually required an operation upon the lumbar spine or an injection of chymopapain. Fifty-four per cent of the patients who were unimproved after epidural steroid injection were also unimproved after chymopapain whereas all patients who were improved, even transiently, after epidural steroid injection were improved after chymopapain injection. A statistical comparison of these two groups revealed the probability of these occurrences of 0.088. There was no correlation between outcome of open surgical procedures and response to epidural steroids. Epidural steroid injection may be a valuable aid to predicting the outcome of chemonucleolysis.

Back Pain↗

PubMedDate not supplied

Type I/II complex partial seizures: no correlation with surgical outcome.

Three complex partial seizure (CPS) types have been described based upon the behaviors seen at the onset of the ictal event. Type I CPSs are preceded by a motionless stare and have been correlated with a temporal focus, whereas Type II CPSs are not preceded by a motionless stare and have been correlated with an extratemporal focus. A third type of CPS, temporal lobe syncope, has been correlated with bilateral mesial temporal foci. We examined the utility of this CPS classification system in predicting surgical outcomes by reviewing our patients who had undergone surgical excision of their epileptogenic foci for the treatment of medically refractory CPSs. Forty-six consecutive patients were evaluated, with the seizure focus ultimately found to be temporal in 41 and frontal in 5. All 5 patients with frontal foci had Type II CPSs; of the 41 patients with temporal foci, 20 had Type I and 21 had the Type II CPSs. Twenty of 26 patients with Type II CPSs and 18 of 20 patients with Type I CPSs had a good or excellent outcome. Although our data suggest that patients with frontal foci have Type II CPSs, the reverse is not true. Furthermore, CPS type is not correlated with the surgical outcome, since there was no significant difference between the CPS type and the category of surgical outcome.

Adolescent↗

PubMed1989

Akinetic versus dyskinetic left ventricular aneurysms diagnosed by gated scintigraphy: difference in surgical outcome.

Forty-one patients selected for left ventricular aneurysm resection and coronary artery bypass grafting were studied by gated radionuclide ventriculography, and right heart catheterization before and after operation to establish whether the presence of paradoxically systolic expansion, as defined by radionuclide ventriculography, influenced the surgical outcome. Patients with systolic paradoxically moving left ventricular aneurysms (n = 28) improved their functional classification (New York Heart Association) (p less than 0.01) and exercise tolerance (watt-minutes) (p less than 0.001) compared with preoperative values, in contrast to the patients with akinetic aneurysms (n = 13), whose status remained unchanged. Left ventricular ejection fraction at rest (p less than 0.001) and exercise (p less than 0.0001) improved along with a significant reduction in left ventricular end-diastolic (p less than 0.002) and end-systolic volume indices (p less than 0.001) among the patients with paradoxical left ventricular aneurysms versus no change in the akinetic group. In a multivariate analysis of different preoperative variables, the presence of dyskinesia was found to be the only independent predictor of a favorable surgical outcome (p less than 0.004). In conclusion, the presence of dyskinesia represents an important marker of the outcome after aneurysmectomy.

Adult↗

PubMed1988

Effects of age and nutritional status on surgical outcomes in head and neck cancer.

Older and younger malnourished and well-nourished head and neck cancer patients scheduled for surgery were studied. More of the young (75%) compared with the old (58%) underwent curative surgery, and only the old with lower clinical states of cancer were selected. When data on those undergoing surgery were analyzed in regard to older and younger malnourished and well-nourished men, the malnourished old had the poorest surgical outcomes of any group, with significantly more complications and morbidity rates. The well-nourished old had outcomes that did not differ from younger patients. On further examination, 60% of the young malnourished and only 20% of the old malnourished received preoperative enteral or parenteral nutritional support. Findings suggest that more attention to the needs of the older malnourished patients could improve surgical outcomes.

Adult↗

PubMed1990

Effects of referral bias on surgical outcomes: a population-based study of surgical patients 90 years of age or older.

