Purpose: Mechanical thrombectomy (MT) has improved outcomes for acute ischemic stroke (AIS); however, patients with renal failure remain at elevated risk for adverse events. Sex-based differences in outcomes following thrombectomy have been reported in heterogeneous stroke populations, but data specific to renal failure patients are limited. Understanding whether sex influences in-hospital mortality and discharge disposition in this high-risk subgroup is clinically important. Materials and Methods: We conducted a retrospective cohort study using the 2019–2022 National Inpatient Sample to identify renal failure patients undergoing MT for AIS. Patients were stratified by sex. Multivariable logistic regression was used to assess associations between sex and in-hospital mortality and non-routine discharge, adjusting for demographic, socioeconomic, clinical, and hospital-level covariates. Results: The study included 3,280 unweighted hospitalizations (1,675 males; 1,605 females). After adjustment, female sex was independently associated with higher odds of non-routine discharge (adjusted odds ratio [OR] 1.536, 95% confidence interval [CI] 1.391–1.696; P<0.001) but not with in-hospital mortality (adjusted OR 0.953, 95% CI 0.874–1.038; P=0.266). Increasing age and select comorbidities were associated with both outcomes. Conclusion Female sex was associated with increased odds of non-routine discharge but not in-hospital mortality among renal failure patients undergoing MT. These findings support equitable application of thrombectomy across sexes while highlighting the importance of sex-aware discharge planning in this high-risk population.

Laparoscopic anterior lumbar interbody fusion (L-ALIF), which employs laparoscopic cameras to facilitate a less invasive approach, originally gained traction during the 1990s but has subsequently fallen out of favor. As the envelope for endoscopic approaches continues to be pushed, a recurrence of interest in laparoscopic and/or endoscopic anterior approaches seems possible. Therefore, evaluating the current evidence base in regard to this approach is of much clinical relevance. To this end, a systematic literature search was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the following keywords: “(laparoscopic OR endoscopic) AND (anterior AND lumbar).” Out of the 441 articles retrieved, 22 were selected for quantitative analysis. The primary outcome of interest was the radiographic fusion rate. The secondary outcome was the incidence of perioperative complications. Meta-analysis was performed using RStudio’s “metafor” package. Of the 1,079 included patients (mean age, 41.8±2.9 years), 481 were males (44.6%). The most common indication for L-ALIF surgery was degenerative disk disease (reported by 18 studies, 81.8%). The mean follow-up duration was 18.8±11.2 months (range, 6–43 months). The pooled fusion rate was 78.9% (95% confidence interval [CI], 68.9–90.4). Complications occurred in 19.2% (95% CI, 13.4–27.4) of L-ALIF cases. Additionally, 7.2% (95% CI, 4.6–11.4) of patients required conversion from L-ALIF to open surgery. Although L-ALIF does not appear to be supported by studies available in the literature, it is important to consider the context from which these results have been obtained. Even if these results are taken at face value, the failure of endoscopy to have a role in the ALIF approach does not mean that it should not be incorporated in posterior approaches.