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Cronkhite SE, Daher M, Balmaceno-Criss M, Knebel A, Nassar JE, Singh M, Mcdonald CL, Basques BA, Diebo BG, Daniels AH. Impact of Gender on Peri-Operative Characteristics and Outcomes of Lumbar Spine Surgery: A Current Concepts Review. World Neurosurg 2024; 190:46-52. [PMID: 38977128 DOI: 10.1016/j.wneu.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024]
Abstract
The success of spine surgery is variable among patients. Finding reliable predictors of successful outcomes will not only maximize patient benefit, but also increase the cost effectiveness of surgery. Recent research has demonstrated the importance of patient specific factors in predicting patient outcomes, including gender. While many studies show that female patients present with worse pain and function preoperatively, there is conflicting data on whether male and female patients reap the same benefits from lumbar spine surgery. In this manuscript we review the current research on gender and sex differences in preoperative characteristics and post-operative outcomes and comment on the need for more studies to better elucidate the mechanism driving the conflicting evidence.
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Affiliation(s)
- Shelby E Cronkhite
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mohammad Daher
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mariah Balmaceno-Criss
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ashley Knebel
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Joseph E Nassar
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Manjot Singh
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Christopher L Mcdonald
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
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Ranganathan N, Mehta A, DiGiovanni WH, Akhbari B, Waryasz G, Pineda LB, Nassour N, Ashkani-Esfahani S. Disparity in sex in ankle fracture treatment. Foot (Edinb) 2023; 57:102057. [PMID: 37757504 DOI: 10.1016/j.foot.2023.102057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/31/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Literature has shown implicit bias in the treatment between non-operative and surgical treatment in patients with certain types of ankle fractures, which comprise 7.6% of all adult fractures. An understanding of any bias across all ankle fracture management may prove to be critical for the understanding of potential correlations between treatment methods and outcomes of patients with ankle fractures. Therefore, this study aimed to determine whether there is a sex-based bias in the operative and non-operative treatment of all ankle fractures. METHODS A retrospective study of 1175 adult patients with ankle fractures was conducted. Data extracted included sex, race, age, type of treatment (non-operative/operative), fracture type (displaced/non-displaced), fracture class, BMI, and length of hospital stay. Odds ratio (OR), Chi-squared, t-test, and Pearson's correlation tests were used with p < 0.05 considered significant. RESULTS The study population consisted of 750 females (63.8%) and 425 males (36.2%). The study demonstrated a sex-based disparity in operative and non-operative treatment revealing that women are less likely than men to receive operative treatment for displaced ankle fractures (OR = 0.7, 95% CI: 0.5-0.9, p = 0.01). Of the 750 females, 417 (55.6%) underwent non-operative treatment, while 333 (44.4%) females had an operation. Of the 425 males, 204 (48%) had non-operative treatment, while 221 (52%) underwent operative treatment. The distribution of ankle fracture classes between both sexes was similar, suggesting fracture class did not influence the observed disparity. CONCLUSION Our results suggest sex correlates with the treatment type for ankle fractures, with women more likely to receive non-operative treatment for displaced fractures. As post-treatment outcomes often reflect the chosen form of treatment, it is imperative to determine if a disparity in sex explicates differences in clinical outcomes.
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Affiliation(s)
- Noopur Ranganathan
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Aayush Mehta
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - William Henry DiGiovanni
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Bardiya Akhbari
- FARIL-SORG Collaborative, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Waryasz
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lorena Bejarano Pineda
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nour Nassour
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Soheil Ashkani-Esfahani
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Clare S, Dash A, Liu Y, Harrison J, Vlastaris K, Waldman S, Griffin R, Cooke P, Vad V, Casey E, Bockman RS, Lane J, McMahon D, Stein EM. Epidural Steroid Injections Acutely Suppress Bone Formation Markers in Postmenopausal Women. J Clin Endocrinol Metab 2022; 107:e3281-e3287. [PMID: 35524754 DOI: 10.1210/clinem/dgac287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Over 9 million epidural steroid injections (ESIs) are performed annually in the United States. Although these injections effectively treat lumbar radicular pain, they may have adverse consequences, including bone loss. OBJECTIVE To investigate acute changes in bone turnover following ESI. We focused on postmenopausal women, who may be at greatest risk for adverse skeletal consequences due to the combined effects of ESIs with aging and estrogen deficiency. METHODS Single-center prospective observational study. Postmenopausal women undergoing lumbar ESIs and controls with no steroid exposure were included. Outcomes were serum cortisol, markers of bone formation, osteocalcin, and procollagen type-1 N-terminal propeptide (P1NP), and bone resorption by C-telopeptide (CTX) measured at baseline, 1, 4, 12, 26, and 52 weeks after ESIs. RESULTS Among ESI-treated women, serum cortisol declined by ~50% 1 week after injection. Bone formation markers significantly decreased 1 week following ESIs: osteocalcin by 21% and P1NP by 22%. Both markers remained suppressed at 4 and 12 weeks, but returned to baseline levels by 26 weeks. There was no significant change in bone resorption measured by CTX. Among controls, there were no significant changes in cortisol or bone turnover markers. CONCLUSION These results provide evidence of an early and substantial reduction in bone formation markers following ESIs. This effect persisted for over 12 weeks, suggesting that ESIs may have lasting skeletal consequences. Given the large population of older adults who receive ESIs, further investigation into the long-term skeletal sequelae of these injections is warranted.
