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Anwar FN, Roca AM, Hartman TJ, Nie JW, Medakkar SS, Loya AC, MacGregor KR, Oyetayo OO, Zheng E, Federico VP, Sayari AJ, Lopez GD, Singh K. Worse Pain and Disability at Presentation Predicts Greater Improvement in Pain, Disability, and Mental Health in Patients Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis. Clin Spine Surg 2024:01933606-990000000-00330. [PMID: 38940454 DOI: 10.1097/bsd.0000000000001650] [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: 10/30/2023] [Accepted: 04/29/2024] [Indexed: 06/29/2024]
Abstract
STUDY DESIGN Retrospective Review. OBJECTIVE To assess the impact of preoperative pain and disability on patient-reported outcome measures (PROMs) following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA Varying preoperative symptom severity in lumbar fusion patients alters perceptions of surgical success. METHODS Degenerative spondylolisthesis patients undergoing elective, primary, single-level MI-TLIF were stratified by preoperative symptom severity: Mild (VAS-B<7/ODI<50), Moderate (VAS-B≥7/ODI<50 or VAS-B<7/ODI≥50), and Severe (VAS-B≥7/ODI≥50). PROMs, Patient-reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), ODI, VAS-B, VAS-Leg (VAS-L), and 9-item Patient Health Questionnaire (PHQ-9) were compared at baseline, 6 weeks, and final follow-up (μ=16.3±8.8 mo). Postoperative PROMs, magnitudes of improvement, and minimal clinically important difference (MCID) achievement rates were compared between cohorts through multivariable regression. RESULTS A total of 177 patients were included. Acute postoperative pain and narcotic consumption were highest in the severe cohort (P≤0.003). All preoperative PROMs worsened from mild to severe cohorts (P<0.001). All PROMs continued to be significantly different between cohorts at 6 weeks and final follow-up, with the worst scores in the Severe cohort (P≤0.003). At 6 weeks, all cohorts improved in ODI, VAS-B, VAS-L, and PHQ-9 (P≤0.003), with the Moderate cohort also improving in PROMIS-PF (P=0.017). All Cohorts improved across PROMs at the final follow-up (P≤0.044). Magnitudes of improvement in ODI, VAS-B, and PHQ-9 increased with worsening preoperative symptom severity (P≤0.042). The Moderate and Severe cohorts demonstrated higher MCID achievement in ODI, VAS-B, and PHQ-9 rates than the Mild cohort. CONCLUSIONS Despite preoperative pain and disability severity, patients undergoing MI-TLIF for degenerative spondylolisthesis report significant improvement in physical function, pain, disability, and mental health postoperatively. Patients with increasing symptom severity continued to report worse severity postoperatively compared with those with milder symptoms preoperatively but were more likely to report larger improvements and achieve clinically meaningful improvement in disability, pain, and mental health.
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Affiliation(s)
- Fatima N Anwar
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Wang J, Lu P, Armstrong M, El-Hayek K, Cleary S, Asbun H, Alseidi A, Wei A, Tran Cao HS. Advancing minimally invasive hepato-pancreato-biliary surgery: ensuring safety with implementation. Surg Endosc 2024:10.1007/s00464-024-10957-x. [PMID: 38886227 DOI: 10.1007/s00464-024-10957-x] [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: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Although minimally invasive hepato-pancreato-biliary (MIS HPB) surgery can be performed with good outcomes, there are currently no standardized requirements for centers or surgeons who wish to implement MIS HPB surgery. The aim of this study was to create a consensus statement regarding safe dissemination and implementation of MIS HPB surgical programs. METHODS Sixteen key questions regarding safety in MIS HPB surgery were generated after a focused literature search and iterative review by three field experts. Participants for the working group were then selected using sequential purposive sampling and snowball techniques. Review of the 16 questions took place over a single 2-h meeting. The senior author facilitated the session, and a modified nominal group technique was used. RESULTS Twenty three surgeons were in attendance. All participants agreed or strongly agreed that formal guidelines should exist for both institutions and individual surgeons interested in implementing MIS HPB surgery and that routine monitoring and reporting of institutional and surgeon technical outcomes should be performed. Regarding volume cutoffs, most participants (91%) agreed or strongly agreed that a minimum annual institutional volume cutoff for complex MIS HPB surgery, such as major hepatectomy or pancreaticoduodenectomy, should exist. A smaller proportion (74%) agreed or strongly agreed that a minimum annual surgeon volume requirement should exist. The majority of participants agreed or strongly agreed that surgeons were responsible for defining (100%) and enforcing (78%) guidelines to ensure the overall safety of MIS HPB programs. Finally, formal MIS HPB training, minimum case volume requirements, institutional support and infrastructure, and mandatory collection of outcomes data were all recognized as important aspects of safe implementation of MIS HPB surgery. CONCLUSIONS Safe implementation of MIS HPB surgery requires a thoughtful process that incorporates structured training, sufficient volume and expertise, a proper institutional ecosystem, and monitoring of outcomes.
