24 results on '"Ziino C"'
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2. The neurologically intact patient with TLICS 4 or 5 burst fracture should be given a trial of nonoperative management.
- Author
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Best SA, Shorten PL, Ziino C, Kagan BD, Lunardini DJ, Krag MH, and Monsey RD
- Subjects
- Humans, Male, Retrospective Studies, Female, Adult, Middle Aged, Injury Severity Score, Conservative Treatment methods, Pain Measurement, Kyphosis therapy, Kyphosis etiology, Treatment Outcome, Spinal Fractures therapy, Thoracic Vertebrae injuries, Lumbar Vertebrae injuries
- Abstract
Thoracolumbar burst fracture treatment in neurologically intact patients is controversial with many classification systems to help guide management. Thoracolumbar Injury Classification and Severity score (TLICS) provides a framework, but evidence is limited, and recommendations are primarily based on expert opinion. In this retrospective cohort study, data was reviewed for patients with thoracolumbar burst fractures at a Level-1 Trauma Center in New England from 2013 to 2018. Neurologically intact patients without subluxation/dislocation on supine computed tomography were included. Multimodal pain control and early mobilization were encouraged. Patients that failed to mobilize due to pain were treated with operative stabilization. Outcome measures include degree of kyphosis, visual analog scale pain scores, and neurological function. Thirty-one patients with thoracolumbar burst fractures with TLICS scores of 4 or 5 were identified, of which 21 were treated nonoperatively. Kyphosis at final follow-up was 26.4 degrees for the nonoperative cohort versus 13.5 degrees for the operative group (P < .001). Nonoperative patients tended towards shorter hospital lengths-of-stay (3.0 vs 7.1 days, P = .085) and lower final pain scores (2.0 vs 4.0, P = .147) compared to the operative group. Two patients (6%) developed radicular pain with mobilization, which resolved after surgical intervention. No patients experienced decline in neurologic function. A trial of mobilization for neurologically intact TLICS grade 4 and 5 thoracolumbar burst fractures is a safe and reasonable treatment option that resulted in successful nonoperative management of 21 out of 31 (68%) patients., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2024
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3. Preoperative vitamin D supplementation is a cost-effective intervention in arthroscopic rotator cuff repair.
- Author
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Patel D, Roy G, Endres N, and Ziino C
- Subjects
- Humans, Rotator Cuff surgery, Cost-Benefit Analysis, Treatment Outcome, Arthroscopy, Dietary Supplements, Retrospective Studies, Vitamin D therapeutic use, Rotator Cuff Injuries surgery
- Abstract
Background: This study investigates the potential role of preoperative 25(OH)D supplementation as a cost-effective strategy to decrease revision rotator cuff repair (RCR) rates and lower the total health care burden from patients undergoing primary arthroscopic RCR. Previous literature has emphasized the importance of vitamin D on bone health maintenance, soft tissue healing, and outcomes in RCR. Inadequate preoperative vitamin D levels may increase revision RCR rates following primary arthroscopic RCR. Although 25(OH)D deficiency is common in RCR patients, serum screening is not routinely performed., Methods: A cost-estimation model was developed to determine the cost-effectiveness of both preoperative selective and nonselective 25(OH)D supplementation in RCR patients in order to reduce revision RCR rates. Prevalence and surgical cost data were obtained from published literature through systematic reviews. Cost of serum 25(OH)D assay and supplementation were obtained from public-use data. Mean and lower and upper bounds of 1-year cost savings were calculated for both the selective and nonselective supplementation scenarios., Results: Preoperative 25(OH)D screening and subsequent selective 25(OH)D supplementation was calculated to result in a mean cost savings of $6,099,341 (range: -$2,993,000 to $15,191,683) per 250,000 primary arthroscopic RCR cases. Nonselective 25(OH)D supplementation of all arthroscopic RCR patients was calculated to result in a mean cost savings of $11,584,742 (range: $2,492,401-$20,677,085) per 250,000 primary arthroscopic RCR cases. Univariate adjustment projects that selective supplementation is a cost-effective strategy in clinical contexts where the cost of revision RCR exceeds $14,824.69 and prevalence of 25(OH)D deficiency exceeds 6.67%. Additionally, nonselective supplementation is a cost-effective strategy in clinical scenarios where revision RCR cost is ≥$4216.06 and prevalence of 25(OH)D deficiency is ≥1.93%., Conclusions: This cost-predictive model promotes the role of preoperative 25(OH)D supplementation as a cost-effective mechanism to reduce revision RCR rates and lower the overall health care burden from arthroscopic RCR. Nonselective supplementation appears to be more cost-effective than selective supplementation, likely due to the lower cost of 25(OH)D supplementation compared to serum assays., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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4. Spinal artery syndrome following kyphoplasty in the setting of a non-compressive extradural cement extravasation: a case report.
- Author
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Striano BM, Goh BC, Ziino C, and Kim S
- Subjects
- Female, Humans, Aged, Paraparesis complications, Arteries, Kyphoplasty adverse effects, Spinal Fractures diagnostic imaging, Spinal Fractures surgery, Fractures, Compression diagnostic imaging, Fractures, Compression surgery, Fractures, Compression complications, Spinal Cord Compression diagnostic imaging, Spinal Cord Compression etiology, Spinal Cord Compression surgery
- Abstract
Introduction: Cement extravasation (CE) during vertebroplasty or kyphoplasty for vertebral compression fracture (VCF) is not uncommon, though neurological deficits occur rarely and when paraparesis occurs severe cord compression has been described. We report a case of progressive paraparesis in the setting of non-compressive extradural CE during kyphoplasty with evidence for spinal artery syndrome and neurological recovery after treatment., Case Presentation: A 77-year-old female with T12 VCF failed conservative treatment and underwent kyphoplasty. In the recovery room, the patient was noted to have bilateral leg weakness, left worse than right, and had urgent CT scan that showed right paracentral CE without cord compression or arterial cement embolization. The patient was transferred to a tertiary hospital and had MRI of the spine that confirmed extradural CE and no cord compression. Because the patient had progression of lower extremity deficits despite medical management, she underwent surgical decompression, cement excision, and spinal fusion with instrumentation. Post op MRI showed T2 hyperintensities in the spinal cord consistent with spinal artery syndrome. One month post op, she had almost complete recovery of her neurological function., Discussion: Spinal artery syndrome may be considered in patients with neurological deficit s/p kyphoplasty even if the extravasated cement does not compress the spinal cord and even if the deficits are worse contralateral to the cement extravasation. If spinal artery syndrome is present and medical management does not improve the deficits, surgery may be indicated even if there is no cord compression., (© 2023. The Author(s), under exclusive licence to International Spinal Cord Society.)
