Silky Chotai

Silky Chotai
Vanderbilt University | Vander Bilt · Department of Neurological Surgery

MD

About

211
Publications
12,726
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2,233
Citations
Citations since 2017
112 Research Items
2018 Citations
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Publications

Publications (211)
Article
CM-I-associated syringomyelia is a risk factor for scoliosis where a larger syrinx size is more likely to be associated with scoliosis. Therefore, the effect of syrinx on scoliosis progression may be alleviated by PFD. There is no difference in the need for fusion surgery between patients undergoing PFD with duraplasty vs. those undergoing extradur...
Article
Full-text available
Although machine learning (ML) has shown promise across disciplines, out-of-sample generalizability is concerning. This is currently addressed by sharing multi-site data, but such centralization is challenging/infeasible to scale due to various limitations. Federated ML (FL) provides an alternative paradigm for accurate and generalizable ML, by onl...
Article
Objectives: Patients undergoing surgery for cervical spine metastases are at risk for unplanned readmission due to comorbidities and chemotherapy/radiation. Our objectives were to: 1) report the incidence of unplanned readmission, 2) identify risk factors associated with unplanned readmission, and 3) determine the impact of an unplanned readmissio...
Article
Full-text available
Maximal safe resection is the mainstay of treatment in the neurosurgical management of gliomas, and preserving functional integrity is linked to favorable outcomes. How these modalities differ in their effectiveness on the extent of resection (EOR), survival, and complications remains unknown. A systematic literature search was performed with the f...
Article
Glioblastoma (GBM) is a highly aggressive primary central nervous system tumor for which median survival continues to be low, despite multimodal treatment and surgical resection. Heterogeneity at many levels (genomic, cytoarchitectural, and metabolic) likely contributes to these poor outcomes, and single-cell approaches can help to identify prognos...
Article
Background: The development of accurate machine learning algorithms requires sufficient quantities of diverse data. This poses a challenge in health care because of the sensitive and siloed nature of biomedical information. Decentralized algorithms through federated learning (FL) avoid data aggregation by instead distributing algorithms to the dat...
Article
Full-text available
Purpose The management of incidentally discovered meningioma remains controversial. We sought to compare outcomes following surgical resection of incidental meningioma to a matched cohort of symptomatic meningiomas. Methods A retrospective single-center case–control study was conducted for patients undergoing resection of incidental meningioma fro...
Article
Full-text available
Introduction Cystic meningiomas are rare, accounting for 2–7% of all intracranial meningiomas. Little is known regarding whether these meningiomas behave differently compared to solid meningiomas. We sought to study this relatively uncommon imaging appearance of meningioma and to evaluate its clinical significance. Methods A single-institution ret...
Article
Background Patients with mild traumatic brain injury (TBI) and intracranial hemorrhage often receive neurosurgical consultation. However, only a small proportion of patients require intervention. Our hypothesis is that low-risk minimal TBI patients managed without immediate neurosurgical consultation will have a reasonable safety and effectiveness...
Article
Study design: Retrospective review of prospectively collected data. Objective: To evaluate the impact of frailty and sarcopenia on outcomes after lumbar spine surgery. Summary of background data: Elderly patients are commonly diagnosed with degenerative spine disease requiring surgical intervention. Frailty and sarcopenia result from age-relat...
Article
Objective Acute subdural hematoma (aSDH) is a neurosurgical emergency. Thrombocytopenia poses a management challenge for these patients. We set out to determine the impact of thrombocytopenia on pre-operative hemorrhage expansion and post-operative outcomes. Methods This retrospective study evaluated patients presenting at our institution with aSD...
Article
Objective: Cerebral arteriovenous malformations (AVMs) are complex vascular lesions at perpetual risk for rupture, which can lead to significant morbidity and mortality. This study sought to evaluate the dynamic relationship between comorbidities and post-procedure complications to quantify the risk of poor discharge outcomes to create a predictiv...
