1
|
Sarikonda A, Leibold A, Sami A, Mansoor Ali D, Tecce E, August A, O'Leary M, Thalheimer S, Heller J, Prasad S, Sharan A, Jallo J, Harrop J, Vaccaro AR, Sivaganesan A. Do Busier Surgeons Have Lower Intraoperative Costs? An Analysis of Anterior Cervical Discectomy and Fusion Using Time-Driven Activity-Based Costing. Clin Spine Surg 2024:01933606-990000000-00294. [PMID: 38637916 DOI: 10.1097/bsd.0000000000001628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/28/2024] [Indexed: 04/20/2024]
Abstract
STUDY DESIGN The present study is a single-center, retrospective cohort study of patients undergoing neurosurgical anterior cervical discectomy and fusion (ACDF). OBJECTIVE Our objective was to use time-driven activity-based costing (TDABC) methodology to determine whether surgeons' case volume influenced the true intraoperative costs of ACDFs performed at our institution. SUMMARY OF BACKGROUND DATA Successful participation in emerging reimbursement models, such as bundled payments, requires an understanding of true intraoperative costs, as well as the modifiable drivers of those costs. Certain surgeons may have cost profiles that are favorable for these "at-risk" reimbursement models, while other surgeons may not. METHODS Total cost was divided into direct and indirect costs. Individual costs were obtained by direct observation, electronic medical records, and through querying multiple departments (business operations, sterile processing, plant operations, and pharmacy). Timestamps for all involved personnel and material resources were documented. All surgeons performing ACDFs at our primary and affiliated hospital sites from 2017 to 2022 were divided into four volume-based cohorts: 1-9 cases (n=10 surgeons, 38 cases), 10-29 cases (n=7 surgeons, 126 cases), 30-100 cases (n=3 surgeons, 234 cases), and > 100 cases (n=2 surgeons, 561 cases). RESULTS The average total intraoperative cost per case was $7,116 +/- $2,945. The major cost contributors were supply cost ($4,444, 62.5%) and personnel cost ($2,417, 34.0%). A generalized linear mixed model utilizing Poisson distribution was performed with the surgeon as a random effect. Surgeons performing 1-9 total cases, 10-29 cases, and 30-100 cases had increased total cost of surgery (P < 0.001; P < 0.001; and P<0.001, respectively) compared to high-volume surgeons (> 100 cases). Among all volume cohorts, high-volume surgeons also had the lowest mean supply cost, personnel cost, and operative times, while the opposite was true for the lowest-volume surgeons (1-9 cases). CONCLUSION It is becoming increasingly important for hospitals to identify modifiable sources of variation in cost. We demonstrate a novel use of TDABC for this purpose. LEVEL OF EVIDENCE Level-III.
Collapse
Affiliation(s)
- Advith Sarikonda
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Adam Leibold
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Ashmal Sami
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Daniyal Mansoor Ali
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Eric Tecce
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Ari August
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Matthew O'Leary
- Department of Medicine, Drexel University College of Medicine
| | - Sara Thalheimer
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Joshua Heller
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Srinivas Prasad
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Ashwini Sharan
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - Jack Jallo
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | - James Harrop
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| | | | - Ahilan Sivaganesan
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience
| |
Collapse
|
2
|