- Published
- 2023
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5. Impact of Certificate of Need on Lumbar Discectomy Reimbursement and Utilization.
- Author
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Ziino C, Bala A, Warren S, and Cheng I
- Subjects
- Aged, Humans, United States, Diskectomy methods, Health Care Costs, Postoperative Complications, Certificate of Need, Medicare
- Abstract
The Certificate of Need (CON) program was established to respond to increasing healthcare costs; however, its impact on spine surgery trends is not well understood. The purpose of this study was to evaluate the impact of CON status on utilization of single-level lumbar discectomy. A combined Medicare and private payer database was used to identify single level lumbar discectomies performed from 2007 to 2015. Utilization and reimbursement trends were compared using the compound annual growth rate (CAGR) with reimbursement adjusted by the consumer price index. For this study, 30,617 lumbar discectomies were analyzed. Procedure utilization increased across all settings. CAGR was highest in the outpatient CON group (19.7%) and lowest in the inpatient non-CON group (0.5%). Reimbursement increased in the outpatient setting (CAGR: 1.2% CON, 1.0% non-CON), but decreased in the inpatient setting (CAGR: -6.1% CON, -5.5% non-CON). These trends are important to consider in a value-based healthcare environment. (Journal of Surgical Orthopaedic Advances 31(4):218-221, 2022).
- Published
- 2022
6. Characteristics of postoperative opioid prescription use following lumbar discectomy.
- Author
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Ziino C, Karhade AV, Schoenfeld AJ, Harris MB, and Schwab JH
- Subjects
- Adult, Diskectomy adverse effects, Humans, Pain, Postoperative drug therapy, Prescriptions, Analgesics, Opioid therapeutic use, Opioid-Related Disorders etiology
- Abstract
Objective: The role of spine surgeons in precipitating and mediating sustained prescription opioid use remains controversial at this time. The purpose of this study was to identify prescription opioid use following lumbar discectomy and characterize the source of opioid prescriptions by clinician specialty (surgeon vs nonsurgeon)., Methods: Using a retrospective review, the authors identified adult patients undergoing lumbar discectomy for a primary diagnosis of disc herniation between 2010 and 2017. The primary outcome was sustained prescription opioid use, defined as issue of an opioid prescription at a time point 90 days or longer after the surgical procedure. The primary predictor variable was prescriber specialty (surgeon vs nonsurgeon). The independent effect of provider specialty on the number of opioid prescriptions issued to patients was assessed using multivariable Poisson regression that accounted for confounding from all other clinical and sociodemographic variables., Results: This study included 622 patients who underwent a lumbar discectomy. A total of 610 opioid prescriptions were dispensed for this population after surgery. In total, 126 patients (20.3%) had at least one opioid prescription in the period beyond 90 days following their surgery. The majority of opioid prescriptions, 494 of 610 (81%), were non-inpatient prescriptions. Among these, only a minority (26%) of outpatient opioid prescriptions were written by surgical providers. Following multivariable Poisson regression analysis, surgical providers were found to have a lower likelihood of issuing an opioid prescription compared to nonsurgical clinicians (incidence rate ratio [IRR] 0.78; 95% CI 0.68-0.89; p = 0.001)., Conclusions: A minority of lumbar discectomy patients continue to receive opioid prescriptions up to 15 months after surgery. Many of these prescriptions are written by nonsurgical providers unaffiliated with the operative team.
- Published
- 2021
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7. The Impact of Certificate of Need Status on the Utilization and Reimbursement of Open and Endoscopic Carpal Tunnel Release.
- Author
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Denduluri SK, Roe A, Bala A, Fogel N, Ziino C, and Kamal RN
- Subjects
- Certificate of Need, Decompression, Surgical, Endoscopy, Humans, Carpal Tunnel Syndrome surgery, Orthopedics
- Abstract
A certificate of need (CON) permits a healthcare organization to build new facilities only if significant medical needs exist. Many states have implemented CON programs to prevent procedure overutilization and price inflation. We hypothesized that there are no differences in reimbursement or utilization for open and endoscopic carpal tunnel release (CTR) when comparing states with and without CON programs. We queried a private-payer database to identify open and endoscopic CTRs performed between 2007 and 2015. In total, 82,689 CTRs were identified: 70,160 open, 12,529 endoscopic. Reimbursement increased for open procedures (compound annual growth rate [CAGR] 1.0% CON, 1.4% non-CON) but only marginally increased or decreased in the endoscopic group (CAGR -0.8% CON, 0.2% non-CON). Utilization increased across all settings, and was highest in the endoscopic CON group (CAGR 17.9%). Least growth was seen in the open non-CON group (CAGR 10.0%). Overall, CON programs may not actually decrease CTR spending or utilization. (Journal of Surgical Orthopaedic Advances 30(2):090-092, 2021).
