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To investigate the factors associated with acute care discharge location to a skilled nursing facility (SNF) after surgery for Cauda Equina Syndrome (CES) to decrease costs, assist with appropriate discharge recommendations, and improve patient outcomes. Retrospective cohort study. Single hospital system. Patients (n=114) who received surgery for CES with subsequent discharge from the hospital. All patients had surgery for CES performed by either an orthopedic surgeon or neurosurgeon. Most of the patients (n=91) received rehabilitation in the hospital prior to discharge. Primary outcome measure was discharge location to SNF or home. Data collected included patient demographics, type of surgery performed, pre-operative symptoms, intra-operative characteristics, post-operative symptoms, and levels of performance and assistance in post-operative physical therapy in the hospital. Total patients (n=114) had an average age (standard deviation) of 55.4 (18.1) years. Average duration of CES symptoms prior to surgery was 43.7 (99.4) days. Factors associated with discharge to SNF after surgery for CES include non-married status (p=0.03), increased estimated blood loss (EBL) during surgery (p=0.02), increased length of stay (p< 0.01), the presence of pre-operative bowel and bladder symptoms (p=0.02), lower pre-operative motor scores and post-operative motor scores (p< 0.01), greater post-operative bed mobility assistance (p< 0.01), decreased first distance walked at first physical therapy evaluation in the hospital (p< 0.01), and decreased total distance walked during length of stay (LOS) at the hospital (p< 0.01). Multivariate analysis revealed decreased total distance walked during LOS is associated with discharge to SNF (p< 0.02). Post-operative discharge to SNF following surgery for CES is associated with level of assistance during physical therapy sessions, decreased ambulation in the hospital after surgery, non-married status, LOS, pre-operative bowel/bladder symptoms, increased EBL, and lower pre-operative and post-operative motor scores. Further research may assist with appropriate discharge determination to improve patient outcomes after surgery for CES. None of the authors have any conflicts to disclose. [ABSTRACT FROM AUTHOR]

Objective: Progestogen (vaginal progesterone or 17-alpha-hydroxyprogesterone caproate [17OHP-C]) administration to patients at risk for preterm delivery is widely used for the prevention of preterm birth (PTB). The mechanisms by which these agents prevent PTB are poorly understood. Progestogens have immunomodulatory functions; therefore, we investigated the local effects of vaginal progesterone and 17OHP-C on adaptive and innate immune cells implicated in the process of parturition.Study Design: Pregnant C57BL/6 mice received vaginal progesterone (1 mg per 200 μL, n = 10) or Replens (control, 200 μL, n = 10) from 13 to 17 days postcoitum (dpc) or were subcutaneously injected with 17OHP-C (2 mg per 100 μL, n = 10) or castor oil (control, 100 μL, n = 10) on 13, 15, and 17 dpc. Decidual and myometrial leukocytes were isolated prior to term delivery (18.5 dpc) for immunophenotyping by flow cytometry. Cervical tissue samples were collected to determine matrix metalloproteinase (MMP)-9 activity by in situ zymography and visualization of collagen content by Masson's trichrome staining. Plasma concentrations of progesterone, estradiol, and cytokines (interferon [IFN]γ, interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-10, IL-12p70, keratinocyte-activated chemokine/growth-related oncogene, and tumor necrosis factor-α) were quantified by enzyme-linked immunosorbent assays. Pregnant mice pretreated with vaginal progesterone or Replens were injected with 10 μg of an endotoxin on 16.5 dpc (n = 10 each) and monitored via infrared camera until delivery to determine the effect of vaginal progesterone on the rate of PTB.Results: The following results were found: (1) vaginal progesterone, but not 17OHP-C, increased the proportion of decidual CD4+ regulatory T cells; (2) vaginal progesterone, but not 17OHP-C, decreased the proportion of decidual CD8+CD25+Foxp3+ T cells and macrophages; (3) vaginal progesterone did not result in M1→M2 macrophage polarization but reduced the proportion of myometrial IFNγ+ neutrophils and cervical active MMP-9-positive neutrophils and monocytes; (4) 17OHP-C did not reduce the proportion of myometrial IFNγ+ neutrophils; however, it increased the abundance of cervical active MMP-9-positive neutrophils and monocytes; (5) vaginal progesterone immune effects were associated with reduced systemic concentrations of IL-1β but not with alterations in progesterone or estradiol concentrations; and (6) vaginal progesterone pretreatment protected against endotoxin-induced PTB (effect size 50%, P = 0.011).Conclusion: Vaginal progesterone, but not 17OHP-C, has local antiinflammatory effects at the maternal-fetal interface and the cervix and protects against endotoxin-induced PTB. [ABSTRACT FROM AUTHOR]