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Watts BV, Calloway K. Implementation of Quality Improvement System in a National Health System. Am J Med Qual 2024; 39:183-187. [PMID: 38992908 DOI: 10.1097/jmq.0000000000000195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
There is a continued need to improve the quality of health care services and the health outcomes associated with that care. Quality improvement model and the Learning Health System framework have emerged as potential methods to achieve the goals of better care and enhanced outcomes. Few practical tools and approaches have been developed to assist with the initiation of quality improvement and development of a Learning Health System. The Department of Veterans Affairs developed and deployed a national system to assist and organize improvement projects and serve as a database for learning. During its first 5 years of use, 7397 quality improvement projects were completed using the electronic tool. National implementation of a structured tool for quality improvement is possible.
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Affiliation(s)
- Bradley V Watts
- Veterans Rural Health Resource Center, VA Office of Rural Health, Washington, DC
- Department of Mental Health, White River Junction VA Medical Center, White River Junction, VT
- Department of Psychiatry, Larner College of Medicine at the University of Vermont, Burlington, VT
| | - Kay Calloway
- Systems Redesign and Quality Improvement, Veterans Integrated Service Network 22, Long Beach, CA
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Jiang SH, Chaudhry NS, Nie JW, Patel S, Ansari D, Nie JZ, Shah P, Patel J, Mehta AI. Discharge within 1 day following elective single-level transforaminal lumbar interbody fusion: a propensityscore-matched analysis of predictors, complications, and readmission. Asian Spine J 2024; 18:362-371. [PMID: 38779702 PMCID: PMC11222876 DOI: 10.31616/asj.2023.0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/28/2024] [Accepted: 02/12/2024] [Indexed: 05/25/2024] Open
Abstract
STUDY DESIGN This was a retrospective case-control study using 8 years of data from a nationwide database of surgical outcomes in the United States. PURPOSE This study aimed to improve our understanding of the risk factors associated with a length of stay (LOS) >1 day and aid in reducing postoperative hospitalization and complications. OVERVIEW OF LITERATURE Despite the proven safety of transforaminal lumbar interbody fusion (TLIF), some patients face prolonged postoperative hospitalization. METHODS Data were collected from the American College of Surgeons National Surgical Quality Improvement Program dataset from 2011 to 2018. The cohort was divided into patients with LOS up to 1 day (LOS ≤1 day), defined as same day or next-morning discharge, and patients with LOS >1 day (LOS >1 day). Univariable and multivariable regression analyses were performed to evaluate predictors of LOS >1 day. Propensity-score matching was performed to compare pre- and postdischarge complication rates. RESULTS A total of 12,664 eligible patients with TLIF were identified, of which 14.8% had LOS ≤1 day and 85.2% had LOS >1 day. LOS >1 day was positively associated with female sex, Hispanic ethnicity, diagnosis of spondylolisthesis, American Society of Anesthesiologists classification 3, and operation length of >150 minutes. Patients with LOS >1 day were more likely to undergo intraoperative/postoperative blood transfusion (0.3% vs. 4.5%, p<0.001) and reoperation (0.1% vs. 0.6%, p=0.004). No significant differences in the rates of postdischarge complications were found between the matched groups. CONCLUSIONS Patients with worsened preoperative status, preoperative diagnosis of spondylolisthesis, and prolonged operative time are more likely to require prolonged hospitalization and blood transfusions and undergo unplanned reoperation. To reduce the risk of prolonged hospitalization and associated complications, patients indicated for TLIF should be carefully selected.
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Affiliation(s)
- Sam H. Jiang
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Nauman S. Chaudhry
- Department of Neurosurgery & Brain Repair, University of South Florida, Lakeland, FL, USA
| | - James W. Nie
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Saavan Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Darius Ansari
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - Jeffrey Z. Nie
- Department of Neurosurgery, Southern Illinois University, Springfield, IL, USA
| | - Pal Shah
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Jaimin Patel
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Ankit I. Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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Ukachukwu AEK, Ogundeji OD, Abu-Bonsrah N, Still MEH, Trillo-Ordonez Y, Oboh EN, Nischal SA, Deng DD, Ugorji C, Seas A, Badejo OA, Malomo TA, Nwaribe EE, Oyemolade TA, Okere OE, Oboh E, Waguia-Kouam R, Rahman R, Asemota I, Reddy R, von Isenburg M, Haglund MM, Fuller AT, Adeleye AO. The Scope, Trends, and Challenges of Neurosurgical Research in Nigeria: A Bibliometric Review. World Neurosurg 2024; 185:e86-e98. [PMID: 37931875 DOI: 10.1016/j.wneu.2023.10.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE This study investigates the scope, trends, and challenges of neurosurgical research in Nigeria since inception of the specialty in 1962. METHODS A bibliometric review of the neurosurgical literature from Nigeria was performed. Variables extracted included year and journal of publication, article topic, article type, research type, study design, article focus area, and limitations. Descriptive and quantitative analyses were performed for all variables. Trends of research publications were described in three periods: pioneering (1962-1981), recession (1982-2001), and resurgent (2002-2021). RESULTS Of the 1023 included articles, 10.0% were published in the pioneering period, 9.2% in the recession period, and 80.8% in the resurgent period. Papers were predominantly published in World Neurosurgery (4.5%) and Nigerian Journal of Clinical Practice (4.0%). A total of 79.9% of the 4618 authors were from Nigerian institutions; 86.3% of the articles covered clinical research and were mainly focused on service delivery and epidemiology (89.9%). The most prominent topics were traumatic brain injury (25.8%) and central nervous system malignancy (21.4%). Only 4.4% of the publications received funding, mostly from agencies in the United States (31.7%). Barriers to neurosurgical research included lack of clinical databases (18.0%), increasing burden of disease (12.5%), and diagnostic challenges (12.4%). CONCLUSIONS Neurosurgical research in Nigeria continues to grow due to increased training, workforce, and infrastructural improvements. Addressing the major challenges through establishment of research databases, development of evidence-based management guidelines, and increasing research training, funding and opportunities can increase research capacity in Nigeria.
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Affiliation(s)
- Alvan-Emeka K Ukachukwu
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA.
| | - Olaniyi D Ogundeji
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Megan E H Still
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Yesel Trillo-Ordonez
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Ehita N Oboh
- Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Shiva A Nischal
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Di D Deng
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Chiazam Ugorji
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Andreas Seas
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Duke University Pratt School of Engineering, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Oluwakemi A Badejo
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
| | - Toluyemi A Malomo
- Department of Neuroscience, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Ena Oboh
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | | | - Raphia Rahman
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Isaac Asemota
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Ramya Reddy
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Megan von Isenburg
- Duke University Medical Center Library and Archives, Durham, North Carolina, USA
| | - Michael M Haglund
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Anthony T Fuller
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Health System, Durham, North Carolina, USA; Duke University Global Health Institute, Durham, North Carolina, USA
| | - Amos O Adeleye
- Department of Neurosurgery, University College Hospital, Ibadan, Nigeria
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Kapinos KA, Peters RM, Murphy RE, Hohmann SF, Podichetty A, Greenberg RS. Inpatient Costs of Treating Patients With COVID-19. JAMA Netw Open 2024; 7:e2350145. [PMID: 38170519 PMCID: PMC10765267 DOI: 10.1001/jamanetworkopen.2023.50145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/15/2023] [Indexed: 01/05/2024] Open
Abstract
Importance With more than 6.2 million hospitalizations due to COVID-19 in the US, recognition of the average hospital costs to provide inpatient care during the pandemic is necessary to understanding the national medical resource use and improving public health readiness and related policies. Objective To examine the mean cost to provide inpatient care to treat COVID-19 and how it varied through the pandemic waves and by important sociodemographic patient characteristics. Design, Setting, and Participants This cross-sectional study used inpatient-level data from March 1, 2020, to March 31, 2022, extracted from a repository of clinical, administrative, and financial information covering 97% of academic medical centers across the US. Main Outcomes and Measures Cost to produce care for each stay was calculated using direct hospital costs to provide care adjusted for geographic differences in labor costs using area wage indices. Results The sample included 1 333 404 stays with a primary or secondary COVID-19 diagnosis from 841 hospitals. The cohort included 692 550 (52%) men, with mean (SD) age of 59.2 (17.5) years. The adjusted mean cost of an inpatient stay was $11 275 (95% CI, $11 252-$11 297) overall, increasing from $10 394 (95% CI, $10 228-$10 559) at the end of March 2020 to $13 072 (95% CI, $12 528-$13 617) by the end of March 2022. Patients with specific comorbidities had significantly higher mean costs than their counterparts: those with obesity incurred an additional $2924 in inpatient stay costs, and those with coagulation deficiency incurred an additional $3017 in inpatient stay costs. Stays during which the patient required extracorporeal membrane oxygenation (ECMO) had an adjusted mean cost of $36 484 (95% CI, $34 685-$38 284). Conclusions and Relevance In this cross-sectional study, an adjusted mean hospital cost to provide care for patients with COVID-19 increased more than 5 times the rate of medical inflation overall. This appeared to be explained partly by changes in the use of ECMO, which increased over time.
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Affiliation(s)
| | - Richard M. Peters
- Department of Population Health, Dell Medical School, The University of Texas at Austin
| | - Robert E. Murphy
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston
| | | | - Ankita Podichetty
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston
| | - Raymond S. Greenberg
- Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas
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Bortnick EM, Logvinenko T, Wang HHS, Fogelman DJ, Shore BJ, Nelson CP, Kurtz MP. Association between lower limb spasticity and cryptorchidism in males with cerebral palsy. Dev Med Child Neurol 2024; 66:82-86. [PMID: 37282840 DOI: 10.1111/dmcn.15644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 06/08/2023]
Abstract
AIM To explore the association between presence and severity of lower limb spasticity (LLS) and risk of orchidopexy for cryptorchidism among people with cerebral palsy (CP) and to further define the cremasteric muscle spasticity theory. METHOD We queried the Pediatric Health Information System database for male patients with CP, stratified patients into those with/without LLS, and compared groups for orchidopexy occurrence. Comparative statistics were performed using χ2 and Mann-Whitney U tests for categorical and continuous variables respectively. The association between orchidopexy and spasticity type was investigated using logistic regression. RESULTS In total, 44 561 males with CP were identified. Of these, 1.6% underwent orchidopexy (median age: 7 years 8 months [interquartile range: 4 years 6 months-11 years 4 months]). LLS presence was significantly associated with higher orchidopexy rate compared to spasticity absence (odds ratio [OR] = 1.33 [1.10-1.59], p = 0.003). Among 7134 patients with LLS, intervention was significantly associated with higher orchidopexy rate (injection procedures: OR = 2.47 [2.27-6.39], p = 0.034; surgical procedure: OR = 2.60 [1.22-6.76], p = 0.026). LLS groin proximity was significantly associated with higher orchidopexy rate (OR = 2.52 [1.42-4.96], p = 0.003). INTERPRETATION A strong association exists between LLS presence and severity and orchidopexy risk among people with CP. These findings support a cremasteric spasticity hypothesis as an important factor of cryptorchidism in CP. Providers should continue to examine for cryptorchidism in males with CP as they age. WHAT THIS PAPER ADDS Lower limb spasticity (LLS) is associated with higher orchidopexy rate in cerebral palsy. Orchidopexy rate was higher in more severe LLS. Orchidopexy rate was higher in more proximal LLS.
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Affiliation(s)
- Eric M Bortnick
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Tanya Logvinenko
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - David J Fogelman
- Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Benjamin J Shore
- Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michael P Kurtz
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
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Albagmi S, Shawaheen M, Asiri EM, Alqadeer TA. Assessment of clinical miscoding errors and potential financial their implications on healthcare management - A case of local hospital in Najran, Saudi Arabia. Saudi Pharm J 2024; 32:101894. [PMID: 38111668 PMCID: PMC10727934 DOI: 10.1016/j.jsps.2023.101894] [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: 08/24/2023] [Accepted: 12/02/2023] [Indexed: 12/20/2023] Open
Abstract
Background Healthcare systems can potentially improve their safety, quality of service, and performance efficiency with a cost reduction, through the introduction and implementation of healthcare information management systems. This study aims to examine the frequency of miscoding errors in principal and secondary diagnoses, exploring demographic and coder-related factors contributing to these errors through the use of the QuadraMed system. The study also investigates the association of coding errors with patient safety and service quality to estimate the potential financial implications resulting from these inaccuracies in the healthcare system. Methods This analytical cross-sectional retrospective study was conducted at a local hospital in Najran, Saudi Arabia, from July 2021 to February 2022 using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) coding system. The costing and financial data were collected from the reimbursement department for eligible 750 patient cases in terms of payment mode, services availed, and length of stay. The financial claims were evaluated to estimate the impact on the quality of service and patient safety. The reimbursement amount was calculated based on codes. The data were analyzed using SPSS and the odds ratio was calculated to estimate the risk of major coding errors in different departments. Results Primary codes 240 (32%) and 40 (5.3) secondary codes were reviewed and percentages and inaccuracies were calculated after recording. The percentage of inaccurate medical codes in principal diagnosis was 57(26.8%) and the percentage of inaccurate medical codes in secondary diagnosis was 21 (9.9%). The primary diagnostic codes have more coding errors with a total number of 240 (32%) coding errors with a moderate level of agreement between the original coder and independent coder with a kappa value of 0.462. The identified recording was done by the independent coder, and the secondary diagnostic code showed 40 (5.3%) cases, with a poor kappa value of 0.128. The results showed the highest number of primary diagnostic codes was among surgery clinics 79 (63.2%). The highest number of secondary diagnostic codes were reported among consultant clinics 12 (9.6%). Conclusions The study concludes that the identification of miscoding in the healthy population has a financial impact on the healthcare organization's infrastructure.
