Effect of Treatment Complications on the Outcomes in Adult Spinal Deformity: A Decision Analysis Approach
Emre AcaroğluÜmit Özgür GülerAysun Cetinyurek‐YavuzYasemin YavusSelim AyhanMontserrat Domingo-SàbatFerrán PelliséFrancisco Javier Sánchez Pérez-GruesoAhmet AlanayIbrahim ObeidFrank Kleinstück
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Introduction Treatment of adult spinal deformity (ASD) is known to be associated with a fairly high rate of complications whereas the impact of these complications on treatment outcomes is less well known. Aim of this study is to analyze the impact of treatment complications on outcomes in ASD using a decision analysis (DA) model. Material and Methods From an international multicentre database of ASD patients (968 pts), 535 who had completed 1 year follow-up (371 non-surgical –NS), 164 surgical –S), constitute the population of this study. DA was structured in two main steps of: 1) Baseline analysis (Assessing the probabilities of outcomes, Assessing the values of preference –utilities-, Combining information on probability and utility and assigning the quality adjusted life expectancy (QALE) for each treatment) and 2) Sensitivity analysis. Complications were analyzed as life threatening (LT) and non-life threatening (NLT) and their probabilities were calculated from the database as well as a thorough literature review. Outcomes were analyzed as improvement (decrease in ODI > 8pts), no change and deterioration (increase in ODI > 8pts). Death/complete paralysis was considered as a separate category. Results All 535 patients (371 NS, 164 S) could be analyzed in regard to complications. Overall, there were 78 NLT and 12 LT complications and 3 death/paralysis. Surgical treatment was significantly more prone to complications (31.7% versus 11.1%, p < 0.001) (Table 1 a). On the other hand, presence of complications did not necessarily decrease the chances of improvement, surgical patients tending to rate better in this respect (Table 1b). Likewise, QALE was not particularly affected by the presence or absence of complications regardless of the type of treatment (Table 1c). Conclusion This study has demonstrated that surgical treatment of ASD is more likely to cause complications compared with non-surgical treatment. On the other hand, presence of complications neither has a negative impact on the likelihood of clinical improvement nor affects the QALE at the first year detrimentally.Keywords:
Spinal Deformity
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The period life table is based on the assumption that the mortality experienced by the population in a given period will remain substantially the same throughout their lives. However, the past records shows continuous decline in mortality, leading to the possibility of a case where the mortality rates does not remained the same. Although, India has experienced continuous decline in mortality rates since more than two decades, Assam is one of the underdeveloped state where mortality rates including infant mortality rate is found to be higher in comparison to other developing states of India. However, during recent years mortality declines have appeared to be more rapid in an urban area of Assam, Guwahati, which is also a premier city of North-Eastern India. This paper attempts to study the pattern of mortality along with life expectancy under dynamic scenario in Guwahati. Further, an attempt has also been made to formulate temporary life expectancy under dynamic consideration and thereby measures the differences between period and dynamic temporary life expectancies.
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A set of life tables for seven geographic regions of Pakistan is presented. Data from Pakistan Demographic Survey – 2007 is used for the preparation of life tables. Life expectancy at birth for male is found 64.21 year in the province of Punjab, shows the highest one and 54 years for female found in the Baluchistan province which is least one. Further, urban areas of Pakistan have been seen on the forefront in terms of life expectancy in Pakistan. From the life table analysis a substantial sex differential could be discerned. The pattern of life expectancy in Baluchistan province is interesting to note, males are having higher life expectancy as compared to females.
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Life expectancy is the most popular mortality indicator with demographers. Unless specified otherwise, it implicitly refers to the value at birth (age 0) of one of the functions derived through a period life table, a key tool of demographic and actuarial analysis. Demographers tend to favor life expectancy because it is a pure measure of the mortality conditions faced by a population, unaffected by that population’s age structure. Life expectancy also has an intuitive interpretation, conditional on the assumption that mortality conditions remain unchanged, as the expected age at death of an average newborn. If life table construction might be limited to an inner circle of demographers and actuaries, this interpretative ease gives life expectancy a much broader appeal.
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A set of life tables for seven geographic regions of Pakistan is presented. Data from Pakistan Demographic Survey – 2007 is used for the preparation of life tables. Life expectancy at birth for male is found 64.21 year in the province of Punjab, shows the highest one and 54 years for female found in the Baluchistan province which is least one. Further, urban areas of Pakistan have been seen on the forefront in terms of life expectancy in Pakistan. From the life table analysis a substantial sex differential could be discerned. The pattern of life expectancy in Baluchistan province is interesting to note, males are having higher life expectancy as compared to females.
