Browsing by Author "Rocos, B"

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    A comparison of three-and two-rod constructs in the correction of severe pediatric scoliosis
    (Journal of Children's Orthopaedics, 2023-04-01) Machida, M; Rocos, B; Zeller, R; Lebel, DE
    Purpose: Managing severe scoliosis is challenging and risky with a significant complication rate regardless of treatment strategy. In this retrospective comparative study, we report our results using a three-rod compared to two-rod construct in the surgical treatment of severe spine deformities to investigate which technique is safer, and which provides superior radiological outcomes. Methods: Forty-six consecutive patients undergoing posterior spine fusion for scoliosis between 2006 and 2017 were identified in our institutional records. Inclusion criteria were minimum coronal deformity of 90°, age < 18 years at the time of surgery and a minimum 2 years of follow-up. Radiographic and clinical parameters, as well as post-operative complications were compared between the two groups. Results: There were 21 patients in the three-rod group and 25 in the two-rod group. The mean preoperative major coronal deformity was 100°± 9 and 102°± 10 in the three-rod and two-rod, respectively (p = 0.6). The average major curve correction was 51% and 59% in three-rod and two-rod groups, respectively (p = 0.03). The post-operative thoracic kyphosis was 30°± 11 and 21°± 12 in the three-rod and the two-rod groups, respectively (p = 0.01). The surgical time was 476 ± 52 and 387 ± 84 min in three-rod and two-rod, respectively (p < 0.01). One patient in the two-rod cohort showed permanent post-operative sensory deficit. There were three unplanned returns to operating theater in the two-rod group. Conclusions: Coronal correction was better with two-rod, whereas sagittal balance was superior with three-rod. Both techniques achieved balanced spine treating severe scoliosis. The two-rod technique was associated with a higher likelihood of requiring revision surgery. Level of evidence: level 3.
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    Alcohol skin preparation causes surgical fires.
    (Annals of the Royal College of Surgeons of England, 2012-03) Rocos, B; Donaldson, LJ

    Introduction

    Surgical fires are a rare but serious preventable safety risk in modern hospitals. Data from the US show that up to 650 surgical fires occur each year, with up to 5% causing death or serious harm. This study used the National Reporting and Learning Service (NRLS) database at the National Patient Safety Agency to explore whether spirit-based surgical skin preparation fluid contributes to the cause of surgical fires.

    Methods

    The NRLS database was interrogated for all incidents of surgical fires reported between 1 March 2004 and 1 March 2011. Each report was scrutinised manually to discover the cause of the fire.

    Results

    Thirteen surgical fires were reported during the study period. Of these, 11 were found to be directly related to spirit-based surgical skin preparation or preparation soaked swabs and drapes.

