Perioperative quality assurance in neurosurgery

Paper I of this thesis is not available in Munin: Assessment of drainage techniques for evacuation of chronic subdural hematoma: a consecutive population-based comparative cohort study. Sjåvik K., Bartek J., Sagberg, L.M., Henriksen, M.L., Gulati, S., Ståhl, F.L., Kristiansson, H., Solheim, O., Föra...

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Main Author: Sjåvik, Kristin
Format: Doctoral or Postdoctoral Thesis
Language:English
Published: UiT The Arctic University of Norway 2018
Subjects:
Online Access:https://hdl.handle.net/10037/12840
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spelling ftunivtroemsoe:oai:munin.uit.no:10037/12840 2023-05-15T17:39:26+02:00 Perioperative quality assurance in neurosurgery Sjåvik, Kristin 2018-06-08 https://hdl.handle.net/10037/12840 eng eng UiT The Arctic University of Norway UiT Norges arktiske universitet https://hdl.handle.net/10037/12840 openAccess Copyright 2018 The Author(s) VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Nevrokirurgi: 786 VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Neurosurgery: 786 DOKTOR-003 Doctoral thesis Doktorgradsavhandling 2018 ftunivtroemsoe 2021-06-25T17:55:58Z Paper I of this thesis is not available in Munin: Assessment of drainage techniques for evacuation of chronic subdural hematoma: a consecutive population-based comparative cohort study. Sjåvik K., Bartek J., Sagberg, L.M., Henriksen, M.L., Gulati, S., Ståhl, F.L., Kristiansson, H., Solheim, O., Förander, P., Jakola, A.S. Available in Journal of Neurosurgery. 2017 Jun;23:1-7 Abstract Background Perioperative treatment for common neurosurgical conditions such as chronic subdural hematomas (CSDH) and meningiomas vary. The perioperative period is by definition the time span from 24 hours before surgery until 30 days postoperatively. Even if the surgical treatment in the operation theater can be exactly the same, complication rates differ, and results vary. The aim of the thesis was to compare recurrences after CSDH burr-hole surgery using three different drainage techniques, to establish the risk of recurrence in CSDH patients using antithrombotic (AT) medication, to clarify the risk/benefit ratio of prophylactic pharmacotherapy initiated the evening before craniotomy for meningioma, and to identify important predictors for complications in meningioma surgery. A future more large-scale aim was to clarify whether this pragmatic research design could be used for further quality work in practical neurosurgery. Methods A comparative effectiveness framework was created to conduct retrospective reviews in different Scandinavian cohorts from three different neurosurgical departments (Karolinska University Hospital, University Hospital of North Norway and St. Olavs University Hospital). The Scandinavian cohorts were all population-based, and all patients treated between 2005 and 2013. Studies included large number of patients ranging from 763 to 1260 patients. Results Active subgaleal drainage for 24 hours after surgery seems to be the most efficient and safest treatment strategy for chronic subdural hematoma. Patients with CSDH on antithrombotic therapy at the time of diagnosis, have similar recurrence rates and mortality compared to those without antithrombotic therapy. Early AT resumption is not associated with more recurrence, but with lower thromboembolic frequency. As needed perioperative administration of low molecular weight heparin, reserved for patients with excess risk because of delayed mobilization, is effective and appears to be the safest strategy, rather than routine administration. Severe complications after meningioma resection are more encountered in elderly patients (>70 years old), dependent patients (Karnofsky performance scale <70), and patients who undergo longer lasting surgery (>4 hours). Patient selection, including careful consideration of the individual risk-benefit ratio, is important in improving the safety of intracranial meningioma resection. Conclusion The framework with its population-based studies provided valid results for the clinical questions raised. The researchers will continue to work on establishing evidence-based guidelines for common neurosurgical conditions within the established research platform. Doctoral or Postdoctoral Thesis North Norway University of Tromsø: Munin Open Research Archive Norway Sjåvik ENVELOPE(12.811,12.811,66.114,66.114) Solheim ENVELOPE(9.612,9.612,63.683,63.683)
institution Open Polar
collection University of Tromsø: Munin Open Research Archive
op_collection_id ftunivtroemsoe
