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This article discusses the use of virtual reality (VR) technology in the field of neurosurgical education. The ImmersiveTouch VR system and Oculus VR headset were used in a pilot study to provide training for residents and medical students. The curriculum included sessions on various cranial neurosurgical approaches, with VR renderings of different scenarios allowing trainees to plan and simulate surgical procedures. The use of VR technology enhanced trainee learning and provided a case-specific, three-dimensional model for better understanding of spatial relationships. Overall, the ImmersiveTouch VR system and associated curriculum were found to be useful tools for trainee learning in cranial neurosurgery. [Extracted from the article]

A 42-year-old male presented with 3-month history of constant right-sided frontal headaches, severe right-sided intermittent sharp jaw pain, odynophagia, globus pharyngis, and worsening episodes of blurry vision in his right eye. Cervicocerebral angiography demonstrated a prominent, 4 cm right sided styloid process with close proximity to the right internal carotid artery (ICA). The patient was referred to otorhinolaryngology for styloidectomy and continued care. [ABSTRACT FROM AUTHOR]

Gender is a known social determinant of health which has been linked disparities in medical care. This study intends to assess the impact of gender on 90-day and long-term morbidity and mortality outcomes following supratentorial brain tumor resection in a coarsened-exact matched population. A total of 1970 consecutive patients at a single, university-wide health system undergoing supratentorial brain tumor resection over a six-year period (09 June 2013 to 26 April 2019) were analyzed retrospectively. Coarsened Exact Matching was employed to match patients on key demographic factors including history of prior surgery, smoking status, median household income, American Society of Anesthesiologists (ASA) grade, and Charlson Comorbidity Index (CCI), amongst others. Primary outcomes assessed included readmission, ED visit, unplanned reoperation, and mortality within 90 days of surgery. Long-term outcomes such as mortality and unplanned return to surgery during the entire follow-up period were also recorded. Whole-population regression demonstrated significantly increased mortality throughout the entire follow-up period for the male cohort (p = 0.004, OR = 1.32, 95% CI = 1.09 − 1.59); however, no significant difference was found after coarsened exact matching was performed (p = 0.08). In both the whole-population regression and matched-cohort analysis, no significant difference was observed between gender and readmission, ED visit, unplanned reoperation, or mortality in the 90-day post-operative window, in addition to return to surgery after throughout the entire follow-up period. After controlling for confounding variables, female birth gender did not significantly predict any difference in morbidity and mortality outcomes following supratentorial brain tumor resection. Difference between mortality outcomes in the pre-matched population versus the matched cohort suggests the need to better manage the underlying health conditions of male patients in order to prevent future disparities. [ABSTRACT FROM AUTHOR]

It is well documented that the interaction between many social factors can affect clinical outcomes. However, the independent effects of economics on outcomes following surgery are not well understood. The goal of this study is to investigate the role socioeconomic status has on postoperative outcomes in a cerebellopontine angle (CPA) tumor resection population. Over 6 years (07 June 2013 to 24 April 2019), 277 consecutive CPA tumor cases were reviewed at a single, multihospital academic medical center. Patient characteristics obtained included median household income, Charlson Comorbidity Index (CCI), race, BMI, tobacco use, amongst 23 others. Outcomes studied included readmission, ED evaluation, unplanned return to surgery (during and after index admission), return to surgery after index admission, and mortality within 90 days, in addition to reoperation and mortality throughout the entire follow-up period. Univariate analysis was conducted amongst the entire population with significance set at a p value <0.05. The population was divided into quartiles based on median household income and univariate analysis conducted between the lowest (Q1) and highest (Q4) socioeconomic quartiles, with significance set at a p value <0.05. Stepwise regression was conducted to determine the correlations amongst study variables and identify confounding factors. Regression analysis of 273 patients did not find household income to be associated with any of the long-term outcomes assessed. Similarly, a Q1 vs Q4 comparison did not yield significantly different odds of outcomes assessed. Although not statistically significant, the odds ratios suggest socioeconomic status may have a clinically significant effect on postsurgical outcomes. Further studies in larger, matched populations are necessary to validate these findings. [ABSTRACT FROM AUTHOR]

