Publications by authors named "Michael Shost"

3 Publications

  • Page 1 of 1

Predictors of Operative Duration and Complications in Single-Level Posterior Interbody Fusions for Degenerative Spondylolisthesis.

World Neurosurg 2021 07 18;151:e317-e323. Epub 2021 Apr 18.

Center for Spine Health, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Neurosurgery, Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA.

Background: The goal of this study was to identify predictors of prolonged operative time (OT) in patients receiving posterior/transforaminal lumbar interbody fusion (P/TLIF) and examine the relationship between prolonged OT and perioperative outcomes in this population.

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing single-level P/TLIF (Common Procedural Terminology code) between 2012 and 2018. Multivariable linear regression models were constructed to identify factors independently associated with changes in OT and examine the relationship between prolonged OT and perioperative outcomes (overall complications, surgical complications, medical complications, 30-day readmission, 30-day reoperation, and length of stay). All models were adjusted for sociodemographic variables, comorbidities, and procedure-specific variables.

Results: Our cohort included 6260 patients. After adjusting for baseline covariates, age between 19 and 39 years increased OT by 15.14 minutes, male sex increased OT by 12.91 minutes, African American race increased OT by 17.82 minutes, other race increased OT by 18.13 minutes, obesity class III increased OT by 27.80 minutes, and the use of navigation increased OT by 10.83 minutes. Our multivariate logistic regression also found that after 2 hours, each additional hour of OT was associated with an increased risk of any complication (3-3.99 hours, odds ratio [OR], 1.68; 4-4.99 hours, OR, 2.33; and >5 hours, OR, 4.65). Incremental increases in OT were also associated with an increased risk of extended length of stay, readmission, and return to the operating room.

Conclusions: The results of this study highlight several factors associated with prolonged OT and underscore its association with poorer perioperative outcomes. These data can be used to risk stratify patients before single-level P/TLIF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2021.04.034DOI Listing
July 2021

Immediate Postoperative Imaging Following Elective Lumbar Fusion Provides Little Clinical Utility.

Spine (Phila Pa 1976) 2021 Jul;46(14):958-964

School of Medicine, Case Western Reserve University, Cleveland, OH.

Study Design: Retrospective review at a single institution of all adult patients who underwent elective lumbar fusion surgery for degenerative spinal disease from 2013 to 2018. Reoperation rates and change in clinical management due to routine imaging findings were the primary outcomes.

Objective: To investigate what effects immediate routine postoperative imaging has on the clinical management of patients following lumbar fusion surgery.

Summary Of Background Data: The clinical utility of routine postoperative imaging following lumbar fusion surgery remains uncertain. Existing studies on the clinical utility of postoperative imaging in lumbar fusion patients have largely focused on imaging obtained post-discharge. We present a retrospective analysis that to our knowledge is the first study reporting on the clinical utility of routine imaging in lumbar fusion patients during the immediate postoperative period.

Methods: The medical records of patients who had undergone elective lumbar instrumented fusion for degenerative disease from 2013 to 2018 by neurosurgeons across one regional healthcare system were retrospectively analyzed. Inpatient records and imaging orders for patients were reviewed. Routine immediate postoperative imaging was defined by any lumbar spine imaging prior to discharge in the absence of specific indications.

Results: Analysis identified 115 patients who underwent elective lumbar instrumented fusion for degenerative disease. One-hundred-twelve patients received routine postoperative imaging. Routine imaging was abnormal in four patients (4%). There was one instance (<1%) where routine immediate postoperative imaging led to change in clinical management. Abnormal routine imaging was not associated with either reoperation or development of neurological symptoms postoperatively (P = 0.10), however, new or worsening neurologic deficits did predict reoperation (P < 0.01).

Conclusion: New neurologic deficit was the only significant predictor of reoperation. Routine imaging, whether normal or abnormal, was not found to be associated with reoperation. The practice of routine imaging prior to discharge following elective lumbar fusion surgery appears to provide little utility to clinical management.Level of Evidence: 3.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BRS.0000000000003953DOI Listing
July 2021

Cryo-electron microscopy structure and analysis of the P-Rex1-Gβγ signaling scaffold.

Sci Adv 2019 10 16;5(10):eaax8855. Epub 2019 Oct 16.

Department of Biological Chemistry & Life Sciences Institute, University of Michigan, Ann Arbor, MI, USA.

PIP-dependent Rac exchanger 1 (P-Rex1) is activated downstream of G protein-coupled receptors to promote neutrophil migration and metastasis. The structure of more than half of the enzyme and its regulatory G protein binding site are unknown. Our 3.2 Å cryo-EM structure of the P-Rex1-Gβγ complex reveals that the carboxyl-terminal half of P-Rex1 adopts a complex fold most similar to those of phosphoinositide phosphatases. Although catalytically inert, the domain coalesces with a DEP domain and two PDZ domains to form an extensive docking site for Gβγ. Hydrogen-deuterium exchange mass spectrometry suggests that Gβγ binding induces allosteric changes in P-Rex1, but functional assays indicate that membrane localization is also required for full activation. Thus, a multidomain assembly is key to the regulation of P-Rex1 by Gβγ and the formation of a membrane-localized scaffold optimized for recruitment of other signaling proteins such as PKA and PTEN.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1126/sciadv.aax8855DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795519PMC
October 2019
-->