    Conclusions

    Despite manufacturer's instructions and warnings, surgical fires continue to occur. Guidance published in the UK and US states that spirit-based skin preparation solutions should continue to be used but sets out some precautions. It may be that fire risk should be included in pre-surgical World Health Organization checklists or in the surgical training curriculum. Surgical staff should be aware of the risk that spirit-based skin preparation fluids pose and should take action to minimise the chance of fire occurring.
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    Controversies in cervical spine trauma: The role of timing of surgical decompression and the use of methylprednisolone sodium succinate in spinal cord injury. A narrative and updated systematic review
    (Indian Spine Journal, 2022-01-01) Hejrati, N; Rocos, B; Fehlings, M
    Traumatic spinal cord injuries (SCIs) have devastating physical, social, and financial consequences for both patients and their families. SCIs most frequently occur at the cervical spine level, and these injuries are particularly prone to causing debilitating functional impairments. Unfortunately, no effective neuroregenerative therapeutic approaches capable of reversing lost neurologic and functional impairments exist, resulting in a large number of patients living with the persistent disability caused by a chronic cervical SCI. Over the past decades, a multitude of nonpharmacologic and pharmacologic neuroprotective strategies have been intensely investigated, including the timing of surgical decompression and the role of methylprednisolone sodium succinate (MPSS) in patients with acute SCI. These strategies have been the source of vibrant debate surrounding their potential risks and benefits. Our aim in this combined narrative and updated systematic review is to provide an assessment on the timing of surgical decompression as well as the role of high-dose MPSS treatment in patients with traumatic SCIs, with a special emphasis on the cervically injured subpopulation. Based on the current literature, there is strong evidence to support early surgical decompression within 24 h of injury to promote enhanced neurologic recovery. Meanwhile, moderate evidence supports the early initiation of a 24-h high-dose MPSS treatment within 8 h of injury, particularly in patients with a cervical SCI.
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    Cyanoacrylate dressings: are they microbiologically impermeable?
    (The Journal of hospital infection, 2010-06) Rocos, B; Blom, AW; Bowker, K
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    Injuries in jumpers-are there any patterns?
    (World Journal of Orthopedics, 2016-01-01) Rocos, B; Chesser, TJ
    Suicide as a cause of death, affects every health system, and is a particular problem in heavily urbanised states and low and middle income countries (which account for 75% of suicide deaths). The World Health Organisation records that 800000 commit suicide each year, representing 1.4% of annual global deaths, and that suicide was the second leading cause of death in 15-29 year-olds across the world in 2012. In the United Kingdom, jumping from height accounts for 3%-5% of the 140000 suicide attempts annually is similar incidence to the rest of Europe. The Medline and EMBASE were interrogated for studies examining suicide caused by jumping from height. Manual screening of titles and abstracts was used to identify relevant works before data was extracted and systematically reviewed to identify the characteristics of a patient who jumps from height to commit suicide, delineate their patterns of injury and explore techniques that could be used to limit its occurrence. Emergency departments receiving patients who jump from a height need to have an understanding of the potential pathology that is likely to be encountered in order to deliver multidisciplinary, efficient and timely care in order that the impact of this devastating physical, psychological and social problem could modified to the benefit of the patients involved.
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    Resuscitation in hip fractures: The practicality and clinical effectiveness of pre-operative resuscitation of patients with hip fracture using blood products
    (Journal of Orthopaedics, 2020-05-01) Rocos, B; Whitehouse, MR; Walsh, K; Reeves, BC; Kelly, MB
    Introduction: This study aimed to determine the practicality and estimate the effect of administering pre-operative blood product resuscitation to a consecutive, prospectively recruited cohort of 100 patients admitted to a single centre with a hip fracture with all other treatment unchanged. Method: 100 patients aged 65 years or over admitted acutely to our unit with unilateral fractured femoral neck during the study period were included in this study, regardless of cognitive function. Patients were excluded only if there were relevant medical comorbidities or consent was declined. Each patient was resuscitated with a single unit of packed red cells in the immediate perioperative period in addition to standard care. The primary outcome was to establish the feasibility of the study protocol employed in using blood products to resuscitate eligible patients and recording reasons for any failures to include eligible patients. Additional data regarding mortality at 30 days following injury, subsequent blood product use, any transfusion related adverse reactions and total blood product use was measured. Results: We were able to show that it is safe and practicable to deliver blood as an early resuscitative strategy in the frail elderly hip fracture population. The mortality rate of the study cohort was 3%. No adverse reaction was observed in any of the 99 patients given blood as a result of the resuscitation strategy and no morbidity was seen that could be attributed to the effect of giving blood. The total amount of blood received by comparable cohorts in the study period and the two preceding years were similar. Conclusions: The study suggests that in the hip fracture population it is both practical and beneficial to move away from reactive transfusion regimens, and instead centre efforts instead on optimal resuscitation at the initial presentation.