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Affiliation(s)
- Salem Albagmi
- Prince Sultan Military College of Health Sciences, Saudi Arabia
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Predictors of 30-day mortality using machine learning approach following carotid endarterectomy. Neurol Sci 2023; 44:253-261. [PMID: 36104471 DOI: 10.1007/s10072-022-06392-2] [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: 04/14/2022] [Accepted: 08/11/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Preoperative prognostication of 30-day mortality in patients with carotid endarterectomy (CEA) can optimize surgical risk stratification and guide the decision-making process to improve survival. This study aims to develop and validate a set of predictive variables of 30-day mortality following CEA. METHODS The patient cohort was identified from the American College of Surgeons National Surgical Quality Improvement Program (2005-2016). We performed logistic regression (enter, stepwise, and forward) and least absolute shrinkage and selection operator (LASSO) method for the selection of variables, which resulted in 28-candidate models. The final model was selected based upon clinical knowledge and numerical results. RESULTS Statistical analysis included 65,807 patients with 30-day mortality in 0.7% (n = 466) patients. The median age of our cohort was 71.0 years (range, 16-89 years). The model with 9 predictive factors which included age, body mass index, functional health status, American Society of Anesthesiologist grade, chronic obstructive pulmonary disorder, preoperative serum albumin, preoperative hematocrit, preoperative serum creatinine, and preoperative platelet count-performed best on discrimination, calibration, Brier score, and decision analysis to develop a machine learning algorithm. Logistic regression showed higher AUCs than LASSO across these different models. The predictive probability derived from the best model was converted into an open-accessible scoring system. CONCLUSION Machine learning algorithms show promising results for predicting 30-day mortality following CEA. These algorithms can be useful aids for counseling patients, assessing preoperative medical risks, and predicting survival after surgery.
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Wahba AJ, Cromwell DA, Hutchinson PJ, Mathew RK, Phillips N. Mortality as an indicator of quality of neurosurgical care in England: a retrospective cohort study. BMJ Open 2022; 12:e067409. [PMID: 36332948 PMCID: PMC9639111 DOI: 10.1136/bmjopen-2022-067409] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Postoperative mortality is a widely used quality indicator, but it may be unreliable when procedure numbers and/or mortality rates are low, due to insufficient statistical power. The objective was to investigate the statistical validity of postoperative 30-day mortality as a quality metric for neurosurgical practice across healthcare providers. DESIGN Retrospective cohort study. SETTING Hospital Episode Statistics data from all neurosurgical units in England. PARTICIPANTS Patients who underwent neurosurgical procedures between April 2013 and March 2018. Procedures were grouped using the National Neurosurgical Audit Programme classification. OUTCOMES MEASURED National 30-day postoperative mortality rates were calculated for elective and non-elective neurosurgical procedural groups. The study estimated the proportion of neurosurgeons and NHS trusts in England that performed sufficient procedures in 3-year and 5-year periods to detect unusual performance (defined as double the national rate of mortality). The actual difference in mortality rates that could be reliably detected based on procedure volumes of neurosurgeons and units over a 5-year period was modelled. RESULTS The 30-day mortality rates for all elective and non-elective procedures were 0.4% and 6.1%, respectively. Only one neurosurgeon in England achieved the minimum sample size (n=2402) of elective cases in 5 years needed to detect if their mortality rate was double the national average. All neurosurgical units achieved the minimum sample sizes for both elective (n=2402) and non-elective (n=149) procedures. In several neurosurgical subspecialties, approximately 80% of units (or more) achieved the minimum sample sizes needed to detect if their mortality rate was double the national rate, including elective neuro-oncology (baseline mortality rate=2.3%), non-elective neuro-oncology (rate=5.7%), neurovascular (rate=6.7%) and trauma (rate=11%). CONCLUSION Postoperative mortality lacks statistical power as a measure of individual neurosurgeon performance. Neurosurgical units in England performed sufficient procedure numbers overall and in several subspecialty areas to support the use of mortality as a quality indicator.
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Affiliation(s)
- Adam J Wahba
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK
| | - David A Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
- Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter J Hutchinson
- Academic Neurosurgery, University of Cambridge, Cambridge, UK
- Clinical Research, Royal College of Surgeons, London, UK
| | - Ryan K Mathew
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nick Phillips
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Clinical Lead for Cranial Neurosurgery, Getting It Right First Time (GIRFT), London, UK
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Kamalapathy PN, Karhade AV, Groot OQ, Lin KYE, Shah AA, Nelson SB, Schwab JH. Predictors of reoperation after surgery for spinal epidural abscess. Spine J 2022; 22:1830-1836. [PMID: 35738500 DOI: 10.1016/j.spinee.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 05/08/2022] [Accepted: 06/13/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal epidural abscess is a rare but severe condition with high rates of postoperative adverse events. PURPOSE The objective of the study was to identify independent prognostic factors for reoperation using two datasets: an institutional and national database. STUDY DESIGN/SETTING Retrospective Review. PATIENT SAMPLE Database 1: Review of five medical centers from 1993 to 2016. Database 2: The National Surgical Quality Improvement Program (NSQIP) was queried between 2012 and 2016. OUTCOME MEASURES Thirty-day and ninety-day reoperation rate. METHODS Two independent datasets were reviewed to identify patients with spinal epidural abscesses undergoing spinal surgery. Multivariate analyses were used to determine independent prognostic factors for reoperation while including factors identified in bivariate analyses. RESULTS Overall, 642 patients underwent surgery for a spinal epidural abscess in the institutional cohort, with a 90-day unplanned reoperation rate of 19.9%. In the NSQIP database, 951 patients were identified with a 30-day unplanned reoperation rate of 12.3%. On multivariate analysis in the NSQIP database, cervical spine abscess was the only factor that reached significance for 30-day reoperation (OR=1.71, 95% CI=1.11-2.63, p=.02, Area under the curve (AUC)=0.61). On multivariate analysis in the institutional cohort, independent prognostic factors for 30-day reoperation were: preoperative urinary incontinence, ventral location of abscess relative to thecal sac, cervical abscess, preoperative wound infection, and leukocytosis (AUC=0.65). Ninety-day reoperation rate also found hypoalbuminemia as a significant predictor (AUC=0.66). CONCLUSION Six novel independent prognostic factors were identified for 90-day reoperation after surgery for a spinal epidural abscess. The multivariable analysis fairly predicts reoperation, indicating that there may be additional factors that need to be uncovered in future studies. The risk factors delineated in this study through the use of two large cohorts of spinal epidural abscess patients can be used to improve preoperative risk stratification and patient management.
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Affiliation(s)
- Pramod N Kamalapathy
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA.
| | - Aditya V Karhade
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA; Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Boston, MA, USA, 02114
| | - Olivier Q Groot
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Kuan-Yu Evan Lin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Akash A Shah
- Department of Orthopaedic Surgery, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, USA, 90095
| | - Sandra B Nelson
- Department of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA, 02114
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA.
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Dicpinigaitis AJ, Al-Mufti F, Bempong PO, Kazim SF, Cooper JB, Dominguez JF, Stein A, Kalakoti P, Hanft S, Pisapia J, Kinon M, Gandhi CD, Schmidt MH, Bowers CA. Prognostic Significance of Baseline Frailty Status in Traumatic Spinal Cord Injury. Neurosurgery 2022; 91:575-582. [PMID: 35944118 DOI: 10.1227/neu.0000000000002088] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/14/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Literature evaluating frailty in traumatic spinal cord injury (tSCI) is limited. OBJECTIVE To evaluate the prognostic significance of baseline frailty status in tSCI. METHODS Patients with tSCI were identified in the National Inpatient Sample from 2015 to 2018 and stratified according to frailty status, which was quantified using the 11-point modified frailty index (mFI). RESULTS Among 8825 operatively managed patients with tSCI identified (mean age 57.9 years, 27.6% female), 3125 (35.4%) were robust (mFI = 0), 2530 (28.7%) were prefrail (mFI = 1), 1670 (18.9%) were frail (mFI = 2), and 1500 (17.0%) were severely frail (mFI ≥ 3). One thousand four-hundred forty-five patients (16.4%) were routinely discharged (to home), and 320 (3.6%) died during hospitalization, while 2050 (23.3%) developed a severe complication, and 2175 (24.6%) experienced an extended length of stay. After multivariable analysis adjusting for age, illness severity, trauma burden, and other baseline covariates, frailty (by mFI-11) was independently associated with lower likelihood of routine discharge [adjusted odds ratio (aOR) 0.82, 95% CI 0.77-0.87; P < .001] and development of a severe complication (aOR 1.17, 95% CI 1.12-1.23; P < .001), but not with in-hospital mortality or extended length of stay. Subgroup analysis by age demonstrated robust associations of frailty with routine discharge in advanced age groups (aOR 0.71 in patients 60-80 years and aOR 0.69 in those older than 80 years), which was not present in younger age groups. CONCLUSION Frailty is an independent predictor of clinical outcomes after tSCI, especially among patients of advanced age. Our large-scale analysis contributes novel insights into limited existing literature on this topic.
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Affiliation(s)
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Phillip O Bempong
- School of Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Jared B Cooper
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Alan Stein
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Piyush Kalakoti
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Simon Hanft
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Jared Pisapia
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Merritt Kinon
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Chirag D Gandhi
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Meic H Schmidt
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico, Albuquerque, New Mexico, USA
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11
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Ghannam MM, Davies JM. Application of Big Data in Vascular Neurosurgery. Neurosurg Clin N Am 2022; 33:469-482. [DOI: 10.1016/j.nec.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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de Vasconcelos Silva ACP, Araujo BM, Spiegel T, da Cunha Reis A. May value-based healthcare practices contribute to comprehensive care for cancer patients? A systematic literature review. J Cancer Policy 2022; 34:100350. [DOI: 10.1016/j.jcpo.2022.100350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 12/30/2022]
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13
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Jin MC, Jensen M, Zhou Z, Rodrigues A, Ren A, Barros Guinle MI, Veeravagu A, Zygourakis CC, Desai AM, Ratliff JK. Health Care Resource Utilization in Management of Opioid-Naive Patients With Newly Diagnosed Neck Pain. JAMA Netw Open 2022; 5:e2222062. [PMID: 35816312 PMCID: PMC9280399 DOI: 10.1001/jamanetworkopen.2022.22062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Research has uncovered heterogeneity and inefficiencies in the management of idiopathic low back pain, but few studies have examined longitudinal care patterns following newly diagnosed neck pain. OBJECTIVE To understand health care utilization in patients with new-onset idiopathic neck pain. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used nationally sourced longitudinal data from the IBM Watson Health MarketScan claims database (2007-2016). Participants included adult patients with newly diagnosed neck pain, no recent opioid use, and at least 1 year of continuous postdiagnosis follow-up. Exclusion criteria included prior or concomitant diagnosis of traumatic cervical disc dislocation, vertebral fractures, myelopathy, and/or cancer. Only patients with at least 1 year of prediagnosis lookback were included. Data analysis was performed from January 2021 to January 2022. MAIN OUTCOMES AND MEASURES The primary outcome of interest was 1-year postdiagnosis health care expenditures, including costs, opioid use, and health care service utilization. Early services were those received within 30 days of diagnosis. Multivariable regression models and regression-adjusted statistics were used. RESULTS In total, 679 030 patients (310 665 men [45.6%]) met the inclusion criteria, of whom 7858 (1.2%) underwent surgery within 1 year of diagnosis. The mean (SD) age was 44.62 (14.87) years among nonsurgical patients and 49.69 (9.53) years among surgical patients. Adjusting for demographics and comorbidities, 1-year regression-adjusted health care costs were $24 267.55 per surgical patient and $515.69 per nonsurgical patient. Across all health care services, $95 379 949 was accounted for by nonsurgical patients undergoing early imaging who did not receive any additional conservative therapy or epidural steroid injections, for a mean (SD) of $477.53 ($1375.60) per patient and median (IQR) of $120.60 ($20.70-$452.37) per patient. On average, patients not undergoing surgery, physical therapy, chiropractic manipulative therapy, or epidural steroid injection, who underwent either early advanced imaging (magnetic resonance imaging or computed tomography) or both early advanced and radiographic imaging, accumulated significantly elevated health care costs ($850.69 and $1181.67, respectively). Early conservative therapy was independently associated with 24.8% (95% CI, 23.5%-26.2%) lower health care costs. CONCLUSIONS AND RELEVANCE In this cross-sectional study, early imaging without subsequent intervention was associated with significantly increased health care spending among patients with newly diagnosed idiopathic neck pain. Early conservative therapy was associated with lower costs, even with increased frequency of therapeutic services, and may have reduced long-term care inefficiency.
