Hurley Medical Center

Endovascular options for infrapopliteal artery disease include plain balloon angioplasty (PTA), drug‑coated balloons (DCB), drug‑eluting and bare‑metal stents (DES), and atherectomy. Retrievable scaffold therapy (RST) has recently emerged as a temporary scaffolding strategy used with DCB, but its comparative effectiveness remains uncertain. A comprehensive literature search identified 21 randomized and 4 single‑arm trials (n = 3184). Eligible studies reported at least one prespecified outcome: 30‑day major adverse events (MAE), 12‑month all‑cause mortality, 6‑month clinically driven target lesion revascularization (CD‑TLR), or 6‑month major amputation. Random‑effects models generated odds ratios (ORs) with 95

STUDY DESIGN: Retrospective Cohort Study. PURPOSE: To compare 30-day postoperative outcomes of cervical disc replacement (CDR) versus anterior cervical discectomy and fusion (ACDF) in single-level cervical degenerative disc disease (CDDD) using a frailty-based propensity score matched model. Frailty, quantified using the Risk Analysis Index (RAI), was treated as both a confounding variable for matching and as an independent predictor of postoperative outcomes, allowing assessment of its predictive value and potential role as an effect modifier in evaluating surgical outcomes following CDR. METHODS: The ACS-NSQIP database (2012-2022) was queried for adults undergoing single-level ACDF or CDR for CDDD. Patients with fractures, tumors, emergent cases, or incomplete data were excluded. Outcomes included 30-day mortality, major and minor complications, Clavien-Dindo IV complications, non-home discharge (NHD), readmission, reoperation, and extended length of stay. Propensity score matching was performed controlling for frailty as quantified by the RAI. Multivariate logistic regression and receiver operating characteristic curves assessed associations and predictive accuracy. RESULTS: Among 97,408 patients (8.7% CDR), CDR patients were younger and less frail. After matching 16,974 patients, CDR was associated with significantly lower odds of major complications (OR 0.57), NHD (OR 0.60), readmission (OR 0.60), and reoperation (OR 0.61) compared to ACDF, with no mortality difference. Each 1-point increase in RAI corresponded to higher odds of mortality (+24%), major complications (+11%), and NHD (+17%). RAI demonstrated strong discrimination for mortality (C=0.85) and NHD (C=0.76). CONCLUSIONS: CDR is associated with fewer short-term adverse outcomes than ACDF, even in frail patients. Frailty strongly predicts postoperative risk but does not diminish the relative safety of CDR. The RAI is a valuable preoperative risk stratification tool for cervical spine surgery.

Coronary artery calcium (CAC) scoring has emerged as a valuable tool for cardiovascular risk assessment, yet its role in asymptomatic individuals at low-to-intermediate risk remains an area of ongoing investigation. This systematic review aimed to evaluate the prognostic value of CAC scoring for predicting hard cardiovascular events and its utility in risk reclassification beyond traditional risk models. A comprehensive literature search was conducted across PubMed/MEDLINE, Embase, and the Cochrane Library for studies published between 2000 and 2025. Prospective cohort studies assessing CAC in asymptomatic adults without established cardiovascular disease and reporting hard coronary outcomes were included. A total of eight studies met the inclusion criteria. Across these studies, CAC demonstrated a consistent and graded association with incident coronary heart disease events, independent of conventional risk factors. Higher CAC scores were associated with significantly increased risk, with several studies reporting markedly elevated risk at CAC ≥100, including hazard ratios approaching 4.6 in low-risk populations, while a CAC score of zero was consistently linked to very low short- to intermediate-term event rates. Importantly, CAC improved risk stratification, particularly among individuals initially classified as intermediate risk, with studies reporting substantial risk reclassification and net reclassification improvement values of approximately 0.25. Evidence also suggested that CAC is more strongly predictive of coronary events than stroke, supporting its role as a coronary-specific risk marker. Although the review included only eight studies and demonstrated methodological heterogeneity in CAC categorization, comparator models, and outcome definitions, findings were directionally consistent across diverse populations and study designs. These results indicate that CAC scoring provides incremental prognostic value and may serve as a clinically useful tool to refine risk assessment and guide individualized preventive strategies in asymptomatic adults at low-to-intermediate cardiovascular risk.

The United States is experiencing a significant demographic shift characterized by an increasingly aging population, or "silver tsunami." These demographic changes have profound implications for spine surgery outcomes, as spinal surgery is one of the most frequent procedures performed annually by neurosurgeons and orthopedic spine surgeons. In current literature, two frailty indices, the Modified Frailty Index (mFI-5 or mFI-11) and the Risk Analysis Index (RAI), are the indices predominantly utilized to risk assess patients prior to surgical treatment. Utilizing a systematic search yielded ten studies. This study employs the area under the curve (AUC) from receiver operating characteristic (ROC) curves to develop a linear regression model aimed at evaluating the predictive performance of these indices for specific outcomes. This investigation focuses on the performance of the mFI and RAI in predicting three key postoperative outcomes in spine surgery patients: 30-day mortality, Clavien-Dindo IV complications, and non-home discharge (NHD). The results indicate that the RAI demonstrates superior predictive accuracy compared to the mFI for 30-day mortality (RAI AUC 0.82 [0.78-0.85] vs. mFI AUC 0.66 [0.62-0.70]) and Clavien-Dindo III-IV complications (RAI AUC 0.69 [0.66-0.72] vs. mFI AUC 0.63 [0.62-0.63]). However, no significant difference was observed in the ability to predict NHD (RAI AUC 0.81 [0.63, 0.91] vs. mFI AUC 0.71 [0.64, 0.77]). These findings suggest that the Risk Analysis Index is a more reliable predictor of 30-day mortality and Major complications (Clavien-Dindo III-IV) in patients undergoing spine surgery.

To characterize temporal, regional, sex-based, and sociodemographic disparities in firearm-related traumatic brain injury (TBI) and spinal cord injury (SCI) in the United States (1990–2023), and to evaluate associations with state-level development and care quality. National incidence, prevalence, and years lived with disability (YLDs) per 100,000 were obtained from the Global Burden of Disease 2023 database. States were grouped into Northeast, Midwest, South, and West regions. Human Development Index (HDI) data were retrieved from the Global Data Lab. A Quality of Care Index (QCI) was derived from scaled prevalence-to-incidence, YLD-to-prevalence, and YLD-to-incidence ratios. Regional variation was assessed with ANOVA; HDI correlations used Pearson’s r. In 2023, firearm-related TBI incidence, prevalence, and YLDs were 1.29, 2.75, and 0.39 per 100,000; for SCI, 0.30, 9.77, and 2.32. From 1990 to 2023, TBI burden rose substantially (incidence + 31.7