Wanner JP, Pennings JS, Nian H, Sivaganesan A, Gupta R, Asher AL, Bydon M, Abtahi A, Zuckerman SL, Devin C, Archer KR, Stephens BF. Rating Spine Surgeons: Physician Review Websites Versus a Patient-reported Outcomes-derived Ranking. Clin Spine Surg 2022; 35:E643-E648. [PMID: 35509107 DOI: 10.1097/bsd.0000000000001333] [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: 10/30/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was an observational study. OBJECTIVES This study aims to determine the correlation between patient-reported outcomes (PROs) pulled from a national spine registry and physician ratings from physician review websites (PRWs). SUMMARY OF BACKGROUND DATA PRWs are frequently utilized by patients to make health care decisions; however, many PRWs appear to incorporate subjective experiences unrelated to a surgeon's clinical performance into ratings. As such, their utility as a health care decision-making tool remains unclear. MATERIALS AND METHODS This study evaluated 8834 patients from the Quality Outcomes Database (QOD) who underwent 1-level elective lumbar spine surgery. The lumbar module of QOD was queried to rank 124 surgeons using PROs (Oswestry Disability Index, EuroQOL, Numerical Rating Scale-back/leg pain, and patient satisfaction). The QOD PRO-ranking system was compared against PRWs including Healthgrades, Vitals, WebMD, and Google. The Spearman correlation coefficients, Kruskal-Wallis tests, and multiple linear regression models were used for statistical comparison. The primary outcome was the correlation between PRW scores and PROs. RESULTS Surgeon PRO-derived ranking showed high intercorrelational congruence with coefficients between the 3 PROs (Oswestry Disability Index, EuroQOL, Numerical Rating Scale back/leg) ranging between 0.70 and 0.88. Low correlations were observed between PRO-derived rankings and PRWs, ranging from 0.23 to 0.37. Healthgrades performed most similarly to PRO-derived rankings, correlating best with patient satisfaction, though the correlation was low (ρ=0.37). CONCLUSIONS While PRWs are often used to evaluate surgeon competency, these results demonstrate they poorly correlate with a surgeon's clinical ability measured by PROs. PRWs should be used with caution when making health care decisions by patients, payers, and administrators. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
| | | | | | | | - Rishabh Gupta
- Departments of Orthopedic Surgery
- Neurosurgery, Vanderbilt University, Nashville, TN
| | | | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, MN
| | | | | | - Clinton Devin
- Departments of Orthopedic Surgery
- Steamboat Orthopedic and Spine Institute, Steamboat Springs, CO
| | - Kristin R Archer
- Departments of Orthopedic Surgery
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, TN
| | | |
Collapse
|
3
|
Schnelle C, Clark J, Mascord R, Jones MA. Is There a Surgeons’ Effect on Patients’ Physical Health, Beyond the Intervention, That Requires Further Investigation? A Systematic Review. Ther Clin Risk Manag 2022; 18:467-490. [PMID: 35502434 PMCID: PMC9056050 DOI: 10.2147/tcrm.s357934] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/04/2022] [Indexed: 12/23/2022] Open
Abstract
Objective To find and review published papers researching surgeons’ effects on patients’ physical health. Clinical outcomes of surgery patients with similar prognoses cannot be fully explained by surgeon skill or experience. Just as there are “hospital” and “psychotherapist” effects, there may be “surgeons” effects that persist after controlling for known variables like patient health and operation riskiness. Methods Cohort studies and randomized controlled trials (RCTs) of any surgical intervention, which, after multivariate adjustment, either showed proportion of variance in patients’ physical health outcomes due to surgeons (random effects) or graded surgeons from best to worst (fixed effects). Studies with <15 surgeons or only ascribing surgeons’ effects to known variables excluded. Medline, PubMed, Embase, and PsycINFO were used for search until June 2020. Manual search for papers referring/referred by resulting studies. Risk of bias assessed by Cochrane risk-of-bias tool and Newcastle–Ottawa Scale. Results Included studies: 52 cohort studies and three RCTs of 52,436+ surgeons covering 102 outcomes (33 unique). Studies either graded surgeons from best to worst or calculated the intra-class correlation coefficient (ICC), the percentage of patients’ variation due to