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Affiliation(s)
- Michael C Jin
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Michael Jensen
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Zeyi Zhou
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Adrian Rodrigues
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Alexander Ren
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | | | - Anand Veeravagu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Corinna C Zygourakis
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Atman M Desai
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - John K Ratliff
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
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Effect of Coronavirus Disease 2019 (Covid-19), a Nationwide Mass Casualty Disaster on Intensive Care Units: Clinical Outcomes and Associated Cost-of-Care. Disaster Med Public Health Prep 2022; 17:e249. [PMID: 35703087 PMCID: PMC9353234 DOI: 10.1017/dmp.2022.159] [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] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The COVID-19 pandemic resulted in millions of deaths worldwide and is considered a significant mass-casualty disaster (MCD). The surge of patients and scarcity of resources negatively impacted hospitals, patients and medical practice. We hypothesized ICUs during this MCD had a higher acuity of illness, and subsequently had increased lengths of stay (LOS), complication rates, death rates and costs of care. The purpose of this study was to investigate those outcomes. METHODS This was a multicenter, retrospective study that compared intensive care admissions in 2020 to those in 2019 to evaluate patient outcomes and cost of care. Data were obtained from the Vizient Clinical Data Base/Resource Manager (Vizient Inc., Irvine, Texas, USA). RESULTS Data included the number of ICU admissions, patient outcomes, case mix index and summary of cost reports. Quality outcomes were also collected, and a total of 1304981 patients from 333 hospitals were included. For all medical centers, there was a significant increase in LOS index, ICU LOS, complication rate, case mix index, total cost, and direct cost index. CONCLUSION The MCD caused by COVID-19 was associated with increased adverse outcomes and cost-of-care for ICU patients.
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Asher AL, Sammak SE, Michalopoulos GD, Yolcu YU, Alexander AY, Knightly JJ, Foley KT, Shaffrey CI, Harbaugh RE, Rose GA, Coric D, Bisson EF, Glassman SD, Mummaneni PV, Bydon M. Time trend analysis of database and registry use in the neurosurgical literature: evidence for the advance of registry science. J Neurosurg 2022; 136:1804-1809. [PMID: 34920432 DOI: 10.3171/2021.9.jns212153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anthony L Asher
- 1Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Sally El Sammak
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Giorgos D Michalopoulos
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Yagiz U Yolcu
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - A Yohan Alexander
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kevin T Foley
- 5Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | - Christopher I Shaffrey
- 6Duke Neurosurgery and Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Robert E Harbaugh
- 7Department of Neurosurgery, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Geoffrey A Rose
- 8Sanger Heart & Vascular Institute, Atrium Health, Charlotte, North Carolina
| | - Domagoj Coric
- 1Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina
| | - Erica F Bisson
- 9Department of Neurological Surgery, University of Utah, Salt Lake City, Utah
| | | | - Praveen V Mummaneni
- 11Department of Neurological Surgery, University of California, San Francisco, California
| | - Mohamad Bydon
- 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Ezuma CO, Lu Y, Pareek A, Wilbur R, Krych AJ, Forsythe B, Camp CL. A Machine Learning Algorithm Outperforms Traditional Multiple Regression to Predict Risk of Unplanned Overnight Stay Following Outpatient Medial Patellofemoral Ligament Reconstruction. Arthrosc Sports Med Rehabil 2022; 4:e1103-e1110. [PMID: 35747652 PMCID: PMC9210490 DOI: 10.1016/j.asmr.2022.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 03/28/2022] [Indexed: 12/21/2022] Open
Abstract
Purpose To determine whether conventional logistic regression or machine learning algorithms were more precise in identifying the risk factors for unplanned overnight admission after medial patellofemoral ligament (MPFL) reconstruction. Methods A retrospective review of the prospectively collected National Surgical Quality Improvement Program database was performed to identify patients who underwent outpatient MPFL reconstruction from 2006–2018. Patients admitted overnight were identified as those with length of stay of 1 or more days. Models were generated using random forest, extreme gradient boosting, adaptive boosting, or elastic net penalized logistic regression, and an additional model was produced as a weighted ensemble of the 4 final algorithms. The predictive capacity of these models was compared to that of logistic regression. Results Of the 1307 patients identified, 221 (16.9%) required at least one overnight stay after MPFL reconstruction. Multivariate logistic regression found the following variables to be predictors of inpatient admission: age (odds ratio [OR] = 1.03 [95% confidence interval {CI} 1.02-1.04]; P <.001), spinal anesthesia (OR = 3.42 [95% CI 1.98-6.08]; P < .001), American Society of Anesthesiologists (ASA) class 3/4 (OR = 1.96 [95% CI 1.25-3.06]; P < .001), history of chronic obstructive pulmonary disease (COPD) (OR = 6.44 [95% CI 1.58-26.17]; P = .02), and body mass index (BMI) (OR = 1.03 [95% CI 1.01-1.05]; P < .001). The ensemble model achieved the best performance based on discrimination assessed via internal validation (area under the curve = 0.722). The variables determined most important by the ensemble model were increasing BMI, increasing age, ASA class, anesthesia, smoking, hypertension, lateral release, and history of COPD. Conclusions An internally validated machine learning algorithm outperformed logistic regression modeling in predicting the need for unplanned overnight hospitalization after MPFL reconstruction. In this model, the most significant risk factors for admission were age, BMI, ASA class, smoking status, hypertension, lateral release, and history of COPD. This tool can be deployed to augment provider assessment to identify high-risk candidates and appropriately set postoperative expectations for patients. Clinical Relevance Identifying and mitigating patient risk factors to prevent adverse surgical outcomes and hospitalizations is one of our primary goals. There may be a key role for machine learning algorithms to help successfully and efficiently risk stratify patients to decrease costs, appropriately set postoperative expectations, and increase the quality of delivered care.
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Affiliation(s)
- Chimere O Ezuma
- School of Medicine, Vagelos Columbia College of Physicians and Surgeons, New York, New York
| | - Yining Lu
- Department of Orthopedic Surgery, Mayo Clinic, and Rochester, Minnesota
| | - Ayoosh Pareek
- Department of Orthopedic Surgery, Mayo Clinic, and Rochester, Minnesota
| | - Ryan Wilbur
- Department of Orthopedic Surgery, Mayo Clinic, and Rochester, Minnesota
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, and Rochester, Minnesota
| | - Brian Forsythe
- Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
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Greenberg JK, Otun A, Ghogawala Z, Yen PY, Molina CA, Limbrick DD, Foraker RE, Kelly MP, Ray WZ. Translating Data Analytics Into Improved Spine Surgery Outcomes: A Roadmap for Biomedical Informatics Research in 2021. Global Spine J 2022; 12:952-963. [PMID: 33973491 PMCID: PMC9344511 DOI: 10.1177/21925682211008424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES There is growing interest in the use of biomedical informatics and data analytics tools in spine surgery. Yet despite the rapid growth in research on these topics, few analytic tools have been implemented in routine spine practice. The purpose of this review is to provide a health information technology (HIT) roadmap to help translate data assets and analytics tools into measurable advances in spine surgical care. METHODS We conducted a narrative review of PubMed and Google Scholar to identify publications discussing data assets, analytical approaches, and implementation strategies relevant to spine surgery practice. RESULTS A variety of data assets are available for spine research, ranging from commonly used datasets, such as administrative billing data, to emerging resources, such as mobile health and biobanks. Both regression and machine learning techniques are valuable for analyzing these assets, and researchers should recognize the particular strengths and weaknesses of each approach. Few studies have focused on the implementation of HIT, and a variety of methods exist to help translate analytic tools into clinically useful interventions. Finally, a number of HIT-related challenges must be recognized and addressed, including stakeholder acceptance, regulatory oversight, and ethical considerations. CONCLUSIONS Biomedical informatics has the potential to support the development of new HIT that can improve spine surgery quality and outcomes. By understanding the development life-cycle that includes identifying an appropriate data asset, selecting an analytic approach, and leveraging an effective implementation strategy, spine researchers can translate this potential into measurable advances in patient care.
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Affiliation(s)
- Jacob K. Greenberg
- Department of Neurological Surgery, Washington University School of Medicine,
St. Louis, MO, USA,Jacob K. Greenberg, Department of
Neurosurgery, Washington University School of Medicine, 660S. Euclid Ave., Box
8057, St. Louis, MO 63 110, USA.
| | - Ayodamola Otun
- Department of Neurological Surgery, Washington University School of Medicine,
St. Louis, MO, USA
| | - Zoher Ghogawala
- Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Po-Yin Yen
- Institute for Informatics, Washington University School of Medicine,
St. Louis, MO, USA
| | - Camilo A. Molina
- Department of Neurological Surgery, Washington University School of Medicine,
St. Louis, MO, USA
| | - David D. Limbrick
- Department of Neurological Surgery, Washington University School of Medicine,
St. Louis, MO, USA
| | - Randi E Foraker
- Institute for Informatics, Washington University School of Medicine,
St. Louis, MO, USA
| | - Michael P. Kelly
- Department of Orthopaedic Surgery, Washington University School of Medicine,
St. Louis, MO, USA
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University School of Medicine,
St. Louis, MO, USA
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Surgeon specialty effect on early outcomes of elective posterior spinal fusion for adolescent idiopathic scoliosis: a propensity-matched analysis of 965 patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2355-2361. [PMID: 35597892 DOI: 10.1007/s00586-022-07248-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/05/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Comparative effectiveness research plays a vital role in health care delivery. Specialty training is one of these variables; surgeons who are trained in different specialties may have different outcomes performing the same procedure. The objective of this study was to investigate the impact of spine surgeon specialty (neurosurgery vs orthopedic surgery) on early perioperative outcome measures of elective posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). METHODS This is a retrospective, 1:4 propensity score-matched cohort study. 5520 AIS patients were reviewed from ACS-NSQIP pediatric database. Propensity score matching was utilized. RESULTS Patients operated on by orthopedic surgeons were more likely to have shorter operation time (263 min vs 285 min), shorter total hospital stay (95 h vs 118 h), lower rate of return to operating room within the same admission (1.2% vs 3.8%), lower discharge rates after postoperative day 4 (23.8% vs 30.9%), and lower unplanned readmission rate (1.6% vs 4.1%), (p < 0.05). On the other hand, patients operated on by neurosurgeons had lower perioperative blood transfusion rate (62.1% vs 69.8%), (p < 0.05). Other outcome measures and mortality rates were not significantly different between the two cohorts. CONCLUSIONS This retrospective study found significant differences in early perioperative outcomes of patients undergoing PSF for AIS by neurosurgeons and orthopedic surgeons. Further studies are recommended to corroborate this finding which may trigger changes in the educational curriculum for neurosurgery residents.
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A Retrospective Comparative Analysis of Perioperative Complications in Navigated versus Conventional Thoracolumbar Fusion in the Setting of Adult Spinal Deformity. World Neurosurg 2022; 162:e616-e625. [PMID: 35339712 DOI: 10.1016/j.wneu.2022.03.085] [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: 02/24/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Stereotactic intraoperative computer-assisted navigation has been shown to improve pedicle screw accuracy in spinal fusion surgery, but evidence of impact of navigation on clinical outcomes is lacking. The aim of this study is to compare rates of perioperative complications between navigated and nonnavigated procedures for deformity correction. METHODS An administrative database was queried for adult patients undergoing thoracolumbar fusion procedures for deformity. Nonelective cases and those involving malignancy, infection, or trauma were excluded. Individuals were divided into 2 cohorts based on the use of stereotactic intraoperative navigation and paired 1:1 for comparison based on a propensity score matching algorithm. Rates of unplanned reoperation and other perioperative complications were compared between matched groups. A multivariable Cox regression model was constructed to identify the impact of navigation on specific subgroups. RESULTS A total of 6150 patients met eligibility criteria for the study; after propensity score matching, 456 patients who underwent conventional fusion were matched to 456 patients receiving intraoperative navigation. Navigated cases took an average of 30 minutes longer than nonnavigated cases. There were no significant differences in rates of complications between cohorts. A subgroup analysis revealed that use of navigation was associated with decreased hazard for reoperation in individuals undergoing interbody fusion. CONCLUSIONS Despite increased surgical duration, the use of navigation does not seem to significantly impact rates of perioperative complications outside of procedures involving interbody fusion. Surgeons should elect to use navigation in cases expected to be of high operative complexity at their own discretion.
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20
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Fuentes AM, Ansari D, Burch TG, Mehta AI. Use of intraoperative MRI for resection of intracranial tumors: A nationwide analysis of short-term outcomes. J Clin Neurosci 2022; 99:152-157. [PMID: 35279588 DOI: 10.1016/j.jocn.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 02/22/2022] [Accepted: 03/02/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Recent evidence supports the use of intraoperative MRI (iMRI) during resection of intracranial tumors due to its demonstrated efficacy and clinical benefit. Though many single-center investigations have been conducted, larger nationwide outcomes have yet to be characterized. METHODS We used the American College of Surgeons National Surgical Quality Improvement Program database to examine baseline characteristics and 30-day postoperative outcomes among patients undergoing craniotomy for tumor resection with and without iMRI. Comparisons between outcomes were accomplished after propensity matching using chi-square tests for categorical variables and Welch two-sample t-tests for continuous variables. RESULTS A total of 38,003 patients met inclusion criteria. Of this population, 54 (0.1%) received iMRI, while 37,949 (99.9%) did not receive iMRI. After propensity score matching, the resulting groups consisted of an iMRI group (n = 54) and a matched non-iMRI group (n = 54). Procedures involving iMRI were associated with significantly increased operation length compared to those without (p < 0.01). Length of hospital stay was higher in patients without iMRI, with this difference trending towards significance (p = 0.05) in the unmatched comparison. Patients undergoing craniotomy without iMRI had a higher rate of readmission (p = 0.04). There was no significant difference in occurrence of other adverse events between the two patient groups. CONCLUSION Despite increasing operative length, iMRI is not associated with higher infection rate and may have a clinical benefit associated with reducing readmissions and a trend towards reducing inpatient length of stay. Additional nationwide analyses including more iMRI patients would provide further insight into the strength of these findings.