In the present study, we performed a scoping review of the social and structural determinant of health (SSDOH)-related academic literature from neurosurgery. To identify the studies to include or consider for our systematic review, we worked with a medical librarian to develop detailed search strategies for each database. The search was limited to studies reported from January 1, 1990 to December 3, 2020. All reports retrieved from the database searches were exported and stored in EndNote X.9 bibliographic and reference manager (Clarivate, Philadelphia, Pennsylvania, USA). The reports were screened by title and abstract independently by two of the co-authors (G.G. and A.O.). Any disagreements between the 2 reviewers were resolved by a third reviewer, who was unaware of the decisions of the primary reviewers. The search resulted in 5940 studies. After exclusions during data extraction, 99 studies remained for the final analysis. From the 99 included studies, 6 social determinants were analyzed, with 3 studies evaluating the highest level of educational attainment, 14 studies evaluating gender, 52 studies evaluating race, and 41 studies evaluating economic stability. Studies referencing SSDOH were found in 8 subspecialties, with 40 studies in spine surgery, 4 studies in functional neurosurgery, 14 studies in vascular neurosurgery, 27 studies in cranial oncology, 5 studies in spinal oncology, 5 studies in pediatric neurosurgery, 1 study in trauma, and 3 studies in general/unspecified subspecialties. Research gaps included the remaining neurosurgical subspecialties and numerous other SSDOHs. These gaps should be areas of future study, with the goal of aligning research with new healthcare initiatives and ensuring consideration of SSDOHs. [ABSTRACT FROM AUTHOR]

Background: Access to medical care seems to be impacted by race. However, the effect of race on outcomes, once care has been established, is poorly understood. Purpose: This study seeks to assess the influence of race on patient outcomes in a brain tumor surgery population. Importance and Relevance to Healthcare Quality: This study offers insights to if or how quality is impacted based on patient race, after care has been established. Knowledge of disparities may serve as a valuable first step toward risk factor mitigation. Methods: Patients differing in race, but matched on other outcomes affecting characteristics, were assessed for differences in outcomes subsequent to brain tumor resection. Coarsened exact matching was used to match 1700 supratentorial brain tumor procedures performed over a 6-year period at a single, multihospital academic medical center. Patient outcomes assessed included unplanned readmission, mortality, emergency department (ED) visits, and unanticipated return to surgery. Results: There was no significant difference in readmissions, mortality, ED visits, return to surgery after index admission, or return to surgery within 30 days between the two races. Conclusion: This study suggests that race does not independently influence postsurgical outcomes but may instead serve as a proxy for other closely related demographics. [ABSTRACT FROM AUTHOR]

Introduction: The LACE1 index has been shown to predict readmissions; however, LACE1 has not been validated for extended postoperative outcomes in an orthopedic surgery population. The purpose of this study is to examine whether LACE1 scores predict unplanned readmissions and adverse outcomes following orthopedic surgery. Use of the LACE1 index to proactively identify at-risk patients may enable actions to reduce preventable readmissions. Methods: LACE1 scores were retrospectively calculated at the time of discharge for all consecutive orthopedic surgery patients (n518,893) at a multicenter health system over 3 years (2016-2018). Coarsened exact matching was used to match patients based on characteristics not assessed in the LACE1 index. Outcome differences between matched patients in different LACE quartiles (i.e. Q4 vs. Q3, Q2, and Q1) were analyzed. Results: Higher LACE1 scores significantly predicted readmission and emergency department visits within 90 days of discharge and for 30-90 days after discharge for all studied quartiles. Higher LACE1 scores also significantly predicted reoperations, but only between Q4 and Q3 quartiles. Conclusions: The results suggest that the LACE1 risk-prediction tool may accurately predict patients with a high likelihood of adverse outcomes after a broad array of orthopedic procedures. [ABSTRACT FROM AUTHOR]

Surgeon providers and billing professionals use Current Procedural Terminology (CPT) codes to specify patient treatment and associated charges. In the present study, coding discrepancies between surgeons' first pass coding and employed coders' final codes were investigated. A total of 500 patients over 3 months were retrospectively analyzed for coding discrepancies. To quantify the impact of change, codes with the most accumulated discrepancies were studied and change to annual relative value unit (RVU) was determined. Final submission of codes to billing demonstrated a 161% increase in total codes by the professional coders, versus original surgeon-derived codes (1594 vs 987 CPT codes). The most common source of change between the surgeon and coder was the addition of distinct codes by the billing professional (270 patients, 54.51%). These results demonstrate the existence of coding discrepancies. Future investigation will evaluate the communication between surgeons and billing professionals. [ABSTRACT FROM AUTHOR]