- Published
- 2021
8. Utilization and Reimbursement Trends Based on Certificate of Need in Single-level Cervical Discectomy.
- Author
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Ziino C, Bala A, and Cheng I
- Subjects
- Aged, Diskectomy, Humans, Outpatients, Retrospective Studies, United States, Certificate of Need, Medicare
- Abstract
Objective: To compare utilization and reimbursement for cervical discectomy in certificate of need (CON) and non-CON states., Summary of Background Data: Cervical discectomy is a commonly performed procedure, but little is known about utilization and reimbursement patterns in the CON setting., Introduction: Cervical discectomy is increasingly used and remains effective. Increasing healthcare costs have led to decreased reimbursement and a push toward outpatient procedures. CON programs were established to ensure that expansion of medical facilities were within acceptable use; however, the literature on their impact in spine surgery is limited. The purpose of this study was to examine the impact of CON status on both reimbursement and utilization in cervical decompression in both inpatient and outpatient settings., Methods: We analyzed a private payer and Medicare database from 2007 to 2015. All single-level cervical discectomies were selected then split into CON and non-CON states. Each group was then further split into inpatient and outpatient. Utilization and reimbursement were analyzed using the compound annual growth rate (CAGR), with reimbursement adjusted by the US Bureau of Labor Statistics Consumer Price Index., Results: We identified 1,580 single level cervical decompressions in our study period: 888 were done in the inpatient setting, whereas 692 were done in the outpatient setting. Adjusted reimbursement only increased in the non-CON outpatient setting, with a CAGR of 2.0%. All other settings had decreased reimbursement. Utilization increased across all four settings, with the highest growth seen in the CON outpatient setting, with a CAGR of 12.7%. The highest average reimbursement was in the non-CON outpatient setting at $4,237., Discussion: Cervical discectomy is seeing increased utilization most rapidly in the outpatient setting, although reimbursement is declining with the exception of procedures done in the non-CON outpatient setting. Surgeons should be aware of these trends in the changing healthcare economic climate., Study Design: A retrospective database review., (Copyright © 2021 by the American Academy of Orthopaedic Surgeons.)
- Published
- 2021
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9. Laminoplasty-an underutilized procedure for cervical spondylotic myelopathy.
- Author
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Lopez WY, Goh BC, Upadhyaya S, Ziino C, Georgakas PJ, Gupta A, Tobert DG, Fogel HA, Cha TD, Schwab JH, Bono CM, and Hershman SH
- Subjects
- Adolescent, Cervical Vertebrae diagnostic imaging, Cervical Vertebrae surgery, Cohort Studies, Humans, Laminectomy, Reproducibility of Results, Retrospective Studies, Treatment Outcome, Laminoplasty, Spinal Cord Diseases diagnostic imaging, Spinal Cord Diseases surgery, Spinal Fusion, Spondylosis diagnostic imaging, Spondylosis surgery
- Abstract
Background Content: Cervical laminoplasty (LP) and laminectomy and fusion (LF) are commonly used surgical techniques for cervical spondylotic myelopathy (CSM). Several recent studies have demonstrated superior perioperative metrics and decreased overall costs with LP, yet LF is performed far more often in the United States., Purpose: To determine the percentage of patients with CSM who are radiographically candidates for LP., Study Design: Retrospective comparative cohort study., Patient Sample: Patients >18 years old who underwent LF or LP for CSM at 2 large academic institutions from 2017 to 2019., Outcome Measures: Candidacy for LP based on radiographic criteria., Methods: Radiographs were assessed by 2 spine surgeons not involved in the care of the patients to determine the C2-C7 Cobb angle and the presence and extent of cervical instability. Patients with kyphosis >13°, > 3.5 mm of listhesis on static imaging, or > 2.5 mm of motion on flexion-extension or standing-supine films were not considered candidates for LP. Intraclass coefficient (ICC) was calculated to assess the interobserver reliability of angular measurements and the presence of instability. The percentage of patients for whom LP was contraindicated was calculated., Results: One hundred eight patients underwent LF while 142 underwent LP. Of the 108 patients who underwent LF, 79.6% were radiographically deemed candidates for LP, as were all 142 patients who underwent LP. The ICC for C2-C7 alignment was 0.90; there was 97% agreement with respect to the presence of instability., Conclusions: In 250 patients with CSM, 228 (91.2%) were radiographically candidates for LP. These data suggest that LP may be an underutilized procedure for the treatment for CSM., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2021
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10. Rod-Screw Constructs Composed of Dissimilar Metals Do Not Affect Complication Rates in Posterior Fusion Surgery Performed for Adult Spinal Deformity.
- Author
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Denduluri SK, Koltsov JCB, Ziino C, Segovia N, McMains C, Falakassa J, Ratliff J, Wood KB, Alamin T, Cheng I, and Hu SS
- Subjects
- Adult, Bone Screws adverse effects, Chromium Alloys, Humans, Retrospective Studies, Kyphosis, Spinal Fusion adverse effects
- Abstract
Study Design: This was a retrospective cohort study., Objective: The objective of this study was to compare implant-related complications between mixed-metal and same-metal rod-screw constructs in patients who underwent posterior fusion for adult spinal deformity., Summary of Background Data: Contact between dissimilar metals is discouraged due to potential for galvanic corrosion, increasing the risk for metal toxicity, infection, and implant failure. In spine surgery, titanium (Ti) screws are most commonly used, but Ti rods are notch sensitive and likely more susceptible to fracture after contouring for deformity constructs. Cobalt chrome (CC) and stainless steel (SS) rods may be suitable alternatives. No studies have yet evaluated implant-related complications among mixed-metal constructs (SS or CC rods with Ti screws)., Methods: Adults with spinal deformity who underwent at least 5-level thoracic and/or lumbar posterior fusion or 3-column osteotomy between January 2013 and May 2015 were reviewed, excluding neuromuscular deformity, tumor, acute trauma or infection. Implant-related complications included pseudarthrosis, proximal junctional kyphosis, hardware failure (rod fracture, screw pullout or haloing), symptomatic hardware, and infection., Results: A total of 61 cases met inclusion criteria: 24 patients received Ti rods with Ti screws (Ti-Ti, 39%), 31 SS rods (SS-Ti, 51%), and 6 CC rods (CC-Ti, 9.8%). Median follow-up was 37-42 months for all groups. Because of the limited number of cases, the CC-Ti group was not included in statistical analyses. There were no differences between Ti-Ti and SS-Ti groups with regard to age, body mass index, or smokers. Implant-related complications did not differ between the Ti-Ti and SS-Ti groups (P=0.080). Among the Ti-Ti group, there were 15 implant-related complications (63%). In the SS-Ti group, there were 12 implant-related complications (39%). There were 3 implant-related complications in the CC-Ti group (50%)., Conclusion: We found no evidence that combining Ti screws with SS rods increases the risk for implant-related complications., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
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11. Laminoplasty versus laminectomy and fusion for cervical spondylotic myelopathy: a cost analysis.