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Affiliation(s)
- Angelica M Fuentes
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Darius Ansari
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Taylor G Burch
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA.
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21
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Yearley AG, Iorgulescu JB, Chiocca EA, Peruzzi PP, Smith TR, Reardon DA, Mooney MA. The current state of glioma data registries. Neurooncol Adv 2022; 4:vdac099. [DOI: 10.1093/noajnl/vdac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The landscape of glioma research has evolved in the past 20 years to include numerous large, multi-institutional, database efforts compiling either clinical data on glioma patients, molecular data on glioma specimens, or a combination of both. While these strategies can provide a wealth of information for glioma research, obtaining information regarding data availability and access specifications can be challenging.
Methods
We reviewed the literature for ongoing clinical, molecular, and combined database efforts related to glioma research to provide researchers with a curated overview of the current state of glioma database resources.
Results
We identified and reviewed a total of 20 databases with data collection spanning from 1975 to 2022. Surveyed databases included both low- and high-grade gliomas, and data elements included over 100 clinical variables and 12 molecular data types. Select database strengths included large sample sizes and a wide variety of variables available, while limitations of some databases included complex data access requirements and a lack of glioma-specific variables.
Conclusions
This review highlights current databases and registries and their potential utility in clinical and genomic glioma research. While many high-quality resources exist, the fluid nature of glioma taxonomy makes it difficult to isolate a large cohort of patients with a pathologically confirmed diagnosis. Large, well-defined, and publicly available glioma datasets have the potential to expand the reach of glioma research and drive the field forward.
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Affiliation(s)
- Alexander G Yearley
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts , USA
| | - Julian Bryan Iorgulescu
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts , USA
- Department of Medical Oncology, Dana-Farber Cancer Institute , Boston, Massachusetts , USA
| | - Ennio Antonio Chiocca
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts , USA
| | - Pier Paolo Peruzzi
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts , USA
| | - Timothy R Smith
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts , USA
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute , Boston, Massachusetts , USA
| | - Michael A Mooney
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts , USA
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22
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Huang J, Shlobin NA, DeCuypere M, Lam SK. Deep Learning for Outcome Prediction in Neurosurgery: A Systematic Review of Design, Reporting, and Reproducibility. Neurosurgery 2022; 90:16-38. [PMID: 34982868 DOI: 10.1227/neu.0000000000001736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
Deep learning (DL) is a powerful machine learning technique that has increasingly been used to predict surgical outcomes. However, the large quantity of data required and lack of model interpretability represent substantial barriers to the validity and reproducibility of DL models. The objective of this study was to systematically review the characteristics of DL studies involving neurosurgical outcome prediction and to assess their bias and reporting quality. Literature search using the PubMed, Scopus, and Embase databases identified 1949 records of which 35 studies were included. Of these, 32 (91%) developed and validated a DL model while 3 (9%) validated a pre-existing model. The most commonly represented subspecialty areas were oncology (16 of 35, 46%), spine (8 of 35, 23%), and vascular (6 of 35, 17%). Risk of bias was low in 18 studies (51%), unclear in 5 (14%), and high in 12 (34%), most commonly because of data quality deficiencies. Adherence to transparent reporting of a multivariable prediction model for individual prognosis or diagnosis reporting standards was low, with a median of 12 transparent reporting of a multivariable prediction model for individual prognosis or diagnosis items (39%) per study not reported. Model transparency was severely limited because code was provided in only 3 studies (9%) and final models in 2 (6%). With the exception of public databases, no study data sets were readily available. No studies described DL models as ready for clinical use. The use of DL for neurosurgical outcome prediction remains nascent. Lack of appropriate data sets poses a major concern for bias. Although studies have demonstrated promising results, greater transparency in model development and reporting is needed to facilitate reproducibility and validation.
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Affiliation(s)
- Jonathan Huang
- Ann and Robert H. Lurie Children's Hospital, Division of Pediatric Neurosurgery, Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Alomari S, Judy B, Weingart J, Lo SFL, Sciubba DM, Theodore N, Witham T, Bydon A. Early Outcomes of Elective Anterior Cervical Diskectomy and Fusion for Degenerative Spine Disease Correlate With the Specialty of the Surgeon Performing the Procedure. Neurosurgery 2022; 90:99-105. [PMID: 34982876 PMCID: PMC10602516 DOI: 10.1227/neu.0000000000001748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/21/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Comparative effectiveness research has a vital role in recent health reform and policies. Specialty training is one of these provider-side variables, and surgeons who were trained in different specialties may have different outcomes on performing the same procedure. OBJECTIVE To investigate the impact of spine surgeon specialty (neurosurgery vs orthopedic surgery) on early perioperative outcome measures of elective anterior cervical diskectomy and fusion (ACDF) for degenerative spine diseases. METHODS This was a retrospective, 1:1 propensity score-matched cohort study. In total, 21 211 patients were reviewed from the American College of Surgeons National Surgical Quality Improvement Program database. Propensity score matching and subgroup analysis were performed. RESULTS In both groups (single-level/multilevel ACDF), patients operated on by neurosurgeons had longer operation time (133 vs 104 min/164 vs 138 min), shorter total hospital stay (24 vs 41 h/25 vs 46 h), and lower rates of return to operating room (0.7% vs 2.1%/0.6% vs 2.4%), nonhome discharge (1.2% vs 4.6%/1.0% vs 4.9%), discharge after postoperative day 1 (6.7% vs 11.9%/10.1% vs 18.9%), perioperative blood transfusion (0.4% vs 2.1%/0.6% vs 3.1%), and sepsis (0.2% vs 0.7%/0.1% vs 0.7%; P < .05). In the single-level ACDF group, patients operated on by neurosurgeons had lower readmission (1.9% vs 4.1%) and unplanned intubation rates (0.1% vs 1.1%; P < .05). Other outcome measures and mortality rates were similar among the 2 cohorts in both groups. CONCLUSION Our analysis found significant differences in early perioperative outcomes of patients undergoing ACDF by neurosurgeons and orthopedic surgeons. These differences might have significant clinical and cost implications for patients, physicians, program directors, payers, and health systems.
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Affiliation(s)
- Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Ayling OGS, Charest-Morin R, Eagles ME, Ailon T, Street JT, Dea N, McIntosh G, Christie SD, Abraham E, Jacobs WB, Bailey CS, Johnson MG, Attabib N, Jarzem P, Weber M, Paquet J, Finkelstein J, Stratton A, Hall H, Manson N, Rampersaud YR, Thomas K, Fisher CG. National adverse event profile after lumbar spine surgery for lumbar degenerative disorders and comparison of complication rates between hospitals: a CSORN registry study. J Neurosurg Spine 2021; 35:698-703. [PMID: 34416721 DOI: 10.3171/2021.2.spine202150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/04/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Previous works investigating rates of adverse events (AEs) in spine surgery have been retrospective, with data collection from administrative databases, and often from single centers. To date, there have been no prospective reports capturing AEs in spine surgery on a national level, with comparison among centers. METHODS The Spine Adverse Events Severity system was used to define the incidence and severity of AEs after spine surgery by using data from the Canadian Spine Outcomes and Research Network (CSORN) prospective registry. Patient data were collected prospectively and during hospital admission for those undergoing elective spine surgery for degenerative conditions. The Spine Adverse Events Severity system defined minor and major AEs as grades 1-2 and 3-6, respectively. RESULTS There were 3533 patients enrolled in this cohort. There were 85 (2.4%) individual patients with at least one major AE and 680 (19.2%) individual patients with at least one minor AE. There were 25 individual patients with 28 major intraoperative AEs and 260 patients with 275 minor intraoperative AEs. Postoperatively there were 61 patients with a total of 80 major AEs. Of the 487 patients with minor AEs postoperatively there were 698 total AEs. The average enrollment was 321 patients (range 47-1237 patients) per site. The rate of major AEs was consistent among sites (mean 2.9% ± 2.4%, range 0%-9.1%). However, the rate of minor AEs varied widely among sites-from 7.9% to 42.5%, with a mean of 18.8% ± 9.7%. The rate of minor AEs varied depending on how they were reported, with surgeon reporting associated with the lowest rates (p < 0.01). CONCLUSIONS The rate of major AEs after lumbar spine surgery is consistent among different sites but the rate of minor AEs appears to vary substantially. The method by which AEs are reported impacts the rate of minor AEs. These data have implications for the detection and reporting of AEs and the design of strategies aimed at mitigating complications.
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Affiliation(s)
- Oliver G S Ayling
- 1Department of Surgery, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia
| | - Raphaele Charest-Morin
- 1Department of Surgery, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia
| | | | - Tamir Ailon
- 1Department of Surgery, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia
| | - John T Street
- 1Department of Surgery, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia
| | - Nicolas Dea
- 1Department of Surgery, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia
| | | | - Sean D Christie
- 10Department of Surgery, Dalhousie University, Halifax, Nova Scotia; and
| | - Edward Abraham
- 3Department of Surgery, Canada East Spine Centre, Saint John, New Brunswick
| | | | | | - Michael G Johnson
- 5Departments of Orthopedics and Neurosurgery, University of Manitoba, Winnipeg, Manitoba
| | - Najmedden Attabib
- 10Department of Surgery, Dalhousie University, Halifax, Nova Scotia; and
| | - Peter Jarzem
- 11Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Michael Weber
- 11Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Jerome Paquet
- 6Department of Surgery, Laval University, Quebec City, Quebec
| | | | | | - Hamilton Hall
- 9Department of Surgery, University of Toronto, Ontario
| | - Neil Manson
- 3Department of Surgery, Canada East Spine Centre, Saint John, New Brunswick
| | | | | | - Charles G Fisher
- 1Department of Surgery, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia
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Alomari S, Liu A, Westbroek E, Witham T, Bydon A, Lo SFL. Effect of patient's sex on early perioperative outcomes following anterior cervical discectomy and fusion. J Clin Neurosci 2021; 93:247-252. [PMID: 34656256 DOI: 10.1016/j.jocn.2021.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Differences in morbidity and mortality measures between males and females have been demonstrated for a variety of spinal surgeries, however, studies of anterior cervical discectomy and fusion (ACDF) are limited. To investigate the impact ofsexon 30-day perioperative outcomes of ACDF. METHODS Retrospective 1:1 propensity score-matched cohort study. Patients who underwent ACDF between 2016 and 2018 were reviewed from the ACS-NSQIP database.Propensity score matchingand subgroup analysis were used. RESULTS 21,180 patients met inclusion criteria. 11,194 patients underwent single-level ACDF and 9986 patients underwent multi-level ACDF. In the single-level group, there were 6168 (55.1%) males and 5026 (44.9%) females. In the multi-level group, there were 5033 (50.4%) males and 4953 (49.6%) females. In both single/multi-level groups, females were more likely to be of older age, be functionally dependent, and have higher BMI and lower preoperative hematocrit level. Males were more likely to be Caucasian, smokers, have myelopathy, diabetes mellitus, hypertension and bleeding disorders. In both single/multi-level groups, except for the higher incidence of urinary tract infection (UTI) in females and myocardial infarction (MI) in males, there were no significant differences in morbidity and mortality between males and females. CONCLUSIONS Several differences in demographics and baseline health status exist between males and females undergoing ACDF. When attempting to control for comorbid conditions, we found that sex by itself is not an independent risk factor for higher perioperative morbidity or mortality in patients undergoing ACDF, except for the higher incidence of UTI in females and MI in males. These results are important findings for clinicians and spine surgeons while counseling patients undergoing this type of procedure.
