BACKGROUND AND OBJECTIVES:Postcraniotomy hypertension is commonly treated with intravenous (IV) antihypertensives to reduce hemorrhage risk. Intensive systolic blood pressure (SBP) control has been associated with adverse effects in hospitalized patients, but its impact after craniotomy is unclear. This study evaluated whether IV nicardipine use to achieve an SBP target <140 mm Hg is associated with hypoperfusion and other adverse outcomes after craniotomy. METHODS:We retrospectively reviewed 1997 adult craniotomy cases (2019-2024) at a tertiary academic center, stratified by IV nicardipine use. The comparison group included patients who received intermittent IV antihypertensives or none. The primary outcome was a composite of acute kidney injury, elevated troponin, elevated B-type natriuretic peptide, stroke, or death. Secondary outcomes included return to operating room, hospital length of stay, and hypotension. Patient characteristics were compared using χ2 and Wilcoxon tests. Propensity scores were estimated using age, sex, and hypertension history, and inverse propensity score weighting (IPSW) was applied to univariate and multivariable outcome models. RESULTS:IV nicardipine was administered to 1207 patients (60.4%). These patients had higher rates of preexisting hypertension (60% vs 37%, P < .01), longer operative times (median 279 vs 251 minutes, P < .01), and longer hospital stays (median 105 vs 80 hours, P < .01). On univariate analysis, the composite outcome (11% vs 7%, P < .01) and return to the operating room (2% vs 0%, P < .01) were more frequent in the nicardipine group. In IPSW-weighted multivariable analyses, IV nicardipine remained associated with the composite primary outcome (odds ratio = 1.32; 95% CI, 1.05-1.68; P = .02). Nicardipine use was independently associated with prolonged hospital length of stay (β = 32.68; 95% CI, 16.1-49.25; P = .001). CONCLUSION:Among patients undergoing craniotomy with an institutional postoperative SBP target <140 mm Hg, patients requiring IV nicardipine had longer hospital stays and higher rates of systemic complications after IPSW-adjusted analysis.

ImportanceAvailability of organs inadequately addresses the need of patients waiting for a transplant.ObjectiveTo estimate the true number of donor patients in the United States and identify inefficiencies in the donation process as a way to guide system improvement.Design, Setting, and ParticipantsA retrospective cross-sectional analysis was performed of organ donation across 13 different hospitals in 2 donor service areas covered by 2 organ procurement organizations (OPOs) in 2017 and 2018 to compare donor potential to actual donors. More than 2000 complete medical records for decedents were reviewed as a sample of nearly 9000 deaths. Data were analyzed from January 1, 2017, to December 31, 2018.ExposureDeaths of causes consistent with donation according to medical record review, ventilated patient referrals, center acceptance practices, and actual deceased donors.Main Outcomes and MeasuresPotential donors by medical record review vs actual donors and OPO performance at specific hospitals.ResultsCompared with 242 actual donors, 931 potential donors were identified at these hospitals. This suggests a deceased donor potential of 3.85 times (95% CI, 4.23-5.32) the actual number of donors recovered. There was a surprisingly wide variability in conversion of potential donor patients into actual donors among the hospitals studied, from 0% to 51.0%. One OPO recovered 18.8% of the potential donors, whereas the second recovered 48.2%. The performance of the OPOs was moderately related to referrals of ventilated patients and not related to center acceptance practices.Conclusions and RelevanceIn this cross-sectional study of hospitals served by 2 OPOs, wide variation was found in the performance of the OPOs, especially at individual hospitals. Addressing this opportunity could greatly increase the organ supply, affirming the importance of recent efforts from the federal government to increase OPO accountability and transparency.

Following aneurysmal subarachnoid hemorrhage (SAH), patients are monitored closely for vasospasm in the intensive care unit. Conditional vasospasm-free survival describes the risk of future vasospasm as a function of time elapsed without vasospasm. Conditional survival has not been applied to this clinical scenario but could improve patient counseling and intensive care unit use. The objective of this study was to characterize conditional vasospasm-free survival following SAH. This was a single institution, retrospective cohort study of patients treated for aneurysmal SAH between 1/1/2000–6/1/2020. The primary outcome was the development of vasospasm defined by the first instance of either radiographic vasospasm on computed tomography angiography, Lindegaard Index > 3.0 by transcranial doppler ultrasonography, or vasospasm-specific intraarterial therapy. Multivariable Cox regression was performed, and conditional vasospasm-free survival curves were constructed. A total of 528 patients were treated for aneurysmal SAH and 309 (58.5%) developed vasospasm. Conditional survival curves suggest patients who survive to postbleed day 10 without vasospasm have a nearly 90% chance of being discharged without vasospasm. The median onset of vasospasm was postbleed day 6. Age more than 50 years was associated with a lower risk (hazard ratio [HR] = .76; 95% confidence interval [CI] 0.64–0.91; p < 0.001). Higher initial systolic blood pressure (HR = 1.18; 95% CI 1.046–1.350; p = .008), Hunt-Hess grades 4 or 5 (HR = 1.304; 95% CI 1.014–1.676), and modified Fisher scale score of 4 (HR = 1.808; 95% CI 1.198–2.728) were associated with higher vasospasm than the respective lower grades. Conditional survival provides a useful framework for counseling patients and making decisions around vasospasm risk for patients with aneurysmal SAH, while risk factor-stratified plots facilitate a patient-centric, evidence-based approach to these conversations and decisions.

BACKGROUND:Near infrared autofluorescence (NIRAF) detection has previously demonstrated significant potential for real-time parathyroid gland identification. However, the performance of a NIRAF detection device - PTeye® - remains to be evaluated relative to a surgeon's own ability to identify parathyroid glands. METHODS:Patients eligible for thyroidectomy and/or parathyroidectomy were enrolled under 6 endocrine surgeons at 3 high-volume institutions. Participating surgeons were categorized based on years of experience. All surgeons were blinded to output of PTeye® when identifying tissues. The surgeon's performance for parathyroid discrimination was then compared with PTeye®. Histology served as gold standard for excised specimens, while expert surgeon's opinion was used to validate in-situ tissues. RESULTS:PTeye® achieved 92.7% accuracy across 167 patients recruited. Junior surgeons (<5 years of experience) were found to have lower confidence in parathyroid identification and higher tissue misclassification rate per specimen when compared to PTeye® and senior surgeons (>10 years of experience). CONCLUSIONS:NIRAF detection with PTeye® can be a valuable intraoperative adjunct technology to aid in parathyroid identification for surgeons.