Preprint
Full-text available
Introduction Cystic meningiomas are rare, accounting for 2–7% of all intracranial meningiomas. Little is known regarding whether these meningiomas behave differently compared to solid meningiomas. We sought to study this relatively uncommon imaging appearance of meningioma and to evaluate its clinical significance. Methods A single-institution ret...
Article
Background: Loss to follow-up (LTF) and unplanned readmission are barriers to recovery after acute subdural hematoma evacuation. The variables associated with these postdischarge events are not fully understood. Objective: To determine factors associated with LTF and unplanned readmission, emphasizing socioeconomic status (SES). Methods: A ret...
Article
Objective: Excision of intracranial meningiomas often requires resection or coagulation of the dura mater. The choice of dural closure technique is individualized and based on surgeon preference. The objective of this study was to determine outcomes following various dural closure techniques for supratentorial meningiomas. Methods: A retrospecti...
Article
Background: Little is known about the impact of discharge against medical advice (DAMA) in patients admitted with concussion. Objective: To explore the prevalence of DAMA and its effect on 30-day readmissions and cost in concussion using a nationally representative sample. Methods: The Nationwide Readmissions Database was queried for concussio...
Preprint
Full-text available
Although machine learning (ML) has shown promise in numerous domains, there are concerns about generalizability to out-of-sample data. This is currently addressed by centrally sharing ample, and importantly diverse, data from multiple sites. However, such centralization is challenging to scale (or even not feasible) due to various limitations. Fede...
Article
Full-text available
The Simpson Grade was introduced in the era of limited resources, outdated techniques, and rudimentary surgical and imaging technologies. With the advent of modern techniques including pre- and post-operative imaging, microsurgical and endoscopic techniques, advanced histopathology and molecular analysis and adjuvant radiotherapy, the utility of th...
Chapter
In this chapter, the questions and answers are intended to cover the following topics in relation to the neurocritical care and neurosurgical management of traumatic brain injuries (TBI) in the following settings: closed and penetrating TBI, traumatic hematomas, skull fractures, scalp injuries, decompressive craniectomy, cisternostomy, venous sinus...
Article
Study design: Retrospective cohort study. Objective: a) Compare operative variables, complications, and patient-reported outcomes (PROs) in patients with an upper instrumented vertebrae (UIV) of C2 vs. C3/4, and b) assess outcomes based on C2 screw type. Summary of background data: When performing elective posterior cervical laminectomy and fu...
Article
OBJECTIVE The objective of this study was to understand the natural history of scoliosis in patients with Chiari malformation type I (CM-I) with and without syringomyelia. METHODS A retrospective review of data was conducted. Patients with CM-I were identified from a cohort of 14,118 individuals age 18 years or younger who had undergone MRI over a...
Chapter
Effective communication is vital for developing a positive physician–patient. The parents often serve as a proxy to report the quality of life and healthcare after surgery in children with neurological diseases. The lack of communication, miscommunication, and loss of information in transition commonly affects the parent counseling, expectations an...
Article
Full-text available
Study Design Systematic review. Surgical decompression for degenerative cervical myelopathy (DCM) is associated with perioperative complications, including difficulty or discomfort with swallowing (dysphagia) as well as changes in sound production (dysphonia). This systematic review aims to (1) outline how dysphagia and dysphonia are defined in the...
Article
Background and Purpose Individual-participant data meta-analyses (IPD-MA) are powerful evidence synthesis studies which are considered the gold-standard of MA. The quality of reporting in these studies is guided by the 2015 Preferred Reporting Items for Systematic Review and Meta-Analysis of Individual Participant Data (PRISMA-IPD) guidelines. The...
Article
Objective: The rarity of colloid cysts in children makes it difficult to characterize this entity and offer meaningful advice on treatment. Infrequent case reports exist, but to date there has been no age-specific assessment. The purpose of this study was to define any differences between children and adults who are evaluated and treated for collo...