During the 11-year period 1975 through 1985, 1,063 surgical procedures were performed on 795 Mayo Clinic patients 90 years of age or older. Preoperative conditions, surgical setting, and perioperative morbidity and mortality were analyzed in a comparison of the local residents of Olmsted County, Minnesota (N = 224), with patients from outside the county but within 250 miles (N = 456) or referrals from a distance of 250 miles or further (N = 115). In comparison with non-Olmsted County patients, Olmsted County patients were generally older, had more preoperative chronic diseases, and underwent more emergency operations. Patients who had traveled 250 miles or more to the Mayo Clinic were more likely to be men and referred for cancer-related surgical procedures. The risks of major morbidity and mortality within 48 hours postoperatively were increased in patients with more preoperative chronic diseases and those undergoing emergency procedures, characteristics most common in Olmsted County patients. Because of differences in these factors between groups, perioperative risks averaged over our entire patient series underestimated risks that would be expected from a population-based cohort such as Olmsted County residents. In general, data from tertiary medical centers probably do not accurately reflect overall practice or outcomes in community settings.

Academic Medical Centers↗

PubMed1990

Cystic medial necrosis of the aorta in patients without Marfan's syndrome: surgical outcome and long-term follow-up.

A retrospective analysis was performed to determine the surgical outcome and long-term follow-up of patients with documented cystic medial necrosis of the aorta. Ninety-three patients were diagnosed as having cystic medial necrosis at the Cleveland Clinic between July 1963 and December 1987 (72% men aged 26 to 77 years, mean 55). Patients who met the standard diagnostic criteria for Marfan's syndrome were deliberately excluded. Sixty-eight percent of the patients had a diastolic murmur and chest roentgenogram revealed a dilated aortic arch in 58% and cardiomegaly in 63%. Cardiac catheterization in 76 patients demonstrated aortic root dilation in 78%, aortic regurgitation in 72%, aortic dissection in 32% and coronary artery disease in 32%. Ninety patients underwent surgery including composite graft repair with reimplantation of the coronary arteries in 34%. Follow-up, obtained on 90 (97%) of the 93 patients, ranged in duration from 0 to 137 months (mean 29). Thirty-four of the 90 patients died (age range 30 to 75 years, mean 60). Ninety-four percent of the known causes of death were related to the cardiovascular system; 65% were the result of aortic dissection or rupture or sudden death. Ninety-six percent of survivors were in New York Heart Association functional class I or II. Overall estimated survival at 1, 3 and 5 years was 72.2%, 63.5% and 57.4%, respectively. Actuarial survival in patients who underwent composite graft reconstruction was 84% at 5 years. The presence of a diastolic murmur at initial presentation was associated with a poor prognosis (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

Post-surgical outcome of 57 patients with Mycobacterium xenopi pulmonary infection.

The outcome of 57 surgically treated cases with pulmonary infection due to Mycobacterium xenopi was studied. Success without any complications was observed in 21 patients while complications were observed in the other 36, during the 1st year (early complications) after surgery in 26 patients and after the 1st year (late complications) in 10. Early complications included two deaths, four relapses, two treatment failures, six cases of respiratory impairment, four cancers and 21 immediate post-operative complications which required 19 supplementary operations. Early complications were more frequent (p less than 0.05) in patients with pleural and/or emphysematous lesions. Late complications included 10 deaths, eight relapses, four pulmonary infections and five cancers. They were more frequent (p less than 0.05) in patients with the following risk factors: under nutrition, smoking/alcohol abuse, gastric ulcers with or without gastrectomy, associated serious illness, respiratory impairment and extensive pre-surgical radiographic lesions. In no case was infection due to M. xenopi directly responsible for lack of improvement.

Adult↗

PubMed1988

Retinal detachment. A study of a population-based patient material in Sweden 1971-1981. IV. Prediction of surgical outcome.

The association between the outcome of 531 surgically treated retinal detachments (RD) and preoperative findings was studied by logistic univariate and multivariate analysis. The following factors were significantly, and negatively associated with the surgical results: 1) previous RD in the same eye, 2) pre-operative visual acuity less than 2/60, 3) cloudy ocular media and/or a poorly dilated pupil, 4) an RD area of more than three quadrants, and 5) no retinal breaks detected. In the multivariate analysis no significant association was found for 9 factors: open angle glaucoma, interval of more than 2 months between symptoms and surgery, aphakia, pre-operative hypotony, absence of demarcation lines, posterior retinal breaks, pre-operative proliferative vitreo-retinopathy, sex and age. The significant factors combined with aphakia were studied in all conceivable combinations. The estimated probability of failure varied between 4 and 93%, indicating that the most important factors were observed.

Female↗

PubMed1988

Management and surgical outcome of suprasellar meningiomas.