- Author
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Goh BC, Striano BM, Lopez WY, Upadhyaya S, Ziino C, Georgakas PJ, Tobert DG, Fogel HA, Cha TD, Schwab JH, Bono CM, and Hershman SH
- Subjects
- Adolescent, Adult, Cervical Vertebrae surgery, Costs and Cost Analysis, Humans, Laminectomy, Postoperative Complications, Retrospective Studies, Treatment Outcome, Laminoplasty adverse effects, Spinal Cord Diseases surgery, Spinal Fusion adverse effects, Spondylosis surgery
- Abstract
Background Context: Laminectomy with fusion (LF) and laminoplasty (LP) are commonly used to treat cervical spondylotic myelopathy (CSM). The decision regarding which procedure to perform is largely a matter of surgeon's preference, while financial implications are rarely considered., Purpose: We aimed to better understand the financial considerations of LF compared to LP in the treatment of CSM., Study Design: Retrospective comparative study., Patient Sample: Adult patients, 18 years of age or older, who had undergone LF or LP for CSM from 2017 to 2019 at 2 large academic centers were included. Patients who had undergone previous cervical spine surgery or procedures that extended above C2 or below T2 were excluded., Outcome Measures: The primary outcome was defined as the total cost of the procedure, which was calculated as the sum of the implant and non-implant supply costs., Methods: Patient demographics, surgical parameters, including estimated blood loss and operative time, and length of stay were collected. Operating room material - both implant and non-implant - cost data was also obtained. Variables were analyzed individually as well as after adjustment based on the number of operative levels involved. Statistical analysis was performed using either Student t test with unequal variance or Wilcoxon rank sum test for continuous variables and chi-squared analysis for categorical variables., Results: Two hundred fifty patients were identified who met inclusion criteria. There was no statistical difference in the mean age at time of surgery (p=.25), gender distribution (p=.33), or re-operation rate between the LF and LP groups (p=.39). Overall, operative time was similar between the LF (165.7 ± 61.9 min) and LP (173.8 ± 58.2 min) groups (p=.29), but the LP cohort had a shorter length of stay at 3.8 ± 2.7 days compared to the LF cohort at 4.8 ± 3.7 days. Implant costs in the LF group were significantly more at $6,204.94 ± $1426.41 compared to LP implant costs at $1994.39 ± $643.09. Mean total costs of LP were significantly less at $2,859.08 ± $784.19 compared to LF total costs of $6,983.16 ± $1,589.17. Furthermore, when adjusted for the number of operative levels, LP remained significantly less costly at $766.12 ± $213.64 per level while LF cost $1,789.05 ± $486.66 per operative level. Additional subgroup analysis limiting the cohorts to patients with either three or four involved vertebral levels demonstrated nearly identical cost savings with LP as compared to LF., Conclusions: This study demonstrates that LF is on average at least 2.4 times the total operative supply cost of LP and at least 2.3 times the operative supply cost of LP when adjusted for the number of operative levels. In patients deemed appropriate for either LP or LF, these data may be incorporated into decision-making for the treatment of CSM., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
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12. Does ACDF Utilization and Reimbursement Change Based on Certificate of Need Status?
- Author
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Ziino C, Bala A, and Cheng I
- Subjects
- Diskectomy economics, Humans, Insurance Claim Review, Retrospective Studies, Spinal Fusion economics, United States, Certificate of Need, Cervical Vertebrae, Diskectomy statistics & numerical data, Patient Acceptance of Health Care, Spinal Fusion statistics & numerical data
- Abstract
Introduction: Anterior cervical discectomy and fusion (ACDF) remain an effective treatment option for multiple pathologies of the cervical spine. As the health care economic climate has changed, so have reimbursements with a concomitant push toward outpatient procedures. Certificate of Need (CON) programs were established in response to burgeoning health care costs which require states to demonstrate need before expansion of medical facilities. The impact of this program on spine surgery is largely unknown. The purpose of this study was to examine the impact of CON status on reimbursement and utilization trends of ACDF in both inpatient and outpatient settings., Materials and Methods: We queried a combined private payer and Medicare database from 2007 to 2015. All single-level ACDFs were identified. We then split each procedure into those performed in CON versus non-CON states. We then further split each group into the inpatient and outpatient settings. Compound annual growth rate (CAGR) was used to compare utilization and reimbursement trends. Reimbursement was adjusted for inflation using the United States Bureau of Labor Statistics consumer price index., Results: A total of 32,727 single-level ACDFs were identified, of which 28,441 were performed in the inpatient setting, and 4286 were performed in the outpatient setting. Reimbursement decreased across all settings, with the most pronounced decrease in the non-CON outpatient setting with an adjusted CAGR of -11.0%. Utilization increased across all groups, although the fastest growth was seen in the outpatient CON setting with a CAGR of 47.7%, and the slowest growth seen in the inpatient non-CON setting at a CAGR of 12.9%., Conclusions: ACDF utilization increased most rapidly in the outpatient setting, and CON status did not appear to hinder growth. Reimbursement decreased across all settings, with the outpatient setting in non-CON states most affected. Surgeons should be aware of these trends in the changing health care environment.
