2.Complete Radiological Findings in Gallstone Ileus.
Kevin P MURPHY ; David E KEARNEY ; Patrick D MC LAUGHLIN ; Michael M MAHER
Journal of Neurogastroenterology and Motility 2012;18(4):448-449
No abstract available.
Gallstones
;
Ileus
3.Surgical revascularization for Moyamoya disease in the United States: A cost-effectiveness analysis
Arvin R. WALI ; David. R. SANTIAGO-DIEPPA ; Shanmukha SRINIVAS ; Michael G. BRANDEL ; Jeffrey A. STEINBERG ; Robert C RENNERT ; Ross MANDEVILLE ; James D. MURPHY ; Scott OLSON ; J. Scott PANNELL ; Alexander A. KHALESSI
Journal of Cerebrovascular and Endovascular Neurosurgery 2021;23(1):6-15
Objective:
Moyamoya disease (MMD) is a vasculopathy of the internal carotid arteries with ischemic and hemorrhagic sequelae. Surgical revascularization confers upfront peri-procedural risk and costs in exchange for long-term protective benefit against hemorrhagic disease. The authors present a cost-effectiveness analysis (CEA) of surgical versus non-surgical management of MMD.
Methods:
A Markov Model was used to simulate a 41-year-old suffering a transient ischemic attack (TIA) secondary to MMD and now faced with operative versus nonoperative treatment options. Health utilities, costs, and outcome probabilities were obtained from the CEA registry and the published literature. The primary outcome was incremental cost-effectiveness ratio which compared the quality adjusted life years (QALYs) and costs of surgical and nonsurgical treatments. Base-case, one-way sensitivity, two-way sensitivity, and probabilistic sensitivity analyses were performed with a willingness to pay threshold of $50,000.
Results:
The base case model yielded 3.81 QALYs with a cost of $99,500 for surgery, and 3.76 QALYs with a cost of $106,500 for nonsurgical management. One-way sensitivity analysis demonstrated the greatest sensitivity in assumptions to cost of surgery and cost of admission for hemorrhagic stroke, and probabilities of stroke with no surgery, stroke after surgery, poor surgical outcome, and death after surgery. Probabilistic sensitivity analyses demonstrated that surgical revascularization was the cost-effective strategy in over 87.4% of simulations.
Conclusions
Considering both direct and indirect costs and the postoperative QALY, surgery is considerably more cost-effective than non-surgical management for adults with MMD.
4.Surgical revascularization for Moyamoya disease in the United States: A cost-effectiveness analysis
Arvin R. WALI ; David. R. SANTIAGO-DIEPPA ; Shanmukha SRINIVAS ; Michael G. BRANDEL ; Jeffrey A. STEINBERG ; Robert C RENNERT ; Ross MANDEVILLE ; James D. MURPHY ; Scott OLSON ; J. Scott PANNELL ; Alexander A. KHALESSI
Journal of Cerebrovascular and Endovascular Neurosurgery 2021;23(1):6-15
Objective:
Moyamoya disease (MMD) is a vasculopathy of the internal carotid arteries with ischemic and hemorrhagic sequelae. Surgical revascularization confers upfront peri-procedural risk and costs in exchange for long-term protective benefit against hemorrhagic disease. The authors present a cost-effectiveness analysis (CEA) of surgical versus non-surgical management of MMD.
Methods:
A Markov Model was used to simulate a 41-year-old suffering a transient ischemic attack (TIA) secondary to MMD and now faced with operative versus nonoperative treatment options. Health utilities, costs, and outcome probabilities were obtained from the CEA registry and the published literature. The primary outcome was incremental cost-effectiveness ratio which compared the quality adjusted life years (QALYs) and costs of surgical and nonsurgical treatments. Base-case, one-way sensitivity, two-way sensitivity, and probabilistic sensitivity analyses were performed with a willingness to pay threshold of $50,000.
Results:
The base case model yielded 3.81 QALYs with a cost of $99,500 for surgery, and 3.76 QALYs with a cost of $106,500 for nonsurgical management. One-way sensitivity analysis demonstrated the greatest sensitivity in assumptions to cost of surgery and cost of admission for hemorrhagic stroke, and probabilities of stroke with no surgery, stroke after surgery, poor surgical outcome, and death after surgery. Probabilistic sensitivity analyses demonstrated that surgical revascularization was the cost-effective strategy in over 87.4% of simulations.
Conclusions
Considering both direct and indirect costs and the postoperative QALY, surgery is considerably more cost-effective than non-surgical management for adults with MMD.
5.Outcomes in Nonagenarians with Hip Fractures Treated Conservatively and Surgically
Malhotra R ; Huq SS ; Chong M ; Murphy D ; Daruwalla ZJ
Malaysian Orthopaedic Journal 2021;15(No.3):21-28
Introduction: We aimed to assess the clinical outcomes in
nonagenarians following a hip fracture. We also further
investigated the factors that influence these outcomes, such
as method of treatment (operative versus conservative), comorbidities, and pre-morbid function.
Materials and methods: We studied 65 nonagenarians that
were identifiable from our hospital hip fracture database. We
reviewed various parameters of these patients admitted after
sustaining a hip fracture (neck of femur or intertrochanteric)
and investigated how these parameters affected patient
outcomes. The main outcomes studied were: inpatient
morbidity, and mortality at one year.
Results: Inpatient morbidity was more likely in patients with
an ASA grade of 3 to 5. Urinary tract infection was the most
common medical complication. The 1-year mortality was
15.4% and was significantly influenced by advancing age.
Surgically managed patients had a 1-year mortality rate
(14.3%) slightly less than non-operative patients (17.4%).
Post injury mobility was significantly better in those who
received operative treatment with 63% of surgical cases
regaining ambulatory status versus 7% of conservatively
managed patients.
Conclusions: We presented the outcomes of hip fractures in
an extreme age group in the population. In nonagenarians
with hip fractures surgery was associated with a 1-year
mortality rate of 14.3% which is comparable to the general
hip fracture population and less than the mortality rate of
conservatively managed patients (17.4%). The primary
advantage of surgery would be that two-thirds of patients
return to ambulatory status. This information is useful to
counsel patients and their families especially since the
elderly are often more fearful of surgical intervention.