surgeons, in diverse ways. Sixteen studies showed exceptionally good and/or bad performers with confidence intervals wholly above or below the average performance. ICCs ranged from 0 to 47%, median 4.0%. There are no well-established reporting standards; highly heterogeneous reporting, therefore no meta-analysis. Discussion Interpretation: There is a surgeons' effect on patients’ physical health for many types of surgeries and outcomes, ranging from small to substantial. Surgeons with exceptional patient outcomes appear regularly even after accounting for all known confounding variables. Many existing cohort studies and RCTs could be reanalyzed for surgeons’ effects especially after methodological reporting guidelines are published. Conclusion In terms of patient outcomes, it can matter which surgeon is chosen. Surgeons with exceptional patient outcomes are worth studying further. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/pL-eGyAGhSk
Collapse
Affiliation(s)
- Christoph Schnelle
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
- Correspondence: Christoph Schnelle, Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia, Email
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Rachel Mascord
- General Dentist, BMA House, Sydney, New South Wales, Australia
| | - Mark A Jones
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| |
Collapse
|
4
|
Sibert NT, Pfaff H, Breidenbach C, Wesselmann S, Kowalski C. Different Approaches for Case-Mix Adjustment of Patient-Reported Outcomes to Compare Healthcare Providers-Methodological Results of a Systematic Review. Cancers (Basel) 2021; 13:cancers13163964. [PMID: 34439117 PMCID: PMC8392243 DOI: 10.3390/cancers13163964] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Patient-reported outcomes need to be reported with case-mix adjustment in order to allow fair comparison between healthcare providers. This systematic review identified different approaches to case-mix adjustment, with wide variation between the various approaches. Abstract Patient-reported outcomes (PROs) are increasingly being used to compare the quality of outcomes between different healthcare providers (medical practices, hospitals, rehabilitation facilities). However, such comparisons can only be fair if differences in the case-mix between different types of provider are taken into account. This can be achieved with adequate statistical case-mix adjustment (CMA). To date, there is a lack of overview studies on current CMA methods for PROs. The aim of this study was to investigate which approaches are currently used to report and examine PROs for case-mix-adjusted comparison between providers. A systematic MEDLINE literature search was conducted (February 2021). The results were examined by two reviewers. Articles were included if they compared (a) different healthcare providers using (b) case-mix-adjusted (c) patient-reported outcomes (all AND conditions). From 640 hits obtained, 11 articles were included in the analysis. A wide variety of patient characteristics were used as adjustors, and baseline PRO scores and basic sociodemographic and clinical information were included in all models. Overall, the adjustment models used vary considerably. This evaluation is an initial attempt to systematically investigate different CMA approaches for PROs. As a standardized approach has not yet been established, we suggest creating a consensus-based methodological guideline for case-mix adjustment of PROs.
Collapse
Affiliation(s)
- Nora Tabea Sibert
- German Cancer Society, Kuno-Fischer-Str. 8, 14507 Berlin, Germany; (C.B.); (S.W.); (C.K.)
- Correspondence:
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Medicine and University Hospital Cologne, Faculty of Human Sciences, University of Cologne, 50933 Cologne, Germany;
| | - Clara Breidenbach
- German Cancer Society, Kuno-Fischer-Str. 8, 14507 Berlin, Germany; (C.B.); (S.W.); (C.K.)
| | - Simone Wesselmann
- German Cancer Society, Kuno-Fischer-Str. 8, 14507 Berlin, Germany; (C.B.); (S.W.); (C.K.)
| | - Christoph Kowalski
- German Cancer Society, Kuno-Fischer-Str. 8, 14507 Berlin, Germany; (C.B.); (S.W.); (C.K.)