- Published
- 2020
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13. An anatomic classification for heterotopic ossification about the hip.
- Author
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DeBaun MR, Ziino C, LaPrade C, Pun S, Avedian RS, and Bellino MJ
- Abstract
Study Design: Retrospective cohort., Summary of Background Data: Heterotopic ossification (HO) about the hip is a debilitating condition that can occur after fixation for acetabular fractures, total hip replacement, or polytrauma with closed head injuries. No classification exists that informs surgical treatment., Purpose: To establish a classification system for HO about the hip by reviewing a consecutive series of HO at a single institution. It was hypothesized that HO about the hip could be grouped into a novel classification scheme based upon the location and involved structures of the hip., Methods: Retrospective chart review of single center's case log for HO excision from 2004 to 2018 was performed. Inclusion criteria included all patients undergoing excision of heterotopic bone excision about the hip. Demographic data, pre and post hip range of motion, surgical approach for each surgery, index surgery date and interval to excision are reported as well as presence and location of HO and Brooker classification., Results: A total of 36 patients (21 men and 15 women) and 40 hips were identified meeting inclusion criteria. The mean age at the time of the index surgery was 47 (range, 16-77 years). Traumatic injury with fracture (35%) included 9 acetabular fractures (22%), 2 long bone fractures (5%) treated with intramedullary devices, one displaced femoral neck fracture (2%), and one pelvic ring injury (2%). Total hip arthroplasty accounted for 32% of patients. Brooker classification was type 4 (35%), 3 (25%), 2 (23%), 1(17%) which translated to 55% anterior, 48% posterior, 3% medial with respect to location. Average improvement in hip flexion and abduction was 22 and 8°, respectively., Conclusion: This study identified discrete locations for heterotopic ossification following hip or acetabulum surgery. Both posterior and anterior structures are implicated in the formation of HO, and this investigation presents a novel classification to guide surgical approach for HO excision based upon location., (© 2020 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)
- Published
- 2020
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14. Decompression With or Without Fusion for Lumbar Stenosis: A Cost Minimization Analysis.
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Ziino C, Mertz K, Hu S, and Kamal R
- Subjects
- Adult, Aged, Decompression, Surgical methods, Female, Humans, Male, Medicare economics, Middle Aged, Postoperative Complications economics, Postoperative Complications epidemiology, Retrospective Studies, Spinal Fusion methods, Spinal Stenosis epidemiology, United States epidemiology, Costs and Cost Analysis methods, Decompression, Surgical economics, Lumbar Vertebrae surgery, Spinal Fusion economics, Spinal Stenosis economics, Spinal Stenosis surgery
- Abstract
Study Design: Retrospective database review., Objective: Compare 1-year episode of care costs between single-level decompression and decompression plus fusion for lumbar stenosis., Summary of Background Data: Lumbar stenosis is the most common indication for surgery in patients over 65. Medicare direct hospital costs for lumbar surgery reached $1.65 billion in 2007. Despite stenosis being a common indication for surgery, there is debate as to the preferred surgical treatment. Cost-minimization analysis is a framework that identifies potential cost savings between treatment options that have similar outcomes. We performed a cost-minimization analysis of decompression versus decompression with fusion for lumbar stenosis from the payer perspective., Methods: An administrative claims database of privately insured patients (Humana) identified patients who underwent decompression (n = 5349) or decompression with fusion (n = 8540) for lumbar stenosis with and without spondylolisthesis and compared overall costs. All patients were identified and costs identified for a 1-year period. Complication rates and costs were described using summary statistics., Results: Mean treatment costs at 1 year after surgery were higher for patients who underwent decompression and fusion compared to patients who underwent decompression alone ($20,892 for fusion vs. $6329 for decompression; P < 0.001). Facility costs (P < 0.001), surgeon costs (P < 0.001), and physical therapy costs (P < 0.001) were higher in the fusion group. Cost differences related to infection or durotomy reached significance (P < 0.04). No difference in cost was identified for supplies., Conclusion: Decompression had significantly lower costs for the treatment of lumbar stenosis, including treatment for postoperative complications. If cost minimization is the primary goal, decompression is favored for surgical treatment of lumbar stenosis. Other factors including shared decision-making directed toward patient's values, patient-reported outcomes, and preferences should also be recognized as drivers of healthcare decisions., Level of Evidence: 3.
- Published
- 2020
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15. Computer-assisted surgical navigation is associated with an increased risk of neurological complications: a review of 67,264 posterolateral lumbar fusion cases.