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Affiliation(s)
- Shannon Clare
- Endocrinology Division, Hospital for Special Surgery, New York, NY 10021, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY 10021, USA
| | - Alexander Dash
- Endocrinology Division, Hospital for Special Surgery, New York, NY 10021, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY 10021, USA
| | - Yi Liu
- Endocrinology Division, Hospital for Special Surgery, New York, NY 10021, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY 10021, USA
| | - Jonathan Harrison
- Endocrinology Division, Hospital for Special Surgery, New York, NY 10021, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY 10021, USA
| | - Katelyn Vlastaris
- Endocrinology Division, Hospital for Special Surgery, New York, NY 10021, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY 10021, USA
| | - Seth Waldman
- Department of Anesthesiology, Critical Care, & Pain Management, Hospital for Special Surgery, and Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Robert Griffin
- Department of Anesthesiology, Critical Care, & Pain Management, Hospital for Special Surgery, and Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Paul Cooke
- Department of Physiatry, Hospital for Special Surgery, New York, NY 10021, USA
| | - Vijay Vad
- Department of Physiatry, Hospital for Special Surgery, New York, NY 10021, USA
| | - Ellen Casey
- Department of Physiatry, Hospital for Special Surgery, New York, NY 10021, USA
| | - Richard S Bockman
- Endocrinology Division, Hospital for Special Surgery, New York, NY 10021, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY 10021, USA
| | - Joseph Lane
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY 10021, USA
| | - Donald McMahon
- Endocrinology Division, Hospital for Special Surgery, New York, NY 10021, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY 10021, USA
| | - Emily M Stein
- Endocrinology Division, Hospital for Special Surgery, New York, NY 10021, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY 10021, USA
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Peteler R, Schmitz P, Loher M, Jansen P, Grifka J, Benditz A. Sex-Dependent Differences in Symptom-Related Disability Due to Lumbar Spinal Stenosis. J Pain Res 2021; 14:747-755. [PMID: 33758537 PMCID: PMC7981139 DOI: 10.2147/jpr.s294524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/06/2021] [Indexed: 11/28/2022] Open
Abstract
Study Design Retrospective observational study. Objective The objective of this study is to identify possible sex-dependent differences in symptom-related disability in patients with lumbar spinal stenosis. Methods 103 consecutive outpatients (42 men and 61 women) with lumbar spinal stenosis were assessed on the basis of their medical history, the physical examination, and a series of questionnaires including the Oswestry Disability Index (ODI), the Roland Morris Disability Questionnaire (RMDQ), the Patient Health Questionnaire module 9 (PHQ-9), and the Depression Anxiety Stress Scales (DASS). Narrowing of the spinal canal was graded according to the method established by Schizas. Parameters were statistically analyzed according to the biological sex of the patients. The influence of the variables on the disability scores was analyzed by means of a multivariate regression model. Results Symptom severity was equally distributed between men and women. Female patients showed higher RMDQ and ODI scores as well as significantly higher intermediate depression scores. The confounding variables age, pain chronicity, and psychological affection as well as the symptoms level of pain and paresis were dependent on patient sex. Conclusion The study shows sex-depended differences in the perception of symptoms of lumbar spinal stenosis and disability of life. The findings suggest that the main mediators are pain perception and psychological influences on the quality of life.