| |
Collapse
|
5
|
Asher AL, Knightly J, Mummaneni PV, Alvi MA, McGirt MJ, Yolcu YU, Chan AK, Glassman SD, Foley KT, Slotkin JR, Potts EA, Shaffrey ME, Shaffrey CI, Haid RW, Fu KM, Wang MY, Park P, Bisson EF, Harbaugh RE, Bydon M. Quality Outcomes Database Spine Care Project 2012-2020: milestones achieved in a collaborative North American outcomes registry to advance value-based spine care and evolution to the American Spine Registry. Neurosurg Focus 2021; 48:E2. [PMID: 32357320 DOI: 10.3171/2020.2.focus207] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/14/2020] [Indexed: 11/06/2022]
Abstract
The Quality Outcomes Database (QOD), formerly known as the National Neurosurgery Quality Outcomes Database (N2QOD), was established by the NeuroPoint Alliance (NPA) in collaboration with relevant national stakeholders and experts. The overarching goal of this project was to develop a centralized, nationally coordinated effort to allow individual surgeons and practice groups to collect, measure, and analyze practice patterns and neurosurgical outcomes. Specific objectives of this registry program were as follows: "1) to establish risk-adjusted national benchmarks for both the safety and effectiveness of neurosurgical procedures, 2) to allow practice groups and hospitals to analyze their individual morbidity and clinical outcomes in real time, 3) to generate both quality and efficiency data to support claims made to public and private payers and objectively demonstrate the value of care to other stakeholders, 4) to demonstrate the comparative effectiveness of neurosurgical and spine procedures, 5) to develop sophisticated 'risk models' to determine which subpopulations of patients are most likely to benefit from specific surgical interventions, and 6) to facilitate essential multicenter trials and other cooperative clinical studies." The NPA has launched several neurosurgical specialty modules in the QOD program in the 7 years since its inception including lumbar spine, cervical spine, and spinal deformity and cerebrovascular and intracranial tumor. The QOD Spine modules, which are the primary subject of this paper, have evolved into the largest North American spine registries yet created and have resulted in unprecedented cooperative activities within our specialty and among affiliated spine care practitioners. Herein, the authors discuss the experience of QOD Spine programs to date, with a brief description of their inception, some of the key achievements and milestones, as well as the recent transition of the spine modules to the American Spine Registry (ASR), a collaboration between the American Association of Neurological Surgeons and the American Academy of Orthopaedic Surgeons (AAOS).
Collapse
Affiliation(s)
- Anthony L Asher
- 1Atrium Health Neuroscience Institute and Atrium Health Musculoskeletal Institute, Charlotte, and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - John Knightly
- 2Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Praveen V Mummaneni
- 3Department of Neurological Surgery, University of California, San Francisco, California
| | - Mohammed Ali Alvi
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew J McGirt
- 1Atrium Health Neuroscience Institute and Atrium Health Musculoskeletal Institute, Charlotte, and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
| | - Yagiz U Yolcu
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew K Chan
- 2Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | | | - Kevin T Foley
- 6Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | | | - Eric A Potts
- 8Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Mark E Shaffrey
- 9Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Christopher I Shaffrey
- 10Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, North Carolina
| | | | - Kai-Ming Fu
- 12Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Michael Y Wang
- 13Department of Neurologic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Paul Park
- 14Department of Neurologic Surgery, University of Miami, Florida
| | - Erica F Bisson
- 15Department of Neurological Surgery, University of Utah, Salt Lake City, Utah; and
| | - Robert E Harbaugh
- 16Department of Neurosurgery, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Mohamad Bydon
- 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
6
|
Asher AL, Devin CJ, Kerezoudis P, Nian H, Alvi MA, Khan I, Sivaganesan A, Harrell FE, Archer KR, Bydon M. Predictors of patient satisfaction following 1- or 2-level anterior cervical discectomy and fusion: insights from the Quality Outcomes Database. J Neurosurg Spine 2019; 31:835-843. [PMID: 31470402 DOI: 10.3171/2019.6.spine19426] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/17/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patient satisfaction with treatment outcome is gaining an increasingly important role in assessing the value of surgical spine care delivery. Nationwide data evaluating the predictors of patient satisfaction in elective cervical spine surgery are lacking. The authors sought to decipher the impacts of the patient, surgical practice, and surgeon on satisfaction with outcome following anterior cervical discectomy and fusion (ACDF). METHODS The authors queried the Quality Outcomes Database for patients undergoing 1- to 2-level ACDF for degenerative spine disease since 2013. Patient satisfaction with the surgical outcome as measured by the North American Spine Society (NASS) scale comprised the primary outcome. A multivariable proportional odds logistic regression model was constructed with adjustments for baseline patient characteristics and surgical practice and surgeon characteristics as fixed effects. RESULTS A total of 4148 patients (median age 54 years, 48% males) with complete 12-month NASS satisfaction data were analyzed. Sixty-seven percent of patients answered that "surgery met their expectations" (n = 2803), while 20% reported that they "did not improve as much as they had hoped but they would undergo the same operation for the same results" (n = 836). After adjusting for a multitude of patient-specific as well as hospital- and surgeon-related factors, the authors found baseline Neck Disability Index (NDI) score, US geographic region of hospital, patient race, insurance status, symptom duration, and Workers' compensation status to be the most important predictors of patient satisfaction. The discriminative ability of the model was satisfactory (c-index 0.66, overfitting-corrected estimate 0.64). CONCLUSIONS The authors' results found baseline NDI score, patient race, insurance status, symptom duration, and Workers' compensation status as well as the geographic region of the hospital to be the most important predictors of long-term patient satisfaction after a 1- to 2-level ACDF. The findings of the present analysis further reinforce the role of preoperative discussion with patients on setting treatment goals and realistic expectations.