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Affiliation(s)
- Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Ann Liu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Erick Westbroek
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Timothy Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Treatments, cost and healthcare utilization of patients with segmental bone defects. Injury 2021; 52:2935-2940. [PMID: 33514450 DOI: 10.1016/j.injury.2021.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Treatment of large segmental defects in skeletal long bones is challenging. Heterogeneity in patient presentation further increase the difficulty in designing and running randomized trials, hence the paucity of published data with large patient numbers. This study was designed to help understand patient presentation, costs and outcomes, using real world data sources. METHODS Two data sources (Premier healthcare database (PHD) and IBM® MarketScan® Commercial Claims and Medicaid databases) were utilized, PHD for intraoperative and cost analyses, MarketScan for payer costs and longitudinal (2-year) outcomes. Patients were included in the analysis if they had diagnoses of osteomyelitis, non-union or open (acute) fractures, treated with bone graft and/or spacers, using either the Masquelet or external frames. Patient cohorts were defined by diagnosis at index (acute fracture, osteomyelitis, non-union) and descriptive statistics were conducted for patient variables (demographic, comorbidities) and outcomes. Risk of complications were estimated using logistic regression models. Hospital and payer costs for index and follow-up periods, were estimated using least means square estimators from generalized linear model outputs. All costs and payments were adjusted for inflation to 2019 consumer price-index. RESULTS 904 patients were identified in PHD (414 fractures, 388 osteomyelitis and 102 nonunion patients). Main comorbidities at time of initial surgery were hypertension (32.7%) followed by obesity (22.1%), diabetes with complications (20.9%) and chronic pulmonary disease (20.6%). Significant variability in surgical operating room time and length of stay were observed, with averages of 484.7 minutes and 11.7 days, respectively. Two-year postoperative infection rates ranged from 33.1% - 58.5%, the highest infection rates being reflective of ongoing infections in patients initially treated for osteomyelitis. Amputation rates ranged from 10.0% in patients with bone loss due to acute factures to 14.5% in patients with osteomyelitis. Osteomyelitis patients were also the costliest, with 12-months hospital costs averaging US$ 156.818 (95%CI: 112,970-217,685). CONCLUSION This study identified high complication rates and costs of segmental bone repair surgery. All patients with segmental bone defects had high costs and risks but patients with osteomyelitis were at significant risk for increased cost and complications, including amputation. Medical innovation is particularly important for this high-risk patient group.
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Evaluating the utility and quality of large administrative databases in pediatric spinal neurosurgery research. Childs Nerv Syst 2021; 37:2993-3001. [PMID: 34402953 DOI: 10.1007/s00381-021-05331-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to assess the quality of articles utilizing large administrative databases to answer questions related to pediatric spinal neurosurgery by quantifying their adherence to standard reporting guidelines. METHODS A systematic literature search was conducted with search terms including "pediatric" and "neurosurgery," associated neurosurgical diagnoses, and the names of known databases. Study abstracts were reviewed to identify clinical studies involving pediatric populations, spine-related pathology or procedures, and large administrative databases. Included studies were graded using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. RESULTS A total of 28 papers of the initial 1496 identified met inclusion criteria. These papers involved 10 databases and had a mean study period of 11.46 ± 12.27 years. The subjects of these research papers were undergoing treatment of scoliosis (n = 5), spinal cord injury (n = 5), spinal cord tumors (n = 9), and spine surgery in general (n = 9). The mean STROBE score was 19.41 ± 2.02 (out of 22). CONCLUSION Large administrative databases are commonly used within pediatric spine-related neurosurgical research to cover a broad spectrum of research questions and study topics. The heterogeneity of research to this point encourages the continued use of large databases to better understand treatment and diagnostic trends, perioperative and long-term outcomes, and rare pathologies within pediatric spinal neurosurgery.
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Alomari S, Porras JL, Lo SFL, Theodore N, Sciubba DM, Witham T, Bydon A. Does the Specialty of the Surgeon Performing Elective Anterior/Lateral Lumbar Interbody Fusion for Degenerative Spine Disease Correlate with Early Perioperative Outcomes? World Neurosurg 2021; 155:e111-e118. [PMID: 34390873 DOI: 10.1016/j.wneu.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Comparative effectiveness research has a vital role in health reform and policies. Specialty training is one of these provider-side variables, and surgeons performing the same procedure who were trained in different specialties may have different outcomes. The objective of this study was to investigate the impact of spine surgeon specialty (neurosurgery vs. orthopedic surgery) on early perioperative outcome measures of elective anterior/lateral lumbar interbody fusion (ALIF/LLIF) for degenerative disc diseases. METHODS In a retrospective, 1:1 propensity score-matched cohort study, 9070 patients were reviewed from the American College of Surgeons National Surgical Quality Improvement Program database. Propensity score matching and subgroup analysis were used. RESULTS In both groups (single-level and multilevel ALIF/LLIF), patients operated on by neurosurgeons had longer operative time (188 minutes vs. 172 minutes/239 minutes vs. 221 minutes); shorter total hospital stay (71 hours vs. 90 hours/89 hours vs. 96 hours); and lower rates of return to the operating room (2.1% vs. 4.1%/2.4% vs. 4.2%), nonhome discharge (8.7% vs. 11.1%/10.1% vs. 14.9%), discharge after postoperative day 3 (22.0% vs. 30.0%/38.0% vs. 43.9%), and perioperative blood transfusion (2.1% vs. 5.1%/5.0% vs. 9.9%) (P < 0.05). In multilevel ALIF/LLIF, patients operated on by neurosurgeons had lower readmission rates (3.9% vs. 6.9%) (P < 0.05). Other outcome measures and mortality rates were similar between the single-level and multilevel ALIF/LLIF cohorts regardless of surgeon specialty. CONCLUSIONS Our analysis found significant differences in early perioperative outcomes of patients undergoing ALIF/LLIF by neurosurgeons and orthopedic surgeons. These differences have significant clinical and cost implications for patients, physicians, program directors, payers, and health systems.
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Affiliation(s)
- Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jose L Porras
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sheng-Fu L Lo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Timothy Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Ansari D, DesLaurier JT, Patel S, Chapman JR, Oskouian RJ. Predictors of Extended Hospitalization and Early Reoperation After Elective Lumbar Disc Arthroplasty. World Neurosurg 2021; 154:e797-e805. [PMID: 34389528 DOI: 10.1016/j.wneu.2021.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lumbar disc arthroplasty (LDA) has emerged as a motion-sparing alternative to lumbar fusion. Although LDA may be amenable to the ambulatory surgical setting, to date no study has identified the factors predisposing patients to extended hospital stay. METHODS A national surgical quality improvement database was queried from 2011 to 2019 for patients undergoing elective, single-level, primary LDA. Univariate and multivariate logistic regression analyses were performed to elucidate predictors of length of stay (LOS) at or above the 90th percentile of the study population (3 days). Secondary study endpoints included rates of complications, as well as predictors and reasons for unplanned reoperation within 30 days. RESULTS A total of 630 patients met eligibility criteria for the study, of whom 517 (82.1%) had LOS <3 days and 113 (17.9%) had LOS ≥3 days. Multivariate logistic regression revealed associations between prolonged hospitalization and postoperative diagnosis of degenerative disk disease, obesity, Hispanic identity, and operation length >120 minutes. Before discharge, patients with LOS ≥3 days were more likely to have venous thromboembolisms, pneumonia, surgical site infections, and reoperations. Independent predictors of reoperation were wound infections, diabetes, and smoking. CONCLUSIONS Complications following elective single-level LDA are relatively rare, with few extended hospitalizations being attributable to any specific complication. Risk factors for prolonged LOS appear to be related to diagnosis and surgical time rather than to modifiable preoperative comorbidities. Conversely, unplanned reoperations within 30 days are associated with optimizable perioperative factors such as smoking, diabetes, and surgical site infection.
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Affiliation(s)
- Darius Ansari
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Clinical Research Division, Seattle Science Foundation, Seattle, Washington, USA
| | - Justin T DesLaurier
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Clinical Research Division, Seattle Science Foundation, Seattle, Washington, USA
| | - Saavan Patel
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Clinical Research Division, Seattle Science Foundation, Seattle, Washington, USA
| | - Jens R Chapman
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Clinical Research Division, Seattle Science Foundation, Seattle, Washington, USA
| | - Rod J Oskouian
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Clinical Research Division, Seattle Science Foundation, Seattle, Washington, USA.
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Stopa BM, Harary M, Jhun R, Job A, Izzy S, Smith TR, Gormley WB. Divergence in the epidemiological estimates of traumatic brain injury in the United States: comparison of two national databases. J Neurosurg 2021; 135:584-593. [PMID: 33254146 DOI: 10.3171/2020.7.jns201896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in the US, but the true incidence of TBI is unknown. METHODS The National Trauma Data Bank National Sample Program (NTDB NSP) was queried for 2007 and 2013, and population-based weighted estimates of TBI-related emergency department (ED) visits, hospitalizations, and deaths were calculated. These data were compared to the 2017 Centers for Disease Control and Prevention (CDC) report on TBI, which used the Healthcare Cost and Utilization Project's National ("Nationwide" before 2012) Inpatient Sample and National Emergency Department Sample. RESULTS In the NTDB NSP the incidence of TBI-related ED visits was 59/100,000 in 2007 and 62/100,000 in 2013. However, in the CDC report there were 534/100,000 in 2007 and 787/100,000 in 2013. The CDC estimate for ED visits was 805% higher in 2007 and 1169% higher in 2013. In the NTDB NSP, the incidence of TBI-related deaths was 5/100,000 in 2007 and 4/100,000 in 2013. In the CDC report, the incidence was 18/100,000 in both years. The CDC estimate for deaths was 260% higher in 2007 and 325% higher in 2013. CONCLUSIONS The databases disagreed widely in their weighted estimates of TBI incidence: CDC estimates were consistently higher than NTDB NSP estimates, by an average of 448%. Although such a discrepancy may be intuitive, this is the first study to quantify the magnitude of disagreement between these databases. Given that research, funding, and policy decisions are made based on these estimates, there is a need for a more accurate estimate of the true national incidence of TBI.
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Affiliation(s)
- Brittany M Stopa
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- 2Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Maya Harary
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- 3Department of Neurosurgery, University of California, Los Angeles, California
| | - Ray Jhun
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- 4Boston University School of Medicine, Boston; and
| | - Arun Job
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- 4Boston University School of Medicine, Boston; and
| | - Saef Izzy
- 5Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy R Smith
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William B Gormley
- 1Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Kortz MW, Kongs BM, McCray E, Grassia F, Hosokawa P, Bernstein JE, Moore SP, Yanovskaya M, Ojemann SG. How neuropsychiatric comorbidity, modulatory indication, demographics, and other factors impact deep brain stimulation inpatient outcomes in the United States: A population-based study of 27,956 patients. Clin Neurol Neurosurg 2021; 208:106842. [PMID: 34339900 DOI: 10.1016/j.clineuro.2021.106842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine how neuropsychiatric comorbidity, modulatory indication, demographics, and other characteristics affect inpatient deep brain stimulation (DBS) outcomes. METHODS This is a retrospective study of 45 months' worth of data from the National Inpatient Sample. Patients were aged ≥ 18 years old and underwent DBS for Parkinson Disease (PD), essential tremor (ET), general dystonia and related disorders, other movement disorder (non-PD/ET), or obsessive-compulsive disorder (OCD) at a US hospital. Primary endpoints were prolonged length of stay (PLOS), high-end hospital charges (HEHCs), unfavorable disposition, and inpatient complications. Logistic models were constructed with odds ratios under 95% confidence intervals. A p-value of 0.05 determined significance. RESULTS Of 214,098 records, there were 27,956 eligible patients. Average age was 63.9 ± 11.2 years, 17,769 (63.6%) were male, and 10,182 (36.4%) patients were female. Most of the cohort was White (51.1%), Medicare payer (64.3%), and treated at a large-bed size (80.7%), private non-profit (76.9%), and metro-teaching (94.0%) hospital. Neuropsychiatric comorbidity prevalence ranged from 29.9% to 47.7% depending on indication. Compared with PD, odds of complications and unfavorable disposition were significantly higher with other movement disorders and dystonia, whereas OCD conferred greater risk for HEHCs (p < 0.05). Patients with ET had favorable outcomes. Neuropsychiatric comorbidity, Black race, and Charlson Comorbidity Index > 0 were significantly associated with unfavorable outcomes (p < 0.05). CONCLUSION The risk of adverse inpatient outcomes for DBS in the United States is independently correlated with non-PD/ET disorders, neuropsychiatric comorbidity, and non-White race, reflecting the heterogeneity and infancy of widespread DBS for these patients.
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Affiliation(s)
- Michael W Kortz
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Brian M Kongs
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO, USA
| | - Edwin McCray
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Fabio Grassia
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Patrick Hosokawa
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jacob E Bernstein
- Department of Neurosurgery, Riverside University Health System, Riverside, CA, USA
| | - Sean P Moore
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO, USA
| | - Mariya Yanovskaya
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO, USA
| | - Steven G Ojemann
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
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Chan AK, Patel AB, Bisson EF, Bydon M, Glassman SD, Foley KT, Shaffrey CI, Potts EA, Shaffrey ME, Coric D, Knightly JJ, Park P, Wang MY, Fu KMG, Slotkin JR, Asher AL, Virk MS, Kerezoudis P, Alvi MA, Guan J, Choy W, Haid RW, Mummaneni PV. "July Effect" Revisited: July Surgeries at Residency Training Programs are Associated with Equivalent Long-term Clinical Outcomes Following Lumbar Spondylolisthesis Surgery. Spine (Phila Pa 1976) 2021; 46:836-843. [PMID: 33394990 DOI: 10.1097/brs.0000000000003903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis of a prospective registry. OBJECTIVE We utilized the Quality Outcomes Database (QOD) registry to investigate the "July Effect" at QOD spondylolisthesis module sites with residency trainees. SUMMARY OF BACKGROUND DATA There is a paucity of investigation on the long-term outcomes following surgeries involving new trainees utilizing high-quality, prospectively collected data. METHODS This was an analysis of 608 patients who underwent single-segment surgery for grade 1 degenerative lumbar spondylolisthesis at 12 high-enrolling sites. Surgeries were classified as occurring in July or not in July (non-July). Outcomes collected included estimated blood loss, length of stay, operative time, discharge disposition, complications, reoperation and readmission rates, and patient-reported outcomes (Oswestry Disability Index [ODI], Numeric Rating Scale [NRS] Back Pain, NRS Leg Pain, EuroQol-5D [EQ-5D] and the North American Spine Society [NASS] Satisfaction Questionnaire). Propensity score-matched analyses were utilized to compare postoperative outcomes and complication rates between the July and non-July groups. RESULTS Three hundred seventy-one surgeries occurred at centers with a residency training program with 21 (5.7%) taking place in July. In propensity score-matched analyses, July surgeries were associated with longer operative times ( average treatment effect = 22.4 minutes longer, 95% confidence interval 0.9-449.0, P = 0.041). Otherwise, July surgeries were not associated with significantly different outcomes for the remaining perioperative parameters (estimated blood loss, length of stay, discharge disposition, postoperative complications), overall reoperation rates, 3-month readmission rates, and 24-month ODI, NRS back pain, NRS leg pain, EQ-5D, and NASS satisfaction score (P > 0.05, all comparisons). CONCLUSION Although July surgeries were associated with longer operative times, there were no associations with other clinical outcomes compared to non-July surgeries following lumbar spondylolisthesis surgery. These findings may be due to the increased attending supervision and intraoperative education during the beginning of the academic year. There is no evidence that the influx of new trainees in July significantly affects long-term patient-centered outcomes.Level of Evidence: 3.