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    Spinal cord signal change on magnetic resonance imaging may predict worse clinical in-and outpatient outcomes in patients with spinal cord injury: A prospective multicenter study in 459 patients
    (Journal of Clinical Medicine, 2021-10-01) Jentzsch, T; Cadotte, DW; Wilson, JR; Jiang, F; Badhiwala, JH; Akbar, MA; Rocos, B; Grossman, RG; Aarabi, B; Harrop, JS; Fehlings, MG
    Prognostic factors for clinical outcome after spinal cord (SC) injury (SCI) are limited but important in patient management and education. There is a lack of evidence regarding magnetic resonance imaging (MRI) and clinical outcomes in SCI patients. Therefore, we aimed to investigate whether baseline MRI features predicted the clinical course of the disease. This study is an ancillary to the prospective North American Clinical Trials Network (NACTN) registry. Patients were enrolled from 2005–2017. MRI within 72 h of injury and a minimum follow-up of one year were available for 459 patients. Patients with American Spinal Injury Association impairment scale (AIS) E were excluded. Patients were grouped into those with (n = 354) versus without (n = 105) SC signal change on MRI T2-weighted images. Logistic regression analysis adjusted for commonly known a priori confounders (age and baseline AIS). Main outcomes and measures: The primary outcome was any adverse event. Secondary outcomes were AIS at the baseline and final follow-up, length of hospital stay (LOS), and mortality. A regression model adjusted for age and baseline AIS. Patients with intrinsic SC signal change were younger (46.0 (interquartile range (IQR) 29.0 vs. 50.0 (IQR 20.5) years, p = 0.039). There were no significant differences in the other baseline variables, gender, body mass index, comorbidities, and injury location. There were more adverse events in patients with SC signal change (230 (65.0%) vs. 47 (44.8%), p < 0.001; odds ratio (OR) = 2.09 (95% confidence interval (CI) 1.31–3.35), p = 0.002). The most common adverse event was cardiopulmonary (186 (40.5%)). Patients were less likely to be in the AIS D category with SC signal change at baseline (OR = 0.45 (95% CI 0.28–0.72), p = 0.001) and in the AIS D or E category at the final follow-up (OR = 0.36 (95% CI 0.16–0.82), p = 0.015). The length of stay was longer in patients with SC signal change (13.0 (IQR 17.0) vs. 11.0 (IQR 14.0), p = 0.049). There was no difference between the groups in mortality (11 (3.2%) vs. 4 (3.9%)). MRI SC signal change may predict adverse events and overall LOS in the SCI population. If present, patients are more likely to have a worse baseline clinical presentation (i.e., AIS) and in-or.
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    Utility of the spinal instability neoplastic score to identify patients with Gorham-Stout disease requiring spine surgery
    (Surgical Neurology International, 2021-01-01) Gui, C; Rocos, B; Lohkamp, LN; Cheung, A; Bleakney, R; Massicotte, E
    Background: Gorham-Stout disease (GSD) is a rare syndrome presenting with progressive osteolysis which in the spine can lead to cord injury, instability, and deformity. Here, the early spine surgery may prevent catastrophic outcomes. Case Description: A 25-year-old male with GSD involving the T2 to T6 levels presented with acute traumatic kyphoscoliosis at T3 and T4 and left lower extremity paraparesis. The CT scan 4 weeks before this showed progressing osteolysis versus the CT 5 years ago. Unfortunately, the patient underwent delayed treatment resulting in permanent neurological sequelae. Surgery included a laminectomy and vertebrectomy of T3/T4 with instrumented fusion from T1-10. The use of the spinal instability neoplastic score (SINS) is a useful tool to prompt early referral to spine surgeons. Conclusion: We recommend using the SINS score in GSD patients who develop spinal lesions to prompt early referral for consideration of surgery.
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    Waiting times for cancer treatment: The impact of multi-disciplinary team meetings
    (Behaviour and Information Technology, 2011-07-01) Goolam-Hossen, T; Metcalfe, C; Cameron, A; Rocos, B; Falk, S; Blazeby, JM
    In the UK, treatment recommendations for patients with cancer are all made within multi-disciplinary team (MDT) meetings. This has benefits, but it may delay treatment starting if MDT decisions require revision before implementation. This study examined whether changes in MDT treatment decisions after the meeting led to a delay in the start of treatment. Consecutive MDT treatment recommendations were recorded and times to start of treatment were calculated. Comparisons of the time from MDT meeting to start of treatment were made between implemented and non-implemented MDT recommendations. Of 363 MDT recommendations, 71 (19.5%, 95% CIs 15.6-24.0) were not implemented. The median time to start of treatment was 24 days (IQR 12-33), increasing to 35 days (IQR 17-77.5), if the MDT decision required revision to another active therapy (p=0.009). Decisions were changed because details about co-morbidity (n=32, 45%), new clinical information (n=24, 34%) or patient choice became apparent (n=13, 18%) and two changed for no clear reason. Significant delays in starting treatment occur if team treatment recommendations are not implemented. Effort and resources are required to ensure that information is present at meetings to allow comprehensive patient-centred decisions to be made and implemented. © 2011 Taylor & Francis.