language English
topic VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Nevrokirurgi: 786
VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Neurosurgery: 786
DOKTOR-003
spellingShingle VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Nevrokirurgi: 786
VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Neurosurgery: 786
DOKTOR-003
Sjåvik, Kristin
Perioperative quality assurance in neurosurgery
topic_facet VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Nevrokirurgi: 786
VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Neurosurgery: 786
DOKTOR-003
description Paper I of this thesis is not available in Munin: Assessment of drainage techniques for evacuation of chronic subdural hematoma: a consecutive population-based comparative cohort study. Sjåvik K., Bartek J., Sagberg, L.M., Henriksen, M.L., Gulati, S., Ståhl, F.L., Kristiansson, H., Solheim, O., Förander, P., Jakola, A.S. Available in Journal of Neurosurgery. 2017 Jun;23:1-7 Abstract Background Perioperative treatment for common neurosurgical conditions such as chronic subdural hematomas (CSDH) and meningiomas vary. The perioperative period is by definition the time span from 24 hours before surgery until 30 days postoperatively. Even if the surgical treatment in the operation theater can be exactly the same, complication rates differ, and results vary. The aim of the thesis was to compare recurrences after CSDH burr-hole surgery using three different drainage techniques, to establish the risk of recurrence in CSDH patients using antithrombotic (AT) medication, to clarify the risk/benefit ratio of prophylactic pharmacotherapy initiated the evening before craniotomy for meningioma, and to identify important predictors for complications in meningioma surgery. A future more large-scale aim was to clarify whether this pragmatic research design could be used for further quality work in practical neurosurgery. Methods A comparative effectiveness framework was created to conduct retrospective reviews in different Scandinavian cohorts from three different neurosurgical departments (Karolinska University Hospital, University Hospital of North Norway and St. Olavs University Hospital). The Scandinavian cohorts were all population-based, and all patients treated between 2005 and 2013. Studies included large number of patients ranging from 763 to 1260 patients. Results Active subgaleal drainage for 24 hours after surgery seems to be the most efficient and safest treatment strategy for chronic subdural hematoma. Patients with CSDH on antithrombotic therapy at the time of diagnosis, have similar recurrence rates and mortality compared to those without antithrombotic therapy. Early AT resumption is not associated with more recurrence, but with lower thromboembolic frequency. As needed perioperative administration of low molecular weight heparin, reserved for patients with excess risk because of delayed mobilization, is effective and appears to be the safest strategy, rather than routine administration. Severe complications after meningioma resection are more encountered in elderly patients (>70 years old), dependent patients (Karnofsky performance scale <70), and patients who undergo longer lasting surgery (>4 hours). Patient selection, including careful consideration of the individual risk-benefit ratio, is important in improving the safety of intracranial meningioma resection. Conclusion The framework with its population-based studies provided valid results for the clinical questions raised. The researchers will continue to work on establishing evidence-based guidelines for common neurosurgical conditions within the established research platform.
format Doctoral or Postdoctoral Thesis
author Sjåvik, Kristin
author_facet Sjåvik, Kristin
author_sort Sjåvik, Kristin
title Perioperative quality assurance in neurosurgery
title_short Perioperative quality assurance in neurosurgery
title_full Perioperative quality assurance in neurosurgery
title_fullStr Perioperative quality assurance in neurosurgery
title_full_unstemmed Perioperative quality assurance in neurosurgery
title_sort perioperative quality assurance in neurosurgery
publisher UiT The Arctic University of Norway
publishDate 2018
url https://hdl.handle.net/10037/12840
long_lat ENVELOPE(12.811,12.811,66.114,66.114)
ENVELOPE(9.612,9.612,63.683,63.683)
geographic Norway
Sjåvik
Solheim
geographic_facet Norway
Sjåvik
Solheim
genre North Norway
genre_facet North Norway
op_relation https://hdl.handle.net/10037/12840
op_rights openAccess
Copyright 2018 The Author(s)
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