Article
Introduction By stabilizing immature leaky vessel formation in neomembranes, statin drugs have been suggested as a non-surgical treatment option for chronic subdural hematomas (cSDH). Statin therapy appears to reduce conservatively managed cSDH volume, however, the utility of these medications in supplementing surgical treatment is unknown. Object...
Article
Introduction Loss to follow-up (LTF) represents an understudied barrier to effective management of chronic subdural hematomas (cSDH). Understanding factors associated with LTF after surgical treatment of cSDH may uncover avenues for quality improvement efforts and modify discharge planning. Objective To identify demographic and clinical factors as...
Article
Objective This study investigates the relationship between neurovascular comorbidities and in-hospital complications in determining functional outcome, mortality, length of stay (LOS), and cost of stay. Methods Patients were identified from the 2012–2015 National Inpatient Sample (NIS) using International Classification of Diseases, Ninth Revision...
Article
Objective: We aim to define the dynamic interplay between neurovascular-specific comorbidities and in-hospital complications on outcomes (functional outcome and mortality), length of stay (LOS), and cost of hospital stay. Methods: The 2012-2015 National Inpatient Sample (NIS) was queried for intracranial aneurysm treatment following subarachnoid...
Article
Introduction : Microvascular decompression with transposition of the involved vessels provides good surgical outcomes in cases of complex and recurrent neurovascular compression syndromes. We conducted a literature review to illustrate the variations in the surgical techniques used for transposition, and to provide a practical decision-making sche...
Article
Study design: Retrospective analysis of prospectively collected registry data. Objective: To develop and validate prediction models for 12-month patient reported outcomes (PROs) of disability, pain, and myelopathy in patients undergoing elective cervical spine surgery. Summary of background data: Predictive models have the potential to be util...
Article
OBJECTIVE National databases collect large amounts of clinical information, yet application of these data can be challenging. The authors present the NeuroPoint Alliance and Institute for Healthcare Improvement (NPA-IHI) program as a novel attempt to create a quality improvement (QI) tool informed through registry data to improve the quality of car...
Article
OBJECTIVE The aim of this study was to determine the timeline of syrinx regression and to identify factors mitigating syrinx resolution in pediatric patients with Chiari malformation type I (CM-I) undergoing posterior fossa decompression (PFD). METHODS The authors conducted a retrospective review of records from pediatric patients (< 18 years old)...
Article
Objectives To evaluate surgical outcomes after transzygomatic middle cranial fossa (MCF) (TZ-MCF) approach for tumor control in patients with large skull base lesions involving the MCF and adjacent sites. Setting This study was done at the tertiary skull base center. Design This is a retrospective case series. Main Outcome Measures The main outcome...
Article
Background: Chronic subdural hematoma evacuation can be achieved in select patients through bedside placement of the Subdural Evacuation Port System (SEPS). This procedure involves drilling a burr hole at the thickest part of the hematoma. Identifying this location is often difficult, given the variable tilt of available imaging and distant anatom...
Article
Study Design. This study retrospectively analyzes prospectively collected data. Objective. Here in this study we aim to determine the factors which impact a patient's ability to RTW in the setting of cervical spine surgery in patients without worker's compensation status. Summary of Background Data. Surgical management of degenerative cervical dise...
Article
MINI: Surgical decompression for degenerative cervical myelopathy can improve functional impairment, disability and quality of life. Surgery, however, is associated with complications, including C5 palsy, new radiculopathy and intraoperative spinal cord injury. There is a pressing need to develop standardized definitions of these complications in o...
Article
Background: Prospective patient-reported outcomes (PROs) registries are central to emerging evidence-driven reform models. These registries entail significant operator and responder burden to capture PROs data. It is important to limit the number of PROs administered. We sought to determine whether the anxiety/depression domain of EQ-5D could be u...