Background: The LACE1 index is a well-studied metric that compacts patient data in an effort to assess readmission risk. Purpose: Assess the capacity of LACE1 scores for predicting short-term undesirable outcomes in an entire single-center population of patients undergoing gynecologic surgery. Importance and Relevance to Healthcare Quality: Proactive identification of high-risk patients, with tools such as the LACE1 index, may serve as the first step toward appropriately engaging resources for reducing readmissions. Methods: This study was a retrospective analysis that used coarsened exact matching. All gynecologic surgery cases over 2 years within a single health system (n 5 12,225) were included for analysis. Outcomes of interest were unplanned readmission, emergency room (ER) evaluation, and return to surgery. Composite LACE1scores were separated into quartiles and matched. For outcome comparison, matched patients were assessed by LACE1 quartile, using Q4 as the reference group. Results: Increasing LACE1 score reflected a higher rate of readmission (p 5 .003, p 5 .001) and visits to the ER at 30 postoperative days (p, .001). Conclusion: The data presented here suggest that LACE1 index is a viable metric for patient outcome prediction following gynecologic surgery. [ABSTRACT FROM AUTHOR]

The LACE+ (Length of stay, Acuity of admission, Charlson Comorbidity Index score, and Emergency department visits in the past 6 months) risk‐prediction tool has never been tested in an orthopedic surgery population. LACE+ may help physicians more effectively identify and support high‐risk orthopedics patients after hospital discharge. LACE+ scores were retrospectively calculated for all consecutive orthopedic surgery patients (n = 18 893) at a multi‐center health system over 3 years (2016‐2018). Coarsened exact matching was employed to create "matched" study groups with different LACE+ score quartiles (Q1, Q2, Q3, Q4). Outcomes were compared between quartiles. In all, 1444 patients were matched between Q1 and Q4 (n = 2888); 2079 patients between Q2 and Q4 (n = 4158); 3032 patients between Q3 and Q4 (n = 6064). Higher LACE+ scores significantly predicted 30D readmission risk for Q4 vs Q1 and Q4 vs Q3 (P <.001). Larger LACE+ scores also significantly predicted 30D risk of ED visits for Q4 vs Q1, Q4 vs Q2, and Q4 vs Q3 (P <.001). Increased LACE+ score also significantly predicted 30D risk of reoperation for Q4 vs Q1 (P =.018), Q4 vs Q2 (P <.001), and Q4 vs Q3 (P <.001). [ABSTRACT FROM AUTHOR]

Endovascular parent vessel sacrifice is an established technique used to treat vascular pathology and tumor infiltration of blood vessels. In high-flow vessels, such as the carotid artery or vertebral artery, distal coil migration and embolization are concerns. A method to mitigate this risk would improve the safety profile of the procedure. Five patients undergoing parent vessel sacrifice were retrospectively identified (from June 2018 to May 2019) for the purpose of illustrating this high-flow parent vessel occlusion technique. The technique utilizes a proximal dual-lumen balloon microcatheter inflated for blood flow arrest. The balloon-assisted, dual microcatheter technique is useful for occlusion of high-flow parent arteries. Because it utilizes both flow arrest and a tethered coil backstop, precise occlusion of a vessel can be achieved. [ABSTRACT FROM AUTHOR]

The potential of length of stay, acuity of admission, Charlson Comorbidity Index score, and emergency department visits in the past 6 months (LACE+) scores in patients undergoing cardiac surgery to predict short-term undesirable outcomes was examined. Coarsened exact matching was used to assess the predictive capacity of the LACE+ index among all cardiac surgery cases over a 2-year period (2016-2018) at 1 health system (n = 4001). Study subjects were matched according to characteristics not assessed by LACE+, including duration of surgery, wound class, body mass index, insurance type, median household income, and race. For a comparison of outcomes, LACE score was divided into quartiles and otherwise matched populations were compared in reference to LACE quartile (Q): Q4 versus Q1, Q4 versus Q2, and Q4 versus Q3. Escalating LACE+ score significantly predicted increased readmission (6.99% versus 25.92% for Q1 versus Q4, 12.79% versus 26.74% for Q2 versus Q4, and 20.52% versus 27.66% for Q3 versus Q4, respectively; P <.001, P <.001, and P =.003), reoperation (2.39% versus 7.73% for Q1 versus Q4, and 4.33% versus 7.67% for Q2 versus Q4, respectively; P <.001 and P =.015, respectively), and emergency room visits at 30 days after surgery (6.64% versus 13.65% for Q1 versus Q4, and 11.20% versus 14.84% for Q2 versus Q4, respectively; P <.001 and P =.041, respectively) as well as readmission, reoperation, and emergency room visits from 30 to 90 days and 0 to 90 days after surgery. Increasing LACE score predicted higher rates of death during follow-up within 30 and 90 postoperative days (P <.001). The LACE+ index may be suitable as a prediction model for important patient outcomes in a cardiac surgery population. [ABSTRACT FROM AUTHOR]