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Affiliation(s)
- Andrew K Chan
- Department of Neurological Surgery, University of California, San Francisco, Ca
| | - Arati B Patel
- Department of Neurological Surgery, University of California, San Francisco, Ca
| | - Erica F Bisson
- Department of Neurological Surgery, University of Utah, Salt Lake City, UT
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | | | - Kevin T Foley
- Department of Neurological Surgery, University of Tennessee Health Science Center, Semmes Murphey Neurologic and Spine Institute, Memphis, TN
| | | | - Eric A Potts
- Goodman Campbell Brain and Spine, Indianapolis, IN
| | - Mark E Shaffrey
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA
| | - Domagoj Coric
- Neuroscience Institute, Carolinas HealthCare System and Carolina NeuroSurgery and Spine Associates, Charlotte, NC
| | | | - Paul Park
- Department of Neurological Surgery, University of Michigan, Ann Arbor, MI
| | - Michael Y Wang
- Departments of Neurological Surgery and Rehab Medicine, University of Miami, FL
| | - Kai-Ming G Fu
- Department of Neurological Surgery, Weill Cornell Medical Center, New York, NY
| | | | - Anthony L Asher
- Neuroscience Institute, Carolinas HealthCare System and Carolina NeuroSurgery and Spine Associates, Charlotte, NC
| | - Michael S Virk
- Department of Neurological Surgery, Weill Cornell Medical Center, New York, NY
| | | | - Mohammed A Alvi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Jian Guan
- Department of Neurological Surgery, University of Utah, Salt Lake City, UT
| | - Winward Choy
- Department of Neurological Surgery, University of California, San Francisco, Ca
| | | | - Praveen V Mummaneni
- Department of Neurological Surgery, University of California, San Francisco, Ca
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Feghali J, Gami A, Rapaport S, Bender MT, Jackson CM, Caplan JM, McDougall CG, Huang J, Tamargo RJ. Aging Patient Population With Ruptured Aneurysms: Trend Over 28 Years. Neurosurgery 2021; 88:658-665. [PMID: 33370795 DOI: 10.1093/neuros/nyaa494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/09/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Given increasing life expectancy in the United States and worldwide, the proportion of elderly patients affected by aneurysmal subarachnoid hemorrhage (aSAH) would be expected to increase. OBJECTIVE To determine whether an aging trend exists in the population of aSAH patients presenting to our institution over a 28-yr period. METHODS A prospectively maintained database of consecutive patients presenting to our institution with subarachnoid hemorrhage between January 1991 and December 2018 was utilized. The 28-yr period was categorized into 4 successive 7-yr quarter intervals. The age of patients was compared among these intervals, and yearly trends were derived using linear regression. RESULTS The cohort consisted of 1671 ruptured aneurysm patients with a mean age of 52.8 yr (standard deviation = 15.0 yr). Over the progressive 7-yr time intervals during the 28-yr period, there was an approximately 4-fold increase in the proportion of patients aged 80 yr or above (P < .001) and an increase in mean patient age from 51.2 to 54.6 yr (P = .002). Independent of this trend but along the same lines, there was a 29% decrease in the proportion of younger patients (<50 yr) from 49% to 35%. On linear regression, there was 1-yr increase in mean patient age per 5 calendar years (P < .001). CONCLUSION Analyses of aSAH patients demonstrate an increase in patient age over time with a considerable rise in the proportion of octogenarian patients and a decrease in patients younger than 50 yr. This aging phenomenon presents a challenge to the continued improvement in outcomes of aSAH patients.
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Affiliation(s)
- James Feghali
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Abhishek Gami
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah Rapaport
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew T Bender
- Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Christopher M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin M Caplan
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cameron G McDougall
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rafael J Tamargo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Lu Y, Khazi ZM, Agarwalla A, Forsythe B, Taunton MJ. Development of a Machine Learning Algorithm to Predict Nonroutine Discharge Following Unicompartmental Knee Arthroplasty. J Arthroplasty 2021; 36:1568-1576. [PMID: 33358514 DOI: 10.1016/j.arth.2020.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/20/2020] [Accepted: 12/01/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Reliable and effective prediction of discharge destination following unicompartmental knee arthroplasty (UKA) can optimize patient outcomes and system expenditure. The purpose of this study is to develop a machine learning algorithm that can predict nonhome discharge in patients undergoing UKA. METHODS A retrospective review of a prospectively collected national surgical outcomes database was performed to identify adult patients who underwent UKA from 2015 to 2019. Nonroutine discharge was defined as discharge to a location other than home. Five machine learning algorithms were developed to predict this outcome. Performance of the algorithms was assessed through discrimination, calibration, and decision curve analysis. RESULTS Overall, of the 7275 patients included, 263 (3.6) patients were unable to return home upon discharge following UKA. The factors determined most important for identification of candidates for nonroutine discharge were total hospital length of stay, preoperative hematocrit, body mass index, preoperative sodium, American Society of Anesthesiologists classification, gender, and functional status. The extreme boosted model achieved the best performance based on discrimination (area under the curve = 0.875), calibration, and decision curve analysis. This model was integrated into a web-based open access application able to provide both predictions and explanations. CONCLUSION The present model can, following appropriate external validation, be used to augment clinician decision-making in patients undergoing elective UKA. Patients with high preoperative probabilities of nonroutine discharge based on nonmodifiable risk factors should be counseled to start the insurance authorization process with case management to avoid unnecessary inpatient stay, and those with modifiable risk can attempt prehabilitation to optimize these parameters before surgery.
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Affiliation(s)
- Yining Lu
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MI
| | - Zain M Khazi
- Department of Orthopaedic Surgery and Rehabilitation, Iowa University Hospitals and Clinics, Iowa City, IO
| | - Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY
| | - Brian Forsythe
- Division of Orthopaedics, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - Michael J Taunton
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MI
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Kumar CD, Dietz N, Sharma M, Cruz A, Counts CE, Wang D, Ugiliweneza B, Boakye M, Drazin D. Spine Surgery in the Octogenarian Population: A Comparison of Demographics, Surgical Approach, and Healthcare Utilization With the PearlDiver Database. Cureus 2021; 13:e14561. [PMID: 34026377 PMCID: PMC8133513 DOI: 10.7759/cureus.14561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background With the recent advances in technology and healthcare, increasing numbers of individuals over the age of 80 will require surgical intervention for spinal pathology. Given the risk of increased complications in the elderly, a limited number of spinal surgeries are performed on octogenarians every year. This makes it difficult to generalize the trends and outcomes of these surgeries to a greater population. This study attempts to understand the trends in the safety profile and healthcare utilization across the United States for octogenarians undergoing spinal fusion and/or decompression surgery for spinal stenosis and/or degenerative disease using the PearlDiver database. Methodology Patients who underwent fusion and/or decompression for stenosis and/or degenerative diseases were extracted using International Classification of Disease ninth and tenth revisions (ICD-9 prior to October 2015, ICD-10 after) from 2007 to 2016 in the PearlDiver database. Three comparative groups were considered: (1) primary fusion without concurrent decompression, (2) primary decompression with concurrent fusion, and (3) fusion with concurrent decompression. Outcomes of interest were patient characteristics, demographics, length of stay, surgery hospitalization payments, and discharge disposition. These outcomes were compared to patients over the age of 20 who also underwent spinal surgery. Results A total of 9,715 patients who underwent spinal surgery were identified in the search. Of the 9,139 patients, 503 were octogenarians and 73 were nonagenarians. Octogenarians and nonagenarians diagnosed with spinal stenosis were more likely to undergo decompression alone rather than fusion or both fusion and decompression (21 for both fusion and decompression; p < 0.0001). Patients diagnosed with both spinal stenosis and degeneration were more likely to undergo both fusion and decompression than fusion or decompression alone (239 for both, 208 for decompression alone, and 23 for fusion alone; p < 0.0001). No statistically significant difference was found in the percentage of patients discharged home following either fusion or decompression or both surgeries (p = 0.0737). The mean length of stay for patients in the 20-79-year age group was 2.79 days, whereas for the octogenarian and nonagenarian cohort it was 3.85 days. The index hospitalization pay for patients in the 20-79-year age group was $19,220, whereas for the octogenarians and nonagenarians cohort it was $15,091. Conclusions Patients over the age of 80 were more likely to undergo either a fusion procedure or a decompression procedure alone rather than both unless they were diagnosed with spinal degeneration. The PearlDiver database analysis indicates that the length of stay for octogenarians and nonagenarians is longer than that for patients in the 20-79-year age group, and that younger patients are more likely to be discharged earlier than patients over the age of 80. Moreover, we observed that the index hospitalization pay was higher for patients over the age of 20 than for octogenarians and nonagenarians in all cases except for a fusion procedure.
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Affiliation(s)
- Chitra D Kumar
- Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Nicholas Dietz
- Neurosurgery, University of Louisville School of Medicine, Louisville, USA
| | - Mayur Sharma
- Neurosurgery, University of Louisville School of Medicine, Louisville, USA
| | - Aurora Cruz
- Neurosurgery, University of Louisville School of Medicine, Louisville, USA
| | | | - Dengzhi Wang
- Neurosurgery, University of Louisville School of Medicine, Louisville, USA
| | - Beatrice Ugiliweneza
- Neurosurgery, University of Louisville School of Medicine, Louisville, USA.,Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, USA.,Department of Health Management and Systems Science, University of Louisville, Louisville, USA
| | - Maxwell Boakye
- Neurosurgery, University of Louisville School of Medicine, Louisville, USA
| | - Doniel Drazin
- Medicine, Pacific Northwest University of Health Sciences, Yakima, USA
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Fuentes AM, Chiu RG, Mehta AI. Disparities in the symptomatic presentation of Moyamoya disease in the United States: A nationwide all-payer analysis. J Clin Neurosci 2021; 87:92-96. [PMID: 33863543 DOI: 10.1016/j.jocn.2021.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/19/2020] [Accepted: 02/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Moyamoya disease is a chronic occlusive cerebrovascular disease that can present with either hemorrhagic or ischemic symptoms. The objective of this study was to evaluate whether the symptomatology of Moyamoya disease differs according to patient demographic groups. METHODS In this study, we used the Nationwide Inpatient Sample (NIS) to investigate differences in the presentation of Moyamoya disease by age group, gender, and ethnicity from 2012 to 2016. After propensity score matching was utilized to control for overall comorbidity, the matched cohorts for each symptomatology were compared using a Chi-square test with respect to the potential risk factors of interest (i.e. age, sex, ethnicity) in order to generate multivariate reported P-values. RESULTS A total of 4,474 patients met inclusion criteria. Patients presenting with ischemic stroke were more likely to be 65 years and older (p < 0.001); patients presenting with intracranial hemorrhage (ICH) were more likely to be 65 years and older (p < 0.001), male (p = 0.027), and Asian (p = 0.007); those presenting with seizure were more likely to be less than 10 years old (p = 0.002) and African American (p < 0.001); and those presenting with headache were more likely to be between 10 and 19 years old (p = 0.008). CONCLUSIONS Our findings demonstrate that the distinct presentations of Moyamoya are associated with patient age, gender, and race. This is the largest study of its kind and adds to the collective understanding of this rare but life-threatening condition.