Article
Full-text available
OBJECTIVE The AANS launched the Quality Outcomes Database (QOD), a prospective longitudinal registry that includes demographic, clinical, and patient-reported outcome (PRO) data to measure the safety and quality of spine surgery. Registry data offer “real-world” insights into the utility of spinal fusion and decompression surgery for lumbar spondyl...
Article
Study design: This study retrospectively analyzes prospectively collected data. Objective: Here we aim to determine the influence of preoperative and 12-month mJOA on satisfaction; and understand the change in mJOA severity classification after surgical management of DCM. Summary of background data: Degenerative cervical myelopathy (DCM) is a...
Article
Objective: To assess the effect depression has on outcomes after cervical epidural steroid injections (CESIs). Design: Retrospective review of a prospectively collected database. Setting: Single institution tertiary care center. Subjects: Fifty-seven patients with cervical spondylosis and cervical radicular pain who were deemed appropriate s...
Article
Introduction: Healthcare reform places emphasis on maximizing the value of care. Methods: A prospective registry was used to analyze outcomes before (1,596 patients) and after (151 patients) implementation of standardized, evidence-based order sets for six high-impact dimensions of perioperative care for all patients who underwent elective surge...
Article
BACKGROUND CONTEXT Physical therapy (PT) is commonly used after lumbar spine surgery, without strong evidence for its effectiveness. Randomized controlled trials outside the United States have found no significant difference between PT and educational controls. Additional research is needed to understand the benefit of PT for postoperative manageme...
Article
Background: Considerable variability exists in the cost of surgery following spine surgery for common degenerative spine diseases. This variation in the cost of surgery can affect the payment bundling during the postoperative 90 d. Objective: To determine the drivers of variability in total 90-d cost for laminectomy and fusion surgery. Methods:...
Article
OBJECTIVE Hospital readmissions lead to a significant increase in the total cost of care in patients undergoing elective spine surgery. Understanding factors associated with an increased risk of postoperative readmission could facilitate a reduction in such occurrences. The aims of this study were to develop and validate a predictive model for 90-d...
Article
Background: In an era of rising health care costs, it is prudent to consider effective use of resources. Given the rapidly expanding elderly population with an anticipated increase in adult spinal deformity, identifying the significant cost drivers for the surgical management is an important step in the process of increasing sustainability and cos...
Article
Background: The healthcare reimbursement models are rapidly transitioning to pay-per-performance episode of care payment models. These models, if designed well, must account for the variability in the cost of index surgeries during the global period. Objective: To analyze the variability in 90-d cost and determine the drivers of the variability...
Article
Background: The choice of anterior vs posterior approach for degenerative cervical myelopathy that spans multiple segments remains controversial. Objective: To compare the outcomes following the 2 approaches using multicenter prospectively collected data. Methods: Quality Outcomes Database (QOD) for patients undergoing surgery for 3 to 5 level...
Article
OBJECTIVE Many patients undergoing spinal fusion for neuromuscular scoliosis have preexisting neurosurgical implants, including ventricular shunts (VSs) for hydrocephalus and baclofen pumps (BPs) for spastic cerebral palsy. Recent studies have discussed a possible increase in implant complication rates following spinal fusion, but published data ar...
Article
Background: Value-based episode of care reimbursement models is being investigated to curb unsustainable health care costs. Any variation in the cost of index spine surgery can affect the payment bundling during the 90-d global period. Objective: To determine the drivers of variability in cost for patients undergoing elective anterior cervical d...
Article
Full-text available
Purpose: The purpose of this study was to compare patient-reported outcomes (PROs), morbidity, and costs of TLIF vs PLF to determine whether one treatment was superior in the setting of single-level degenerative spondylolisthesis. Methods: Patients undergoing TLIF or PLF for single-level spondylolisthesis were included for retrospective analysis...
Article
Full-text available
Background: Numerous studies have demonstrated the benefits of early decompression and stabilization in unstable spine injuries with incomplete neurological deficits. However, a clear consensus on timing to operative intervention still does not exist in those with a normal neurological exam and unstable spine. Objective: To determine the optimal...