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Recent decades in Croatia are marked by a gradual decline in mortality and a constantly progressing life expectancy. Eurostat data show men have gained 3.3 and women have gained 2.6 years of life expectancy at birth from 2000 until 2013. However, with present decreasing levels of mortality in Croatia, life tables dealing only with all-cause mortality have lost their usefulness as an indicator of population health. In this paper we present an overview of the trends and patterns in causes of death and explore the effect the eradication of certain diseases would have had on age-specific probabilities of dying. In addition, we investigate which age groups contributed the most to the life extension in Croatia, separately for men and women. The effect of eliminating a certain group of diseases as the cause of death is estimated using a multiple- decrement approach. When exploring the effect on life expectancy which stems from the elimination of one or more causes of death, construction of multiple-decrement life tables is a standard and suitable approach. Simply put, a multiple-decrement life table considers deaths by cause. As a first step, we develop a regular life table in which all deaths combined are taken into account, in the form of an abridged life table for the population of Croatia in 2011. In what follows, we use the cause-specific deaths to calculate life table components assuming that a particular cause of death is eliminated. The number of deaths for each of these multiple-decrement tables is calculated by excluding deaths due to certain specified causes. In this paper we investigate main causes of death, beginning with diseases of circulatory system and malignant neoplasms. These two account for approximately three quarters of all causes of death according to official data published by the Croatian Bureau of Statistics. Life table calculations are based on the 2011 estimated mid-year population and death recorded during the period 2010-2012. Results indicate the impact of the elimination of major diseases on overall life expectancy in Croatia. The gain in life expectancy is shown to be the highest when diseases of circulatory system as the cause of death are eliminated. If diseases of circulatory system as the cause of death are eliminated, the number of additional years at birth that an inhabitant of Croatia would expect to live on average surpasses 14. The second highest influence is that of the elimination of malignant neoplasms as the cause of death. Eradication of other causes of death is shown to have a much smaller impact on life expectancy. As the aforementioned results are suggesting, from birth, an individual in Croatia has a significantly greater chance of dying from diseases of the circulatory system compared to the chance of dying from malignant neoplasms. The extension of life expectancy at birth can be accomplished by lowering mortality throughout the life cycle. It is of interest to show in which age groups mortality decreased the most, i.e. where the gains in life expectancy are the highest. Analysis of changes in life expectancy, conducted by the application of decomposition techniques, revealed that male life expectancy at birth increased during the last two decades mostly due to the reduction of mortality in the age group 60-69, while the highest contribution to the reduced female mortality is found in the age group 70-79 (followed by the age group 60- 69). To draw a comparison, in western European countries the biggest gains in life expectancy at birth for men are realized by reducing mortality in the age group 70-79, and for women in the age group 80+. Such a development can probably be expected in Croatia as well. As for policy implications, we may argue that the initial results of our analysis seem to indicate the importance of health promotion and interventions regarding the reduction of the prevalence of cardiovascular diseases, which could lead to a morbidity compression, especially in advanced, older ages.
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OBJECTIVES: Life expectation is a valuable summary index in public health and actuarial science. The life expectancies published in the vital statistics, however, are derived from the "current" rather than from the "cohort" life table. The former is based on a strong assumption of constant mortality in the population, whereas the latter calls for a recording of the mortality experience of a group of individuals, which is often an impossible task. Thus, a method of calculating cohort life expectancy without actual follow up is much needed. METHODS: Estimation of cohort life expectancy was based on an age-cohort model. Mortality data for the male population in Taiwan from 1951 to 1990 are used to illustrate the methodology. RESULTS: The increment of life expectancy over time in Taiwan is actually steeper than was previously thought using the current life table technique. CONCLUSIONS: The method is easy to implement and the data required are the usual age and period cross classified mortality data. It warrants further investigation.
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Objective. To perform 3D biomechanical analysis of spine deformity and relevant anatomical structures in children. Material and Methods. A total of 37,000 children and adolescents aged from 7 to 17 years were screened for multiplane spinal deformity. Screening was performed using computer optic topography. Deformity was assessed with topographical criterion. Results. The coronal plane deformity was detected in 4,230 (11.4 %), sagittal — in 2,048 (5.5 %), and horizontal — in 1,072 (2.9 %) patients. Out of all children with detected pathology, 68.1 % had single plane deformity, 26.6 % — two-plane, and 5.3 % — three-plane deformity. Pathogenesis of multiplane deformities was considered. Seven variants of spinal deformity were identified. Conclusion. In children, as a rule, the deformity under 10° has a single-plane character and more than 10° degree — a multiplane one. Multiplane deformities cause changes in topography of all anatomical structures, which ultimately results in deformity of locomotor system as a whole.
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Spinal deformity is a kind of three dimensional deformity.X-ray and conventional CT can not display accuratelly the deformity of their very complicated osteal structure,but post-processing technique of spinal CT can provide actual evidence for diagnosing of spinal deformity.The purpose of this article is to introduce the application of post-processing technique of MPR,CPR and VRT,the employment of this technique can accurate diagnosis and evaluation of the disease in pre-and post-operation.
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