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Affiliation(s)
- Angelica M Fuentes
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Ryan G Chiu
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Alomari S, Lubelski D, Sacino AN, Sciubba DM, Bydon A. Does Myelopathy Increase the Morbidity and Mortality of Elective Single-Level Anterior Cervical Discectomy and Fusion? An Updated Propensity-Matched Analysis of 3938 Patients From the American College of Surgeons National Surgical Quality Improvement Program Database. Neurosurgery 2021; 89:109-115. [PMID: 33826725 DOI: 10.1093/neuros/nyab091] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/24/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Myelopathy is thought to be associated with higher morbidity and mortality after anterior cervical discectomy and fusion (ACDF); however, the literature investigating this association has limitations. OBJECTIVE To investigate the influence of myelopathy on early perioperative complications of elective single-level ACDF. METHODS Patients who underwent ACDF between 2016 and 2018 were reviewed from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Propensity score matching analysis was used. RESULTS Twenty percent of the cohort was myelopathic. These patients were significantly older, had more comorbidities, more likely to be functionally dependent, and to undergo emergency surgery when compared to the nonmyelopathic cohort. When 1969 myelopathic patients were 1:1 propensity matched with nonmyelopathic patients, there was no difference between the myelopathic and nonmyelopathic patients in incidence of postoperative intensive care unit admission or death. Patients in the myelopathic group were significantly more likely to have a nonhome discharge and less likely to be discharged on the first postoperative day. Myelopathic patients had a higher rate of return to operating room within the same admission (2.2%) as well as a higher unplanned readmission rate (4.2%). The total operation time (143 min) and average length of hospital stay (52 h) were significantly higher in the myelopathic group when compared to the nonmyelopathic group (117 min) and (33 h), respectively. CONCLUSION Patients with myelopathy who undergo elective single-level ACDF have higher risks of several perioperative events including longer operative time, longer hospital stay, higher return to operating room, and unplanned readmission rates, when compared to nonmyelopathic patients. On the other hand, myelopathic patients did not exhibit higher mortality rate.
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Affiliation(s)
- Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Amanda N Sacino
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Alomari S, Liu A, Westbroek E, Witham T, Bydon A, Larry Lo SF. Influence of Sex on Early Outcomes of Elective Lumbar Fusions: An Updated Propensity-Matched and Subgroup Analysis. World Neurosurg 2021; 150:e388-e399. [PMID: 33722719 DOI: 10.1016/j.wneu.2021.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Existing data have demonstrated significant differences in morbidity and mortality measures between men and women undergoing various spinal surgeries. However, studies of lumbar fusion surgery have been limited. Thus, we investigated the effects of patient sex on 30-day perioperative outcomes after elective lumbar fusion spine surgery. METHODS Patients who had undergone lumbar fusion from 2015 to 2018 were reviewed from the American College of Surgeons National Surgical Quality Improvement Program database. Propensity score matching was used to determine whether the patient's sex had influenced the 30-day perioperative complications. RESULTS A total of 44,526 cases had met the inclusion criteria and were reviewed. Of the 44,526 patients, 13,715 had undergone posterior lumbar fusion, 21,993 had undergone posterior/transforaminal lumbar interbody fusion, and 8818 had undergone anterior/lateral lumbar interbody fusion. The women were more likely to be older, functionally dependent, and taking steroids for chronic conditions and to have a higher body mass index and lower preoperative hematocrit level. The men were more likely to be white, to smoke, and to have diabetes mellitus, hypertension, and bleeding disorders. In all cohorts, except for a higher incidence of urinary tract infection in the female patients and myocardial infarction in the male patients, no significant differences were found in morbidity and mortality between the sexes. CONCLUSIONS Several differences in demographics and baseline health status were found between men and women undergoing lumbar fusion. When attempting to control for comorbid conditions using propensity score matching, we found that sex was an independent predictor of urinary tract infection in women and myocardial infarction in men across major morbidity and mortality categories in patients undergoing lumbar fusion surgery.
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Affiliation(s)
- Safwan Alomari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ann Liu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erick Westbroek
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Timothy Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Association of Race with Early Outcomes of Elective Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: Propensity-Matched and Subgroup Analysis. World Neurosurg 2021; 150:e176-e181. [PMID: 33684580 DOI: 10.1016/j.wneu.2021.02.113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the impact of race on 30-day postoperative complication rates of elective posterior spinal fusions (PSF) for adolescent idiopathic scoliosis (AIS). METHODS Patients who underwent PSF between 2012 and 2018 were reviewed from the American College of Surgeons National Surgical Quality Improvement Program pediatric database. Propensity score matching was utilized to evaluate whether patient race (i.e., black vs. white) was correlated with postoperative complications. RESULTS A total of 4051 PSF for AIS cases met criteria for inclusion. Of these, 3221 (79.5%) patients were white and 830 (20.5%) were black. Several baseline characteristics significantly differed between cohorts. Patients in the black cohort had a significantly higher body mass index, a greater proportion of female patients, higher ASA scores, preoperative diagnosis of asthma or cardiac risk factors, and prior use of steroids. The total number of vertebral segments fused was also greater in the black cohort. After controlling for differences in baseline characteristics with propensity score matching analysis, the only significant difference in morbidity and mortality identified was a higher incidence of venous thromboembolism among the black cohort (2.8% vs. 0.1%; P < 0.001). CONCLUSIONS In contrast to prior literature, our analysis did not identify black race as an independent risk factor for higher perioperative morbidity or mortality in patients of young age group undergoing elective PSF for AIS, except the higher incidence of venous thromboembolism. The findings of the present study suggest that previously reported perioperative morbidity and mortality outcomes in black patients may be secondary to baseline health characteristics, and not due to race itself.
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Ezuma CO, Kosber RL, Kovacevic D. Biological sex impacts perioperative complications after reverse shoulder arthroplasty for proximal humeral fracture. JSES Int 2021; 5:371-376. [PMID: 34136842 PMCID: PMC8178601 DOI: 10.1016/j.jseint.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background The purpose of this study was to determine the difference in complication rates between males and females undergoing reverse shoulder arthroplasty for proximal humerus fractures. We hypothesized that (1) females were more likely to undergo reverse shoulder arthroplasty for fracture, and (2) males were more likely to sustain a perioperative complication. Methods The National Surgical Quality Improvement Program database was queried to identify patients who underwent reverse shoulder arthroplasty for proximal humerus fracture between 2011 and 2018. Patients were stratified based on biological sex. Patient demographics, comorbidities, and 30-day perioperative complication rates were collected. Univariate analyses and multiple variable logistic regression modeling were performed. Results About 905 patients were included in the analysis—175 (19.3%) were male and 730 (80.7%) were female. Males were more likely to sustain perioperative complications (26.3% vs. 14.1%; P < .001)—pneumonia (2.9% vs. 0.5%; P = .016), unplanned intubation (2.3% vs. 0.4%; P = .029), and unplanned reoperation (9.1% vs. 1.1%; P < .001). On multivariate analysis, males were at a 2.4-fold increase risk of developing any complication (OR = 2.38 [95% CI 1.55-3.65]; P < .001) and a 10-fold increase risk of returning to the operating room for an unplanned reoperation (OR = 10.59 [95% CI 4.23-27.49]; P < .001) compared with females. Conclusion Females were more likely to undergo reverse shoulder arthroplasty for proximal humerus fracture, but males were at increased risk of sustaining short-term complications. This study provides useful information for clinicians to consider when counseling their patients during the perioperative period.
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Affiliation(s)
- Chimere O Ezuma
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Rashed L Kosber
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - David Kovacevic
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
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Fuentes AM, Patil S, Chiu RG, Glastris G, Behbahani M, Mehta AI. Revision Discectomy with or without Fusion for the Treatment of Recurrent Lumbar Disc Herniation: A Nationwide Analysis of Risk Profiles and Short-Term Outcomes. World Neurosurg 2021; 148:e346-e355. [PMID: 33412314 DOI: 10.1016/j.wneu.2020.12.139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/27/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We compared the demographics, risk factors, and complications for adult patients with recurrent lumbar disc herniation (RLDH) undergoing revision discectomy with or without concurrent fusion. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who had undergone revision discectomy with or without simultaneous fusion. The demographic variables and various peri- and postoperative complications were compared between these 2 patient groups. RESULTS A total of 6901 discectomy patients were included in the present study, of whom 2996 (43.4%) had undergone revision discectomy with fusion and 3905 (56.6%) had undergone revision discectomy alone. The revision discectomy with fusion group was significantly more likely to be older, female, and White or Black and to have a higher average body mass index than was the revision discectomy alone group. The discectomy with fusion group had longer hospital lengths of stay and was more likely to have a diagnosis of hypertension, insulin-dependent and non-insulin-dependent diabetes, and chronic obstructive pulmonary disease. In addition, the patients who had undergone discectomy with fusion were significantly more likely to develop pneumonia, require ventilation for >48 hours, require a blood transfusion, and to develop urinary tract infection, myocardial infarction, deep vein thrombosis, or pulmonary embolism compared with the patients who had undergone revision discectomy only. CONCLUSIONS Our findings reveal that older patients with more comorbidities were more likely to undergo revision discectomy with fusion. Also, this surgical group experienced more adverse events after their procedure compared with the revision discectomy only group.
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Affiliation(s)
- Angelica M Fuentes
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Shashank Patil
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ryan G Chiu
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Georgia Glastris
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mandana Behbahani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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Identifying the Most Appropriate ACDF Patients for an Ambulatory Surgery Center: A Pilot Study Using Inpatient and Outpatient Hospital Data. Clin Spine Surg 2020; 33:418-423. [PMID: 32235168 DOI: 10.1097/bsd.0000000000000967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Retrospective cohort analysis of prospectively collected data. OBJECTIVES Using a national cohort of patients undergoing elective anterior cervical discectomy and fusion (ACDF) in an inpatient/outpatient setting, the current objectives were to: (1) outline preoperative factors that were associated with complications, and (2) describe potentially catastrophic complications so that this data can help stratify the best suited patients for an ambulatory surgery center (ASC) compared with a hospital setting. SUMMARY OF BACKGROUND DATA ASCs are increasingly utilized for spinal procedures and represent an enormous opportunity for cost savings. However, ASCs have come under scrutiny for profit-driven motives, lack of adequate safety measures, and inability to handle complications. METHODS Adults who underwent ACDF between 2008 and 2014 were identified in the National Surgical Quality Improvement Program (NSQIP) database. Inclusion criteria were: principal procedure ACDF [Current Procedural Terminology (CPT) 22551, 22552], elective, neurological/orthopedic surgeons, length of stayof 0/1 day, and being discharged home. The primary outcome was presence of any complication. The secondary outcome was occurrence of potentially catastrophic complications. RESULTS A total of 12,169 patients underwent elective ACDF with a length of stay of 0/1 day and were discharged directly home. A total of 179 (1.47%) patients experienced a complication. Multivariate logistic regression revealed the following factors were significantly associated with a complication: Charlson Comorbidity Index (CCI) >3, history of transient ischemic attack/cerebrovascular accident, abnormal bilirubin, and operative time of >2 hours. Approximate comorbidity score cutoffs associated with <2% risk of complication were: American Society of Anesthesiologists (ASA)≤2, CCI≤2, modified frailty index (mFI) ≤0.182. A total of 51 (0.4%) patients experienced potentially catastrophic complications. CONCLUSIONS The current results represent a preliminary, pilot analysis using inpatient/outpatient data in selecting appropriate patients for an ASC. The incidence of potentially catastrophic complication was 0.4%. These results should be validated in multi-institution studies to further optimize appropriate patient selection for ASCs.
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Resident Involvement Is Not Associated With Increased Risk of Postoperative Complications After Arthroscopic Knee Surgery: A Propensity-Matched Study. Arthroscopy 2020; 36:2689-2695. [PMID: 32389776 DOI: 10.1016/j.arthro.2020.04.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/26/2020] [Accepted: 04/26/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate whether resident involvement in knee arthroscopy procedures affects postoperative complications or operative times. METHODS The American College of Surgeons National Surgical Quality Improvement Program registry was queried to identify patients who underwent common knee arthroscopy procedures between 2006 through 2012. Patients with a history of knee arthroplasty, septic arthritis or osteomyelitis of the knee, concomitant open or mini-open procedures, or without information on resident involvement were excluded. A 1:1 propensity score match was performed based on age, sex, obesity, smoking history, and American Society of Anesthesiologist classification to match cases with resident involved to nonresident cases. Fisher exact tests, Pearson's χ2 tests, and Wilcoxon rank sum tests were used to compare patient demographics, comorbidities, and 30-day complications. Wilcoxon rank sum tests were used to compare operative time and length of hospital stay between the 2 groups, with statistical significance defined as P < .05. RESULTS After matching, 2954 cases (50% resident involvement) were included in the study with no significant differences in demographics or comorbidities between the 2 cohorts. The overall rate of 30-day complications was 1.1% in the nonresident and resident involved group (P = 1.000). There was no significant difference in postoperative surgical (nonresident vs resident involved: 0.48% vs 0.83%, P = .2498) or medical (nonresident vs resident involved: 0.62% vs 0.83%, P = .5111) complications. However, knee arthroscopy cases that residents were involved with had significantly longer operative times (69.8 vs 66.8 minutes, P = .0002), and length of hospital stay (0.85 vs 0.21 days, P = .0332) when compared with cases performed without a resident. CONCLUSIONS Resident involvement in knee arthroscopy procedures is not a significant risk for medical or surgical 30-day postoperative complications. Resident participation in knee arthroscopy was associated with statistically significant but likely clinically insignificant increased operative time as well as length of hospital stay. LEVEL OF EVIDENCE Level III: Retrospective Cohort Study.
