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    Smoking influences outcome in patients who had thrombolysed ischaemic stroke: the ENCHANTED study
    (2021)
    Lingli Sun
    ;
    Lili Song
    ;
    Jie Yang
    ;
    Richard I Lindley
    ;
    Thompson Robinson
    <jats:sec><jats:title>Background and purpose</jats:title><jats:p>As studies vary in defining the prognostic significance of smoking in acute ischaemic stroke (AIS), we aimed to determine the relation of smoking and key outcomes in patient participants who had thrombolysed AIS of the international quasi-factorial randomised Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Post-hoc analyses of ENCHANTED, an international quasi-factorial randomised evaluation of intravenous alteplase-dose comparison and levels of blood pressure control in patients who had thrombolysed AIS. Multivariable logistic regression models with inverse probability of treatment weighting (IPTW) propensity scores were used to determine associations of self-reported smoking status and clinical outcomes, according to 90-day modified Rankin Scale (mRS) scores and symptomatic intracerebral haemorrhage (sICH).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of 4540 patients who had an AIS, there were 1008 (22.2%) current smokers who were younger and predominantly male, with more comorbidities of hypertension, coronary artery disease, atrial fibrillation and diabetes mellitus, and greater baseline neurological impairment, compared with non-smokers. In univariate analysis, current smokers had a higher likelihood of a favourable shift in mRS scores (OR 0.88, 95% CI 0.77 to 0.99; p=0.038) but this association reversed in a fully adjusted model with IPTW (adjusted OR 1.15, 95% CI 1.04 to 1.28; p=0.009). A similar trend was also apparent for dichotomised poor outcome (mRS scores 2–6: OR 1.18, 95% CI 1.05 to 1.33; p=0.007), but not with the risk of sICH across standard criteria.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Smoking predicts poor functional recovery in patients who had thrombolysed AIS.</jats:p></jats:sec><jats:sec><jats:title>Trial registration number</jats:title><jats:p><jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="clintrialgov" xlink:href="NCT01422616">NCT01422616</jats:ext-link>.</jats:p></jats:sec>
    Scopus© Citations 8
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    A Chilean Experience of Telestroke in a COVID-19 Pandemic Year
    (2022)
    Carlos Delfino
    ;
    MAZZON AGURTO, ENRICO  
    ;
    Felipe Jurado Díaz
    ;
    MUÑOZ VENTURELLI, PAULA ANDREA  
    ;
    BRUNSER, ALEJANDRO  
    <jats:p>&lt;b&gt;&lt;i&gt;Background and Purpose:&lt;/i&gt;&lt;/b&gt; Telemedicine for stroke patients’ care (telestroke [TS]) has grown notably in recent decades and may offer advantages during health crisis. Hospital admissions related to stroke have decreased globally during the COVID-19 pandemic, but scarce information is available regarding the effect of COVID-19 in TS. Using a population-based TS registry, we investigated the impact of the first year of the COVID-19 pandemic throughout our TS network in Santiago, Chile. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Stroke codes evaluated after the onset of COVID-19 restrictions in Chile (defined as March 15, 2020) were compared with those evaluated in 2019. We analyzed differences between number of stroke codes, thrombolysis rate, stroke severity, and time from the stroke onset to hospital admission. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; We observed that the number of stroke codes and the number of patients undergoing reperfusion therapy did not change significantly (&lt;i&gt;p&lt;/i&gt; = 0.669 and 0.415, respectively). No differences were found with respect to the median time from the stroke onset to admission (&lt;i&gt;p&lt;/i&gt; = 0.581) or in National Institutes of Health Stroke Scale (NIHSS) scores (&lt;i&gt;p&lt;/i&gt; = 0.055). The decision-making-to-needle time was significantly shorter in the COVID-19 period (median 5 min [IQR 3–8], &lt;i&gt;p&lt;/i&gt; &amp;#x3c; 0.016), but no significant changes were found at the other times. &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; This study demonstrates the potential of adapting TS to extreme situations such as the COVID-19 pandemic, as well as the importance of establishing networks that facilitate patient access to quality treatments. </jats:p>
    Scopus© Citations 7  1
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    Unplanned Readmission Following Early Postoperative Complications After Fusion Surgery in Adult Spine Deformity: A Multicentric Study
    (2021)
    Gaston Camino-Willhuber
    ;
    Alfredo Guiroy
    ;
    Mariano Servidio
    ;
    Nelson Astur
    ;
    Fernando Nin-Vilaró
    <jats:sec><jats:title>Study Design:</jats:title><jats:p> Multicentric retrospective study, Level of evidence III. </jats:p></jats:sec><jats:sec><jats:title>Objective:</jats:title><jats:p> The objective of this multicentric study was to analyze the prevalence and risk factors of early postoperative complications in adult spinal deformity patients treated with fusion. Additionally, we studied the impact of complications on unplanned readmission and hospital length of stay. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Eight spine centers from 6 countries in Latin America were involved in this study. Patients with adult spinal deformity treated with fusion surgery from 2017 to 2019 were included. Baseline and surgical characteristics such as age, sex, comorbidities, smoking, number of levels fused, number of surgical approaches were analyzed. Postoperative complications at 30 days were recorded according to Clavien-Dindo and Glassman classifications. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> 172 patients (120 females/52 males, mean age 59.4 ± 17.6) were included in our study. 78 patients suffered complications (45%) at 30 days, 43% of these complications were considered major. Unplanned readmission was observed in 35 patients (20,3%). Risk factors for complications were: Smoking, previous comorbidities, number of levels fused, two or more surgical approaches and excessive bleeding. Hospital length of stay in patients without and with complications was of 7.8 ± 13.7 and 17 ± 31.1 days, respectively ( P 0.0001). </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> The prevalence of early postoperative complications in adult spinal deformity patients treated with fusion was of 45% in our study with 20% of unplanned readmissions at 30 days. Presence of complications significantly increased hospital length of stay. </jats:p></jats:sec>
      2Scopus© Citations 16