The authors analyse 22 cases of suprasellar meningiomas, drawing attention to factors influencing on the surgical outcome. In all but one case, symptomatology began with progressive visual failure in one eye. Bilateral anosmia was noted in 4 patients with large tumour. Mental disorders were conspicuous in 5 cases and 3 patients suffered from epilepsy. Headache was severe in 5 cases. Endrocrinological disorders were observed in 3 patients. The sella turcica was of normal shape in all cases. Marked hyperostosis of the planum or tuberculum existed in 7 cases. The tumour was heavy-calcified in 2 cases. CT scanning showed everytime a marked enhancement of the tumour and in 4 cases, a large hypodense area surrounded the tumour. The patients were operated on through a bifrontal approach or a unilateral frontal flap. A partial anterior frontal lobectomy was regularly performed on one side. While the tumour is piecemeal exacavated, the dural attachment at the base is reached as quickly as possible. Complications consisted in rhinorrhea of CSF in 2 cases, once in a transitory diabetes insipidus and in a secondary hydrocephalus. Post-operative mortality remains high. Among the eleven cases of large tumours, a direct postoperative death occurred, due to a severe arterial bleeding. Two other patients died 4 and 6 weeks respectively after operation. An other patient died 8 years after operation, from meningitis. Among the 5 cases of medium-sized tumours, one post-operative death occurred in a young female, 30 of age, following urinary infection by Klebsiella, complicated by toxicemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1989

Effect of postoperative subconjunctival 5-fluorouracil injections on the surgical outcome of trabeculectomy in the Japanese.

A controlled study was carried out to evaluate the effect of postoperative subconjunctival 5-fluorouracil (5-FU) injections on the surgical outcomes of trabeculectomy in the Japanese (a total of 196 eyes in 157 patients). The eyes that had undergone trabeculectomy with postoperative 5-FU (5-FU group) included 36 eyes with primary open-angle glaucoma (POAG) and 17 with secondary glaucoma (SG) undergoing their first or second trabeculectomy. There were also 34 eyes with refractory glaucoma. The eyes that had had trabeculectomy without postoperative 5-FU (control group) included 46 POAG and 31 SG eyes undergoing their first or second trabeculectomy and 24 refractory glaucoma eyes. The surgical techniques and postoperative care were virtually identical between the two groups, except that the control group did not receive 5-FU. The results were analyzed by means of a life table method and a postoperative intraocular pressure (IOP) level equal to or less than 20 mmHg was adopted as the criterion for successful IOP control. In the 5-FU group, the success probability (%) at the 3-year follow-up was 93.9 +/- 4.2 (SE) for POAG eyes, 93.8 +/- 6.1 for SG eyes, and 86.7 +/- 5.6 for refractory glaucoma eyes. In the control group, it was 55.0 +/- 7.9, 37.2 +/- 13.5, and 16.1 +/- 7.4, respectively. The difference in success probability between the 5-FU and control groups was highly significant (P less than 0.001 or 0.01). In the POAG and SG eyes, the mean postoperative IOP was significantly lower in the 5-FU group than in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1988

Transcutaneous oxygen and carbon dioxide pressure monitoring to determine severity of limb ischemia and to predict surgical outcome.

Transcutaneous oxygen and carbon dioxide pressure (PO2 and PCO2) foot monitoring was compared with ankle Doppler-derived systolic pressure regarding their respective abilities to discriminate the severity of limb ischemia before vascular reconstruction and to predict surgical outcome early in the postoperative period. Transcutaneous PO2 (tcPCO2), foot-chest tcPO2 index, transcutaneous PCO2 (tcPCO2), foot tcPO2/tcPCO2 index (tcPO2/tcPCO2), ankle Doppler systolic pressure (AP), and ankle-brachial pressure index (ABI) were determined in 89 revascularized limbs. The measurement of tcPO2 and foot-chest tcPO2 was found to be more sensitive to degrees of severity of limb ischemia and more closely associated with the outcome of revascularization than AP and ABI. TcPCO2 and tcPO2/tcPCO2 were not useful in assessment of the vascular patient undergoing reconstructive surgery. Before operation, tcPO2 less than or equal to 22 torr and foot-chest tcPO2 less than or equal to 0.46 indicate severe limb ischemia requiring urgent revascularization. After operation, tcPO2 less than or equal to 22 torr and foot-chest tcPO2 index less than or equal to 0.53 indicate that revascularization is likely to fail. We conclude that tcPO2 monitoring, as a metabolic test of actual tissue perfusion, is a more reliable indicator of preoperative limb ischemia and postoperative outcome of revascularization than hemodynamic, Doppler-derived pressure tests.

Aged↗