- Author
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Ajiboye RM, Koltsov JCB, Karamian B, Swinford S, Montgomery BK, Arzeno A, Ziino C, and Cheng I
- Abstract
Background: Pedicle screw malposition may result in neurological complications following posterolateral lumbar fusions (PLF). While computer-assisted navigation (NAV) and intraoperative neuromonitoring (ION) have been shown to improve safety in deformity surgeries, their use in routine PLFs remain controversial. This study assesses the risk of complications and reoperation for pedicle screw revision following PLF with and without ION and/or NAV surgery., Methods: Retrospective analyses were performed using the Truven Health MarketScan
® databases to identify patients that had primary PLF with and without NAV and/or ION for degenerative lumbar disorders from years 2007-2015. Patients undergoing concomitant interbody fusions, spinal deformity surgery or fusion to the thoracic spine were excluded. Complications and reoperation for pedicle screw revision within 90 days of surgery were assessed., Results: During the study period, 67,264 patients underwent PLFs. NAV only was used in 3.5% of patients, ION only in 17.9% and both NAV and ION in 0.8% of patients. In univariate analyses, there was a difference in the risk of neurological injuries among groups (NAV only: 1.4%, ION only: 0.8%, NAV and ION: 0.5%, No NAV or ION: 0.6%, P<0.001). In multivariable models, the use of NAV was associated with a higher risk of neurological complications when compared to ION only or no ION or NAV [NAV vs. ION only: odds ratio (OR) and 95% confidence interval (CI) =2.1 (1.4, 3.2), P=0.002; NAV vs. no ION or NAV: OR and 95% CI =2.5 (1.7, 3.5), P<0.001]. There was no difference in reoperation rates among the groups (P=0.135)., Conclusions: Although the overall risk of neurological complications following PLFs is low, the use of NAV only was associated with an increased risk of neurological complications. No differences were observed in the rates of pedicle screw revision among groups., Competing Interests: Conflicts of Interest: I Cheng—Nuvasive, Royalties, consulting; Globus Medical, Royalties; Spine Wave, Royalties; SpineCraft, Royalties; Cytonics, Stock; Spine Innovations, Stock; SpinalCyte, Stock. The other authors have no conflicts of interest to declare., (2019 Journal of Spine Surgery. All rights reserved.)- Published
- 2019
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16. Evolution of a Posttraumatic Femoral Head Bone Cyst: A Case Study and Surgical Management.
- Author
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Ziino C and Safran MR
- Abstract
Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: M.R.S. has received fellowship support from Breg, ConMed, Ossur, and Smith & Nephew; research support from Ferring and Smith & Nephew; educational support from Biomet; consulting fees from Medacta and Smith & Nephew; and royalties from DJO, Elsevier, Smith & Nephew, Stryker, and Williams & Wilkins. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
- Published
- 2019
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17. Analysis of single-position for revision surgery using lateral interbody fusion and pedicle screw fixation: feasibility and perioperative results.
- Author
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Ziino C, Arzeno A, and Cheng I
- Abstract
Background: To analyze perioperative and radiographic outcomes following revision surgery using lateral lumbar interbody fusion (LLIF) performed entirely in the lateral position. Traditionally, patients undergoing interbody fusion in the lateral decubitus position are placed prone for pedicle screw fixation. However prone positioning carries known risks and may increase surgical time due to the need to re-drape and reposition. Little is published regarding revision surgery in a single position., Methods: Sixteen patients over the age of 18 with degenerative lumbar pathology who underwent a revision of previous lumbar fusion using interbody fusion via lateral access and revision of posterior instrumentation from a single surgeon met inclusion criteria. Patients who underwent combined procedures requiring repositioning or had inadequate preoperative imaging were excluded. Patients remained in the lateral decubitus position for the entirety of the procedure including interbody placement, revision of prior instrumentation, and pedicle screw fixation. Demographics, surgical details, and perioperative outcomes were reported., Results: The mean operative time was 211 minutes for all cases, 161 minutes for single-level procedures and 296 minutes for two-level procedures. Mean estimated blood loss was 206 cc. The mean patient age was 66, 70% of which were male. The mean body mass index (BMI) was 27.4 and Charleson Comorbidity Index (CCI) was 3. All cases were performed on the lumbar spine (T12/L1-L4/L5), with the majority of procedures performed at the L2/3 level (44%). The mean pelvic incidence (PI) was 60 degrees (range, 41-71 degrees) with mean preoperative PI/lumbar lordosis (LL) mismatch of 23.9 degrees. Mean postoperative PI/LL mismatch was 12 degrees., Conclusions: Revision surgery in the lateral position is feasible with complication rates comparable to published literature. The need to reposition is eliminated and single position surgery reduces operative time., Competing Interests: Conflicts of Interest: I Cheng—Nuvasive, Royalties, consulting; Globus Medical, Royalties; Stryker Spine, Consulting; Spine Wave, Royalties; SpineCraft, Consulting; Cytonics, Stock; Spine Innovations, Stock; SpinalCyte, Stock. The other authors have no conflicts of interest to declare.
- Published
- 2019
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18. Trans-Metaphyseal Screws Placed in Children: An Argument for Monitoring and Potentially Removing the Implants.
- Author
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Gamble JG, Ziino C, Imrie MN, and Young JL
- Subjects
- Child, Child, Preschool, Female, Femoral Fractures diagnostic imaging, Femoral Fractures surgery, Fracture Fixation, Internal instrumentation, Growth Plate diagnostic imaging, Humans, Infant, Male, Osteotomy instrumentation, Tibial Fractures diagnostic imaging, Tibial Fractures surgery, Bone Screws adverse effects, Device Removal, Growth Plate surgery
- Abstract
Background: Surgeons frequently use trans-metaphyseal screws in children to achieve osteosynthesis after fractures or stability after reconstructive osteotomies. Screws that were initially inserted below the cortex of bone can become prominent and symptomatic due to the process of funnelization that narrows the wide metaphysis to the diameter of the thinner diaphysis., Methods: Case series presentation of 11 children who presented with screw prominence after the cutback process range in age from 19 to 169 months. We used the screws as radiographic markers to quantitate the amount of bone "cutback" or lost during the process of funnelization., Results: The average length of screw protrusion beyond the edge of the bone when symptomatic was 8.7 mm (range, 3.3 to 14.3 mm). Time from implantation to the last radiograph averaged 40 months (range, 19 to 84 mo). The average loss of bone width at the time of presentation was 21% (range, 7% to 36%)., Conclusions: These cases suggest that orthopaedic surgeons should consider monitoring children after implantation of trans-metaphyseal screws and informing parents and patients about the possibility of screw prominence necessitating removal due to the process of metaphyseal funnelization., Level of Evidence: Level IV.