Article
Study design: Retrospective review of prospective patient outcomes and cost data OBJECTIVE.: To analyze the contribution of surgeon-specific variability in cost and patient-reported outcomes (PROs) to overall variability in anterior cervical discectomy and fusion (ACDF), while adjusting for patient comorbidities. Summary of background data: Cost...
Article
Background/aims: Scoliosis is common in patients with Chiari malformation-I (CM-I). This study examined the change in scoliosis severity after posterior fossa decompression (PFD) for CM-I. Methods: We conducted a retrospective review at a single tertiary center for children undergoing PFD with untreated scoliosis, and identified 17 patients with...
Article
Full-text available
OBJECTIVE The American Association of Neurological Surgeons launched the Quality Outcomes Database (QOD), a prospective longitudinal registry that includes demographic, clinical, and patient-reported outcome (PRO) data, to measure the safety and quality of neurosurgical procedures, including spinal surgery. Differing results from recent randomized...
Article
OBJECTIVE Patient-reported outcomes (PROs) play a pivotal role in defining the value of surgical interventions for spinal disease. The concept of minimum clinically important difference (MCID) is considered the new standard for determining the effectiveness of a given treatment and describing patient satisfaction in response to that treatment. The...
Article
Full-text available
The lesions involving cavernous sinus (CS) and lateral sellar region includes tumors, vascular lesions, infection, inflammation, and trauma. Tumors associated with CS cause significant distortion of the microanatomy posing an additional surgical challenge to the neurosurgeons. The surgical approach and microsurgical anatomy with respect to the orig...
Article
Study design: Retrospective Cohort Study OBJECTIVE.: To evaluate the causes, timing, and factors associated with unplanned 90-day readmissions following elective spine surgery. Summary of background data: Unplanned readmissions after spine surgery are costly and an important determinant of the value of care. Several studies using database inform...
Article
Full-text available
Purpose: Non-steroidal anti-inflammatory drugs (NSAIDs) play an important role in postoperative pain management. However, their use in the setting of spine fusion surgery setting has long been a topic of controversy. In this review we examined relevant research, including in vivo, animal, and clinical human studies, with the aim of understanding t...
Article
Treatment of spinal pathology is a significant contributor to the current rise in health care spending in the United States. To maximize value, the cost of spine care must be analyzed to assess for any inefficiencies. In parallel, outcomes must be tracked to ensure that any potential cost reductions do not have a negative impact on the efficacy of...
Article
OBJECTIVE Readmission and return to operating room after surgery are increasingly being used as a proxy for quality of care. Nearly 60% of these readmissions are unplanned, which translates into billions of dollars in health care costs. The authors set out to analyze the incidence of readmission at their center, to define causes of unplanned readmi...
Article
OBJECTIVE In this analysis the authors compare the characteristics of smokers to nonsmokers using demographic, socioeconomic, and comorbidity variables. They also investigate which of these characteristics are most strongly associated with smoking status. Finally, the authors investigate whether the association between known patient risk factors an...
Article
Background Identifying risk factors for negative postoperative outcomes is an important part of providing quality care. Here, we build machine learning (ML) ensembles to model the independent impact of presurgical comorbidities on discharge disposition and length of stay (LOS) following brain tumor resection from the HCUP National Inpatient Sample...
Data
Preoperative comorbidities of admissions used to train the disposition ensemble
Data
Preoperative comorbidities from admissions used to train the LOS ensemble
Data
Patient characteristics for admissions included in LOS ensemble
Data
Patient characteristics for admissions included in disposition ensemble
Article
Osteoporosis is responsible for a global medical and economic burden that will grow as the elderly population doubles over the next 20 years. Measuring the cost of the effects of osteoporosis on treatment of spinal disorders is important as we prioritize distribution of resources in the healthcare community. This article examines the monetary cost...