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The Impact of Resident Involvement on Postoperative Complications After Shoulder Arthroscopy: A Propensity-Matched Analysis. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00138. [PMID: 33939395 PMCID: PMC7494138 DOI: 10.5435/jaaosglobal-d-20-00138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE Shoulder arthroscopy is the second most frequently performed procedure by orthopaedic surgeons taking the American Board of Orthopaedic Surgery part II examination. However, the impact of resident involvement on outcomes after shoulder arthroscopy is poorly understood. The aim of this study was to investigate whether resident involvement in shoulder arthroscopic procedures affects postoperative complication rates and surgical time using propensity score-matched cohorts. METHODS The American College of Surgeons National Surgical Quality Improvement Program registry was queried to identify patients who underwent common shoulder arthroscopic procedures between 2006 and 2012. Cases without information on resident involvement, treatment of septic arthritis or osteomyelitis of the shoulder, or concomitant open or miniopen procedures were excluded from the study. A 1:1 propensity score match was used based on demographic and comorbidity factors to match cases with resident involvement to nonresident cases. Patient demographics, comorbidities, surgical time, length of hospital stay, and 30-day postoperative complications were compared between the two groups. RESULTS Overall, 15,857 patients who underwent shoulder arthroscopy were identified. After propensity score matching, 3474 cases (50% with resident involvement) were included. Appropriate matching was verified with no difference in demographic or health characteristics. No significant differences in the overall rate of 30-day complications was noted in resident-involved versus nonresident group (P = 0.576). No significant difference was observed in postoperative surgical or medical complications. Resident involvement was significantly longer surgical time (75.9 ± 35.9 versus 75.1 ± 40.5 minutes, P = 0.03) when compared with cases performed without a resident. CONCLUSIONS Resident involvement in shoulder arthroscopy is not associated with increased risk for medical or surgical 30-day postoperative complications. Resident participation in shoulder arthroscopy cases did increase surgical time; however, this finding is likely clinically insignificant.
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Reddy AK, Ryoo JS, Denyer S, McGuire LS, Mehta AI. Determining the role of adjuvant radiotherapy in the management of meningioma: a Surveillance, Epidemiology, and End Results analysis. Neurosurg Focus 2020; 46:E3. [PMID: 31153148 DOI: 10.3171/2019.3.focus1971] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/25/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe aim of this study was to illustrate the demographic characteristics of meningioma patients and observe the effect of adjuvant radiation therapy on survival by using the Surveillance, Epidemiology, and End Results (SEER) database. More specifically, the authors aimed to answer the question of whether adjuvant radiotherapy following resection of atypical meningioma confers a cause-specific survival benefit. Additionally, they attempted to add to previous characterizations of the epidemiology of primary meningiomas and assess the effectiveness of the standard of care for benign and anaplastic meningiomas. They also sought to characterize the efficacy of various treatment options in atypical and anaplastic meningiomas separately since nearly all other analyses have grouped these two together despite varying treatment regimens for these behavior categories.METHODSSEER data from 1973 to 2015 were queried using appropriate ICD-O-3 codes for benign, atypical, and anaplastic meningiomas. Patient demographics, tumor characteristics, and treatment choices were analyzed. The effects of treatment were examined using a multivariate Cox proportional hazards model and Kaplan-Meier survival analysis.RESULTSA total of 57,998 patients were included in the analysis of demographic, meningioma, and treatment characteristics. Among this population, cases of unspecified WHO tumor grade were excluded in the multivariate analysis, leaving a total of 12,931 patients to examine outcomes among treatment paradigms. In benign meningiomas, gross-total resection (HR 0.289, p = 0.013) imparted a significant cause-specific survival benefit over no treatment. In anaplastic meningioma cases, adjuvant radiotherapy imparted a significant survival benefit following both subtotal (HR 0.089, p = 0.018) and gross-total (HR 0.162, p = 0.002) resection as compared to gross-total resection alone. In atypical tumors, gross-total resection plus radiotherapy did not significantly change the hazard risk (HR 1.353, p = 0.628) compared to gross-total resection alone. Similarly, it was found that adjuvant radiation did not significantly benefit survival after a subtotal resection (HR 1.440, p = 0.644).CONCLUSIONSThe results of this study demonstrate that the role of adjuvant radiotherapy, especially after the resection of atypical meningioma, remains somewhat unclear. Thus, given these results, prospective randomized clinical studies are warranted to provide clear information on the effects of adjuvant radiation in meningioma treatment.
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Lu Y, Cregar WM, Goodloe JB, Khazi Z, Forsythe B, Gerlinger TL. General Anesthesia Leads to Increased Adverse Events Compared With Spinal Anesthesia in Patients Undergoing Unicompartmental Knee Arthroplasty. J Arthroplasty 2020; 35:2002-2008. [PMID: 32247674 DOI: 10.1016/j.arth.2020.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/21/2020] [Accepted: 03/05/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The volume of unicompartmental knee arthroplasty (UKA) has increased dramatically in recent years with good reported long-term outcomes. UKA can be performed under general or neuraxial (ie, spinal) anesthesia; however, little is known as to whether there is a difference in outcomes based on anesthesia type. The purpose of the present study is to compare perioperative outcomes between anesthesia types for patients undergoing primary elective UKA. METHODS Patients who underwent primary elective UKA from 2007 to 2017 were identified from the American College of Surgeons-National Surgical Quality Improvement Program Database. Operating room times, length of stay (LOS), 30-day adverse events, and readmission rates were compared between patients who received general anesthesia and those who received spinal anesthesia. Propensity-adjusted multivariate analysis was used to control for selection bias and baseline patient characteristics. RESULTS A total of 8639 patients underwent UKA and met the inclusion criteria for this study. Of these, 4728 patients (54.7%) received general anesthesia and 3911 patients (45.3%) received spinal anesthesia. On propensity-adjusted multivariate analyses, general anesthesia was associated with increased operative time (P < .001) and the occurrence of any severe adverse event (odds ratio [OR], 1.39; 95% confidence interval [95% CI], 1.04-1.84; P = .024). In addition, general anesthesia was associated with higher rates of deep venous thrombosis (OR, 2.26; 95% CI, 1.11-4.6; P = .024) and superficial surgical site infection (OR, 1.04; 95% CI, 0.6-1.81; P < .001). Finally, general anesthesia was also associated with a reduced likelihood of discharge to home (OR, 0.72; 95% CI, 0.59-0.88; P < .001). No difference existed in postoperative hospital LOS or readmission rates among cohorts. CONCLUSION General anesthesia was associated with an increased rate of adverse events and increased operating room times as well as a reduced likelihood of discharge to home. There was no difference in hospital LOS or postoperative readmission rates between anesthesia types.
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Affiliation(s)
- Yining Lu
- Division of Orthopaedics, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - William M Cregar
- Division of Orthopaedics, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - J Brett Goodloe
- Department of Orthopaedic Surgery and Physical Rehabilitation, Medical University of South Carolina, Charleston, SC
| | - Zain Khazi
- Department of Orthopaedic Surgery and Rehabilitation, Iowa University Hospitals and Clinics, Iowa City, IA
| | - Brian Forsythe
- Division of Orthopaedics, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - Tad L Gerlinger
- Division of Orthopaedics, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
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Lu Y, Khazi ZM, Patel BH, Agarwalla A, Cancienne J, Werner BC, Forsythe B. Big Data in Total Shoulder Arthroplasty: An In-depth Comparison of National Outcomes Databases. J Am Acad Orthop Surg 2020; 28:e626-e632. [PMID: 32692100 DOI: 10.5435/jaaos-d-19-00173] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The practice of identifying trends in surgical decision-making through large-scale patient databases is commonplace. We hypothesize that notable differences exist between claims-based and prospectively collected clinical registries. METHODS We queried the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), a prospective surgical outcomes database, and PearlDiver (PD), a claims-based private insurance database, for patients undergoing primary total shoulder arthroplasties from 2007 to 2016. Comorbidities and 30-day complications were compared. Multiple regression analysis was performed for each cohort to identify notable contributors to 30-day revision surgery. RESULTS Significant differences were observed in demographics, comorbidities, and postoperative complications for the age-matched groups between PD and NSQIP (P < 0.05 for all). Multiple regression analysis in PD identified morbid obesity and dyspnea to lead to an increased risk for revision surgery (P = 0.001) in the <65 cohort and dyspnea and diabetes to lead to an increased risk for revision surgery in the ≥65 cohort (P = 0.015, P < 0.001). Multiple regression did not reveal any risk factors for revision surgery in the <65 age group for the NSQIP; however, congestive heart failure was found to have an increased risk for revision surgery in the ≥65 cohort (P < 0.001). CONCLUSIONS Notable differences in comorbidities and complications for patients undergoing primary total shoulder arthroplasty were present between PD and NSQIP. LEVEL OF EVIDENCE Retrospective cohort study, level III.
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Affiliation(s)
- Yining Lu
- From Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL (Mr. Lu, Mr. Patel, Dr. Agarwalla, Dr. Cancienne, and Dr. Forsythe), the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA (Mr. Khazi), and the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA (Dr. Werner)
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Hauser BM, Gupta S, Xu E, Wu K, Bernstock JD, Chua M, Khawaja AM, Smith TR, Dunn IF, Bergmark RW, Bi WL. Impact of insurance on hospital course and readmission after resection of benign meningioma. J Neurooncol 2020; 149:131-140. [PMID: 32654076 DOI: 10.1007/s11060-020-03581-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/02/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Surgical outcomes and healthcare utilization have been shown to vary based on patient insurance status. We analyzed whether patients' insurance affects case urgency for and readmission after craniotomy for meningioma resection, using benign meningioma as a model system to minimize confounding from the disease-related characteristics of other neurosurgical pathologies. METHODS We analyzed 90-day readmission for patients who underwent resection of a benign meningioma in the Nationwide Readmission Database from 2014-2015. RESULTS A total of 9783 meningioma patients with private insurance (46%), Medicare (39%), Medicaid (10%), self-pay (2%), or another scheme (3%) were analyzed. 72% of all cases were elective; with 78% of cases in privately insured patients being elective compared to 71% of Medicare (p > 0.05), 59% of Medicaid patients (OR 2.3, p < 0.001), and 49% of self-pay patients (OR 3.4, p < 0.001). Medicare (OR 1.5, p = 0.002) and Medicaid (OR 1.4, p = 0.035) were both associated with higher likelihood of 90-day readmission compared to private insurance. In comparison, 30-day analyses did not unveil this discrepancy between Medicaid and privately insured, highlighting the merit for longer-term outcomes analyses in value-based care. Patients readmitted within 30 days versus those with later readmissions possessed different characteristics. CONCLUSIONS Compared to patients with private insurance coverage, Medicaid and self-pay patients were significantly more likely to undergo non-elective resection of benign meningioma. Medicaid and Medicare insurance were associated with a higher likelihood of 90-day readmission; only Medicare was significant at 30 days. Both 30 and 90-day outcomes merit consideration given differences in readmitted populations.
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Affiliation(s)
| | - Saksham Gupta
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA.,Computational Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Edward Xu
- Computational Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Kyle Wu
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Joshua D Bernstock
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Melissa Chua
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Ayaz M Khawaja
- Computational Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Timothy R Smith
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA.,Computational Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Regan W Bergmark
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Wenya Linda Bi
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA.
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Feghali J, Marinaro E, Lubelski D, Luciano MG, Huang J. Novel Risk Calculator for Suboccipital Decompression for Adult Chiari Malformation. World Neurosurg 2020; 139:526-534. [DOI: 10.1016/j.wneu.2020.04.169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 11/27/2022]
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Arthroscopic débridement has similar 30-day complications compared with open arthrotomy for the treatment of native shoulder septic arthritis: a population-based study. J Shoulder Elbow Surg 2020; 29:1121-1126. [PMID: 32057658 DOI: 10.1016/j.jse.2019.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/27/2019] [Accepted: 11/07/2019] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS This study aimed to determine whether there are significant differences in 30-day perioperative complications between arthroscopic and open débridement (irrigation and débridement [I&D]) for septic arthritis (SA) of the shoulder using the American College of Surgeons National Surgical Quality Improvement Program database. METHODS Patients undergoing arthroscopic or open I&D of the native shoulder from 2006-2016 were identified in the National Surgical Quality Improvement Program database. Those with a diagnosis of SA were included in the study. Patients with a concurrent diagnosis of osteomyelitis around shoulder (n = 25) or polyarthritis (n = 2) were excluded from the study. Patient demographics, comorbidities, and complications were compared between the groups. Poisson regression, which controlled for age and American Society of Anesthesiologists (ASA) score, was used to calculate the relative risks with 95% confidence intervals for minor adverse events, serious adverse events, total adverse events, and unplanned reoperations between the 2 treatment groups, with significance set at P < .0125 after Bonferroni correction. RESULTS Overall, 147 and 57 patients underwent arthroscopic and open I&D, respectively, for SA of the shoulder. Patients in the open I&D group were more likely to be smokers (P = .0213), whereas patients in the arthroscopy group had higher ASA scores (P = .0008). After controlling for age and ASA score, we found no significant differences in the risk of minor adverse events (P = .0995), serious adverse events (P = .2241), total adverse events (P = .1871), or unplanned reoperations (P = .3855). CONCLUSION Arthroscopic débridement appears to be a safe alternative to open débridement for SA of the native shoulder. The incidence and risk of 30-day perioperative complications are similar after arthroscopic and open I&D for SA of the shoulder.
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