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- 2019
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19. Single position versus lateral-then-prone positioning for lateral interbody fusion and pedicle screw fixation.
- Author
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Ziino C, Konopka JA, Ajiboye RM, Ledesma JB, Koltsov JCB, and Cheng I
- Abstract
Background: To compare perioperative and radiographic outcomes following lateral lumbar interbody fusions in two cohorts of patients who either underwent single position or dual position surgery., Methods: Patients over the age of 18 with degenerative lumbar pathology who underwent a lumbar interbody fusion via lateral access from 2012-2015 from a single surgeon met inclusion criteria. Patients who underwent combined procedures, had a history of retroperitoneal surgery, or had inadequate preoperative imaging were excluded. Patients who remained in the lateral decubitus position for pedicle screw fixation [single-position (SP)] were compared to those turned prone [dual-position (DP)]. Demographics, surgical details, and perioperative outcomes were compared between groups., Results: A total of 42 SP and 24 DP patients were analyzed. The DP group had a 44.4-minute longer operating room time compared to the SP group (P<0.001) after adjusting for the number of levels operated (P<0.001) and unilateral versus bilateral screw placement (P=0.048). Otherwise, no differences were observed in peri-operative outcomes. Lordosis was not different between groups pre-operatively (P>0.999) or post-operatively (P=0.479), and neither was the pre- to post-operative change (P=0.283)., Conclusions: Lateral pedicle screw fixation following lateral interbody fusion decreases operating room time without compromising post-operative lordosis, complication rates, or perioperative outcomes., Competing Interests: Conflicts of Interest: Cheng—Nuvasive, Royalties, consulting; Globus Medical, Royalties; Stryker Spine, Consulting; Spine Wave, Royalties; SpineCraft, Consulting; Cytonics, Stock; Spine Innovations, Stock; SpinalCyte, Stock. The other authors have no conflicts of interest to declare.
- Published
- 2018
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20. Bisphosphonate and Teriparatide Use in Thoracolumbar Spinal Fusion: A Systematic Review and Meta-analysis of Comparative Studies.
- Author
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Buerba RA, Sharma A, Ziino C, Arzeno A, and Ajiboye RM
- Subjects
- Clinical Trials as Topic methods, Humans, Lumbar Vertebrae diagnostic imaging, Lumbar Vertebrae drug effects, Osteoporosis diagnostic imaging, Osteoporosis drug therapy, Osteoporosis surgery, Spinal Fractures diagnostic imaging, Spinal Fractures drug therapy, Spinal Fractures surgery, Spinal Fusion trends, Thoracic Vertebrae diagnostic imaging, Thoracic Vertebrae drug effects, Bone Density Conservation Agents administration & dosage, Diphosphonates administration & dosage, Lumbar Vertebrae surgery, Spinal Fusion methods, Teriparatide administration & dosage, Thoracic Vertebrae surgery
- Abstract
Study Design: Systematic review and meta-analysis., Objective: To compare the efficacy of the use of either bisphosphonates or teriparatide on radiographic and functional outcomes of patients that had thoracolumbar spinal fusion., Summary of Background Data: Controversy exists as to whether bisphosphonates interfere with successful spinal arthrodesis. An alternative osteoporosis medication is teriparatide, a synthetic parathyroid hormone that has an anabolic effect on osteoblast function. To date, there is limited comparative data on the influence of bisphosphonates or teriparatide on spinal fusion., Methods: A systematic search of medical reference databases was conducted for comparative studies on bisphosphonate or teriparatide use after thoracolumbar spinal fusion. Meta-analysis was performed using the random-effects model for heterogeneity. Radiographic outcomes assessed include fusion rates, risk of screw loosening, cage subsidence, and vertebral fracture., Results: No statistically significant differences were noted between bisphosphonates and control groups regarding fusion rate and risk of screw loosening (fusion: odds ratio [OR] = 2.2, 95% confidence interval [CI]: 0.87-5.56, P = 0.09; loosening: OR = 0.45, 95% CI: 0.14-1.48, P = 0.19). Teriparatide use was associated with higher fusion rates than bisphosphonates (OR = 2.3, 95% CI: 1.55-3.42, P < 0.0001). However, no statistically significant difference was noted between teriparatide and bisphosphonates regarding risk of screw loosening (OR = 0.37, 95% CI: 0.12-1.18, P = 0.09). Lastly, bisphosphonate use was associated with decreased odds of cage subsidence and vertebral fractures compared to controls (subsidence: OR = 0.29, 95% CI 0.11-0.75, P = 0.01; fracture: OR = 0.18, 95% CI 0.07-0.48, P = 0.0007)., Conclusion: Bisphosphonates do not appear to impair successful spinal fusion compared to controls although teriparatide use is associated with higher fusion rates than bisphosphonates. In addition, bisphosphonate use is associated with decreased odds of cage subsidence and vertebral fractures compared to controls that had spinal fusion., Level of Evidence: 3.
- Published
- 2018
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21. Fatigue and sleep disturbance following traumatic brain injury--their nature, causes, and potential treatments.