Collapse
Affiliation(s)
- Anthony L Asher
- 1Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates and Neurological Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Clinton J Devin
- 2Orthopaedics of Steamboat Springs, Steamboat Springs, Colorado
| | | | - Hui Nian
- 4Department of Biostatistics, Vanderbilt University School of Medicine, and Departments of
| | - Mohammed Ali Alvi
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and
| | | | | | - Frank E Harrell
- 4Department of Biostatistics, Vanderbilt University School of Medicine, and Departments of
| | - Kristin R Archer
- 6Orthopedic Surgery, and
- 7Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mohamad Bydon
- 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota; and
| |
Collapse
|
7
|
Sabatino MJ, Gans CV, Zynda AJ, Chung JS, Miller SM, Wilson PL, Jo CH, Ellis HB. An electronic patient-reported outcomes measurement system in paediatric orthopaedics. J Child Orthop 2019; 13:431-437. [PMID: 31489051 PMCID: PMC6701445 DOI: 10.1302/1863-2548.13.190053] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The purpose of the study was to evaluate the reliability, review differences and assess patient satisfaction of electronic patient-reported outcome measures (PROMs) compared with paper PROMs. METHODS Participants between 12 and 19 years of age with a knee-related primary complaint were randomized into two groups. Group 1 completed paper PROMs followed by electronic, while Group 2 received the electronic followed by paper. PROMs included the Pediatric International Knee Documentation Committee (Pedi-IKDC), Hospital for Special Surgery (HSS) Pediatric Functional Activity Brief Scale (HSS Pedi-FABS), Tegner Activity Level Scale, Visual Analogue Scale (VAS), PedsQL Teen and a satisfaction survey. RESULTS In all, 87 participants were enrolled with one excluded due to incomplete PROMs. Of the 86 participants, 54 were female and 32 were male with an average age of 14.3 years (12 to 18). A high degree of reliability was found when comparing the paper and electronic versions of the Pedi-IKDC (0.946; p < 0.001), HSS Pedi-FABS (0.923; p < 0.001), PedsQL Teen (0.894; p < 0.001), Tegner Activity Level Scale before injury (0.848; p < 0.001) and the Tegner Activity Level Scale after (0.930; p < 0.001). Differences were noted between the VAS scores, with paper scores being significantly higher than electronic (5.3 versus 4.6; p < 0.001). While not significant, a trend was noted in which electronic PROMs took, overall, less time than paper (10.0 mins versus 11.2 mins; p = 0.096).Of all participants, 69.8% preferred the electronic PROMs, 67.4% felt they were faster, 93.0% stated they would complete forms at home prior to appointments and 91.8% were not concerned about the safety/privacy of electronic forms. CONCLUSION PROMs captured electronically were reliable when compared with paper. Electronic PROMs may be quicker, will not require manual scoring and are preferred by patients. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- M. J. Sabatino
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA,Correspondence should be sent to M. J. Sabatino, Scottish Rite for Children, Orthopedic and Sports Medicine Center, 5700 Dallas Parkway, Frisco, TX 75034, USA.
| | - C. V. Gans
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - A. J. Zynda
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - J. S. Chung
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA,Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - S. M. Miller
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA,Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - P. L. Wilson
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA,Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA
| | - C. H. Jo
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - H. B. Ellis
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA,Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA
| |
Collapse
|