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Affiliation(s)
- Raffael Peteler
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Bavaria, Germany.,Department of Trauma Surgery, Caritas-Krankenhaus St. Josef, Regensburg, Bavaria, Germany
| | - Paul Schmitz
- Department of Trauma Surgery, Caritas-Krankenhaus St. Josef, Regensburg, Bavaria, Germany
| | - Martin Loher
- Department of Trauma Surgery, Caritas-Krankenhaus St. Josef, Regensburg, Bavaria, Germany
| | - Petra Jansen
- Department of Sport Science, University of Regensburg, Regensburg, Bavaria, Germany
| | - Joachim Grifka
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Bavaria, Germany
| | - Achim Benditz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Bad Abbach, Bavaria, Germany
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Lee CW, Lo YT, Devi S, Seo Y, Simon A, Zborovancik K, Alsheikh MY, Lamba N, Smith TR, Mekary RA, Aglio LS. Gender Differences in Preoperative Opioid Use in Spine Surgery Patients: A Systematic Review and Meta-analysis. PAIN MEDICINE 2020; 21:3292-3300. [PMID: 32989460 DOI: 10.1093/pm/pnaa266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Opioids are frequently used in spine surgeries despite their adverse effects, including physical dependence and addiction. Gender difference is an important consideration for personalized treatment. There is no review assessing the prevalence of opioid use between men and women before spine surgeries. DESIGN We compared the prevalence of preoperative opioid use between men and women. SETTING Spine surgery. SUBJECTS Comparison between men and women. METHODS PubMed, Embase, and Cochrane were searched from inception to November 9, 2018. Clinical characteristics and prevalence of preoperative opioid use were collected. Where feasible, data were pooled from nonoverlapping studies using random-effects models. RESULTS Four studies with nonoverlapping populations were included in the meta-analysis (one prospective, three retrospective cohorts). The prevalence of preoperative opioid use was 0.64 (95% CI = 0.40-0.83). Comparing men with women, no statistically significant difference in preoperative opioid use was detected (relative risk [RR] = 0.99, 95% CI = 0.96-1.02). Surgery location (cervical, lumbar) and study duration (more than five years or five years or less) did not modify this association. All involved open spine surgery. Only one secondary analysis provided data on both pre- and postoperative opioid use stratified by gender, which showed a borderline significantly higher prevalence of postoperative use in women than men. CONCLUSIONS The prevalence of opioid use before spine surgery was similar between men and women, irrespective of surgery location or study duration. More studies characterizing the pattern of opioid use between genders are still needed.
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Affiliation(s)
- Chung-Wang Lee
- School of Pharmacy, MCPHS University, Boston, Massachusetts
| | - Yu Tung Lo
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sharmila Devi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yookyung Seo
- School of Pharmacy, MCPHS University, Boston, Massachusetts
| | - Angela Simon
- School of Pharmacy, MCPHS University, Boston, Massachusetts
| | | | - Mona Y Alsheikh
- Clinical Pharmacy Department, School of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Nayan Lamba
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Radiation Oncology Program, Boston, Massachusetts, USA
| | - Timothy R Smith
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rania A Mekary
- School of Pharmacy, MCPHS University, Boston, Massachusetts.,Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Linda S Aglio
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Davison MA, Lilly DT, Eldridge CM, Singh R, Bagley C, Adogwa O. Regional differences in prolonged non-operative therapy utilization prior to primary ACDF surgery. J Clin Neurosci 2020; 80:143-151. [PMID: 33099337 DOI: 10.1016/j.jocn.2020.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/20/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022]
Abstract
There is a paucity of data characterizing regional variations in the utilization and costs of conservative management in patients suffering from cervical stenosis prior to anterior cervical discectomy and fusion (ACDF) surgery. An understating of these regional trends becomes critical as outcomes-based reimbursement strategies become standard. The objective of this investigation was to evaluate for regional differences in the utilization and overall costs of maximal non-operative therapy (MNT) prior to ACDF surgery. Medical records from patients with symptomatic cervical stenosis undergoing a ≤3-level index ACDF procedure between 2007 and 2016 were accessed from a large insurance database. Geographic regions (Midwest, Northeast, South, and West) reflected U.S. Census Bureau definitions. MNT utilization within 2-years prior to ACDF surgery was analyzed. An index ACDF surgery was performed in 15,825 patients. Patient regional breakdown was as follows: South (67.6% of patients), Midwest (21.8% of patients), West (8.9% of patients), Northeast (1.6% of patients). Regional variations were identified in the number of patients utilizing NSAIDs (p < 0.001), opioids (p < 0.001), muscle relaxants (p < 0.001), cervical epidural steroid injections (p = 0.001), physical therapy/occupational therapy treatments (p < 0.001), and chiropractor visits (p < 0.001). The West (64.5%) and South (63.5%) had the greatest proportion of patients utilizing narcotics. When normalized by the number of opioid using-patients however, the Northeast (691.4 pills/patient) and South (674.4 pills/patient) billed for the most opioid pills. The total direct cost associated with all MNT prior to index ACDF was $17,255,828. The Midwest ($1,277.72 per patient) and South ($1,047.86 per patient) had the greatest average dollars billed.
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Affiliation(s)
- Mark A Davison
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States
| | - Daniel T Lilly
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States
| | - Cody M Eldridge
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Ravinderjit Singh
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Carlos Bagley
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States.