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Ponsford JL, Ziino C, Parcell DL, Shekleton JA, Roper M, Redman JR, Phipps-Nelson J, and Rajaratnam SM
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- Activities of Daily Living, Adaptation, Physiological, Adolescent, Adult, Australia, Brain Injuries diagnosis, Brain Injuries rehabilitation, Chronic Pain epidemiology, Chronic Pain etiology, Chronic Pain physiopathology, Combined Modality Therapy, Depression epidemiology, Depression etiology, Depression physiopathology, Fatigue epidemiology, Fatigue physiopathology, Female, Humans, Injury Severity Score, Male, Middle Aged, Neuropsychological Tests, Physical Examination, Polysomnography methods, Prognosis, Risk Factors, Sickness Impact Profile, Sleep Wake Disorders epidemiology, Sleep Wake Disorders physiopathology, Young Adult, Brain Injuries complications, Fatigue etiology, Fatigue therapy, Quality of Life, Sleep Wake Disorders etiology, Sleep Wake Disorders therapy
- Abstract
Background: Although fatigue and sleep disturbance are commonly reported following traumatic brain injury (TBI), understanding of their nature and treatment remains limited., Objectives: This article reviews a series of investigations of the nature and causes of fatigue and sleep disturbance following TBI., Methods: A large cohort of community-based patients with TBI, recruited from a TBI rehabilitation program, completed measures of subjective fatigue and sleep disturbances, as well as attentional measures. A subgroup of participants completed polysomnography and assessment of dim light melatonin onset., Results: Fatigue and sleep disturbance are common. Both are associated with anxiety, depression, and pain. However, fatigue is also associated with slowed information processing and the need for increased effort in performing tasks. Sleep disturbances contribute to fatigue. Objective sleep studies show reduced sleep efficiency, increased sleep onset latency, and increased time awake after sleep onset. Depression and pain exacerbate but cannot entirely account for these problems. There is increased slow-wave sleep. Individuals with TBI show lower levels of evening melatonin production, associated with less rapid-eye movement sleep., Conclusions: These findings suggest potential treatments including cognitive behavior therapy supporting lifestyle modifications, pharmacologic treatments with modafinil and melatonin, and light therapy to enhance alertness, vigilance, and mood. Controlled trials of these interventions are needed.
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- 2012
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22. Selective attention deficits and subjective fatigue following traumatic brain injury.
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Ziino C and Ponsford J
- Subjects
- Adolescent, Adult, Case-Control Studies, Female, Humans, Male, Middle Aged, Neuropsychological Tests statistics & numerical data, Reaction Time physiology, Attention Deficit Disorder with Hyperactivity etiology, Brain Injuries complications, Mental Fatigue etiology
- Abstract
The present study aimed to investigate the relationship between subjective fatigue and selective attention deficits following traumatic brain injury (TBI). Forty-six participants with mild-severe TBI and 46 healthy controls completed fatigue scales (Visual Analogue Scale--Fatigue, Fatigue Severity Scale [FSS] and Causes of Fatigue Questionnaire [COF]), and attentional measures including subtests from the Test of Everyday Attention, and the Complex Selective Attention Task (C-SAT). TBI participants reported greater fatigue on the FSS and COF, performed more slowly on attentional measures, and made more errors on the C-SAT. After controlling for anxiety and depression, fatigue was significantly correlated with performance only on the C-SAT. Findings suggest a relationship between subjective fatigue and impairment on tasks requiring higher order attentional processes., (Copyright (c) 2006 APA, all rights reserved.)
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- 2006
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23. Vigilance and fatigue following traumatic brain injury.
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Ziino C and Ponsford J
- Subjects
- Adolescent, Adult, Attention physiology, Blood Pressure physiology, Female, Humans, Male, Middle Aged, Psychomotor Performance physiology, Reaction Time physiology, Stress, Psychological psychology, Arousal physiology, Brain Injuries psychology, Fatigue psychology
- Abstract
Research findings have suggested that individuals with traumatic brain injury (TBI) show greater psychophysiological and subjective costs associated with performing vigilance tasks, but have not examined relationships with fatigue. The present study aimed to investigate vigilance and its relationship with subjective and objective fatigue measures. Forty-six TBI participants and 46 controls completed a 45-minute vigilance task. They also completed a subjective fatigue scale (the VAS-F) and a selective attention task before and after the vigilance task, and had their blood pressure (BP) monitored. TBI participants performed at a lower level on the vigilance task, but performed at a similar level across the duration of the task. Higher subjective fatigue ratings on the VAS-F were associated with more misses on the vigilance task for TBI participants. TBI participants showed greater increases in diastolic BP, and these were associated with greater increases in subjective fatigue ratings on the VAS-F. A subgroup of TBI participants showed a decline in performance on the vigilance task and also showed disproportionate increases in subjective fatigue. Findings provide support for the coping hypothesis, suggesting that TBI individuals expend greater psychophysiological costs in order to maintain stable performance over time, and that these costs are also associated with subjective increases in fatigue.
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- 2006
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24. Measurement and prediction of subjective fatigue following traumatic brain injury.
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Ziino C and Ponsford J
- Subjects
- Adolescent, Adult, Affect physiology, Anxiety etiology, Brain Injuries complications, Demography, Depression etiology, Female, Humans, Injury Severity Score, Male, Middle Aged, Neuropsychological Tests statistics & numerical data, Pain Measurement, Predictive Value of Tests, Regression Analysis, Surveys and Questionnaires, Brain Injuries physiopathology, Fatigue etiology, Research Design statistics & numerical data
- Abstract
Numerous outcome studies have found fatigue to be a common problem following traumatic brain injury (TBI). This study examined the magnitude, causes and impact of fatigue following TBI using three subjective fatigue scales, and investigated its relationship with demographic and injury-related factors, and mood. Forty-nine controls and 49 TBI participants (36.2% with GCS score of 13-15, 29.8% with GCS score of 9-12, and 34% with GCS score of 3-8) were seen at a mean of approximately 8 months post injury. All participants completed three subjective fatigue measures, including the Fatigue Severity Scale (FSS), Visual Analogue Scale-Fatigue (VAS-F) and Causes of Fatigue Questionnaire (COF). TBI participants reported a significantly greater impact of fatigue on their lifestyle on the FSS relative to controls, and reported activities requiring physical and mental effort as more frequent causes of fatigue on the COF. There were, however, no significant group differences on subscales of the VAS-F. Greater time since injury and higher education levels were associated with higher fatigue levels, independent of the effects of mood. Injury severity and age were not found to be significant predictors of subjective fatigue severity in TBI participants.
- Published
- 2005
- Full Text
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