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Davison MA, Lilly DT, Moreno J, Bagley C, Adogwa O. Gender differences in use of prolonged non-operative therapies prior to index ACDF surgery. J Clin Neurosci 2020; 78:228-235. [PMID: 32507293 DOI: 10.1016/j.jocn.2020.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/04/2020] [Indexed: 11/30/2022]
Abstract
Prior to anterior cervical discectomy and fusion (ACDF) surgery, patients suffering from cervical stenosis traditionally trial non-operative treatments for pain management. There is a paucity of data evaluating gender disparities in the prolonged utilization of conservative therapy prior to ACDF surgery. Therefore, the purpose of this study was to assess for gender-based differences in the utilization and cost of maximal non-operative therapy (MNT) for cervical stenosis prior to ACDF surgery. Medical records from patients with symptomatic cervical stenosis undergoing 1, 2, or 3-level index ACDF procedures between 2007 and 2016 were gathered from an insurance database consisting of 20.9 million covered lives. The utilization of MNTs within 5 years prior to index ACDF surgery was assessed. A total of 2254 patients (females: 53.1%) underwent an index ACDF surgery. There were a significantly greater percentage of female patients that utilized NSAIDs (p < 0.0001), opioids (p = 0.0019), muscle relaxants (p < 0.0001), cervical epidural steroid injections (p = 0.0428), and physical therapy/occupational therapy treatments (p < 0.0001). The total direct cost associated with all MNT prior to index ACDF was $4,833,384. On average, $2028.01 was spent per male patient while $2247.29 was spent per female patient. When normalized by number of pills billed per patient utilizing therapy, female patients utilized more NSAIDs (males: 591.8 pills, females: 669.3 pills), opioids (male: 1342.0 pills, female: 1650.1 pills), and muscle relaxants (males: 823.7 pills, females: 1211.1 pills). The results suggest that there may be gender differences in the utilization of non-operative therapies for symptomatic cervical stenosis prior to ACDF surgery.
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Affiliation(s)
- Mark A Davison
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States
| | - Daniel T Lilly
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, United States
| | - Jessica Moreno
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Carlos Bagley
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Owoicho Adogwa
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States
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Gender differences in the 3-month utilization of nonoperative therapies prior to primary lumbar microdiscectomy. J Clin Neurosci 2020; 76:107-113. [DOI: 10.1016/j.jocn.2020.04.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/04/2020] [Indexed: 11/19/2022]
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Davison MA, Lilly DT, Moreno J, Cheng J, Bagley C, Adogwa O. Regional Variation in Nonoperative Therapy Utilization for Symptomatic Lumbar Stenosis and Spondylolisthesis: A 2-Year Costs Analysis. Global Spine J 2020; 10:138-147. [PMID: 32206512 PMCID: PMC7076589 DOI: 10.1177/2192568219844227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To characterize regional variations in maximal nonoperative therapy (MNT) costs in patients suffering from lumbar stenosis or spondylolisthesis. METHODS Medical records from patients with symptomatic lumbar stenosis or spondylolisthesis undergoing primary ≤3-level lumbar decompression and fusion procedures from 2007 to 2016 were gathered from a large insurance database. Geographic regions (Midwest, Northeast, South, and West) reflected the US Census Bureau definitions. Records were searchable by International Classification of Diseases diagnosis/procedure codes, Current Procedural Terminology codes, and insurance-specific generic drug codes. Utilization of MNT, defined as cost billed, prescriptions written, and number of units disbursed, within 2-years prior to index surgery was assessed. RESULTS A total of 27 877 patients underwent 1-, 2-, or 3-level lumbar decompression and fusion surgery. Regional breakdown of the study cohort was as follows: South 62.3%, Midwest 25.2%, West 10.4%, Northeast 2.1%. Regional variations in the number of patients using nonsteroidal anti-inflammatory drugs (NSAIDs) (P < .0001), opioids (P < .0001), muscle relaxants (P < .0001), and lumbar steroid injections (P < .0001) were detected. A significant difference was identified in the regional MNT failure rates (P < .0001). The total cost associated with MNT prior to index surgery was $48 411 125 ($1736.60/patient), with the Midwest ($1943.83/patient) responsible for the greatest average spending. Despite comprising 62.3% of the cohort, the South was accountable for 67.5% of NSAID prescriptions, 64.6% of opioid prescriptions, and 71.2% of muscle relaxant prescriptions. CONCLUSIONS Regional differences exist in the costs of MNT in patients with lumbar stenosis and spondylolisthesis prior to surgery. Future studies should focus on identifying patients likely to fail prolonged nonoperative management.
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Affiliation(s)
| | | | - Jessica Moreno
- University of Texas South Western Medical Center, Dallas, TX, USA
| | - Joseph Cheng
- University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Carlos Bagley
- University of Texas South Western Medical Center, Dallas, TX, USA
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Mendoza-Elias N, Dunbar M, Ghogawala Z, Whitmore RG. Opioid Use, Risk Factors, and Outcome in Lumbar Fusion Surgery. World Neurosurg 2020; 135:e580-e587. [DOI: 10.1016/j.wneu.2019.12.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 11/28/2022]
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