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Affiliation(s)
- Jane Wang
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Pamela Lu
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Misha Armstrong
- Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, New York City, NY, USA
| | - Kevin El-Hayek
- Department of Surgery, The MetroHealth System, Cleveland, OH, USA
| | - Sean Cleary
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Horacio Asbun
- Department of Surgery, Baptist Health Miami Cancer Institute, Miami, FL, USA
| | - Adnan Alseidi
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Alice Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Hop S Tran Cao
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
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Greenberg S, Abou Assali M, Li Y, Bossie H, Neighorn C, Wu E, Mukherjee K. ROBOtic Care Outcomes Project for acute gallbladder pathology. J Trauma Acute Care Surg 2024; 96:971-979. [PMID: 38189678 DOI: 10.1097/ta.0000000000004240] [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: 01/09/2024]
Abstract
BACKGROUND Robotic cholecystectomy is being increasingly used for patients with acute gallbladder disease who present to the emergency department, but clinical evidence is limited. We aimed to compare the outcomes of emergent laparoscopic and robotic cholecystectomies in a large real-world database. METHODS Patients who received emergent laparoscopic or robotic cholecystectomies from 2020 to 2022 were identified from the Intuitive Custom Hospital Analytics database, based on deidentified extraction of electronic health record data from US hospitals. Conversion to open or subtotal cholecystectomy and complications were defined using ICD10 and/or CPT codes. Multivariate logistic regression with inverse probability treatment weighting (IPTW) was performed to compare clinical outcomes of laparoscopic versus robotic approach after balancing covariates. Cost analysis was performed with activity-based costing and adjustment for inflation. RESULTS Of 26,786 laparoscopic and 3,151 robotic emergent cholecystectomy patients being included, 64% were female, 60% were ≥45 years, and 24% were obese. Approximately 5.5% patients presented with pancreatitis, and 4% each presenting with sepsis and biliary obstruction. After IPTW, distributions of all baseline covariates were balanced. Robotic cholecystectomy decreased odds of conversion to open (odds ratio, 0.68; 95% confidence interval, 0.49-0.93; p = 0.035), but increased odds of subtotal cholecystectomy (odds ratio, 1.64; 95% confidence interval, 1.03-2.60; p = 0.037). Surgical site infection, readmission, length of stay, hospital acquired conditions, bile duct injury or leak, and hospital mortality were similar in both groups. There was no significant difference in hospital cost. CONCLUSION Robotic cholecystectomy has reduced odds of conversion to open and comparable complications, but increased odds of subtotal cholecystectomy compared with laparoscopic cholecystectomy for acute gallbladder diseases. Further work is required to assess the long-term implications of these differences. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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Affiliation(s)
- Shannon Greenberg
- From the Department of Surgery (S.G.), University of Indiana Medical Center, Indianapolis, Indiana; Division of Acute Care Surgery (M.A.A., K.M.), Loma Linda University Health, Loma Linda; Intuitive Surgical Inc. (Y.L., H.B., C.N.), Sunnyvale; and Division of Gastrointestinal and Minimally Invasive Surgery (E.W.), Loma Linda University Health, Loma Linda, California
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Lawson McLean A, Vetrano IG, Lawson McLean AC, Conti A, Mertens P, Müther M, Nemir J, Peschillo S, Santacroce A, Sarica C, Tuleasca C, Zoia C, Régis J. Revitalizing neurosurgical frontiers: The EANS frontiers in neurosurgery committee's strategic framework. BRAIN & SPINE 2024; 4:102794. [PMID: 38601776 PMCID: PMC11004717 DOI: 10.1016/j.bas.2024.102794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/12/2024]
Abstract
Introduction The field of neurosurgery faces challenges with the increasing involvement of other medical specialties in areas traditionally led by neurosurgeons. This paper examines the implications of this development for neurosurgical practice and patient care, with a focus on specialized areas like pain management, peripheral nerve surgery, and stereotactic radiosurgery. Research question To assess the implications of the expanded scope of other specialties for neurosurgical practice and to consider the response of the EANS Frontiers in Neurosurgery Committee to these challenges. Materials and methods Analysis of recent trends in neurosurgery, including the shift in various procedures to other specialties, demographic challenges, and the emergence of minimally invasive techniques. This analysis draws on relevant literature and the initiatives of the Frontiers in Neurosurgery Committee. Results We explore a possible decrease in neurosurgical involvement in certain areas, which may have implications for patient care and access to specialized neurosurgical interventions. The Frontiers in Neurosurgery Committee's role in addressing these concerns is highlighted, particularly in terms of training, education, research, and networking for neurosurgeons, especially those early in their careers. Discussion and conclusion The potential decrease in neurosurgical involvement in certain specialties warrants attention. This paper emphasizes the importance of carefully considered responses by neurosurgical societies, such as the EANS, to ensure neurosurgeons continue to play a vital role in managing neurological diseases. Emphasis on ongoing education, integration of minimally invasive techniques, and multidisciplinary collaboration is essential for maintaining the field's competence and quality in patient care.
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Affiliation(s)
- Aaron Lawson McLean
- Department of Neurosurgery, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena University Hospital, Jena, Germany
| | - Ignazio G. Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna C. Lawson McLean
- Department of Neurosurgery, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena University Hospital, Jena, Germany
| | - Alfredo Conti
- UOC Neurochirurgia, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
- Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Patrick Mertens
- Department of Neurosurgery, University Hospital of Neurology and Neurosurgery, Hospices Civils de Lyon, University Lyon 1, Lyon, France
| | - Michael Müther
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Jakob Nemir
- Department of Neurosurgery, University Hospital Center Zagreb, School of Medicine, Zagreb, Croatia
| | - Simone Peschillo
- Endovascular Neurosurgery, Unicamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Antonio Santacroce
- Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, Hamm, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
- European Radiosurgery Center Munich, Munich, Germany
| | - Can Sarica
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontatio, Canada
| | - Constantin Tuleasca
- Lausanne University Hospital (CHUV), Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland
- University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM), Lausanne, Switzerland
| | - Cesare Zoia
- UOC Neurochirurgia, Ospedale Moriggia Pelascini, Gravedona e Uniti, Italy
| | - Jean Régis
- Aix Marseille University, Department of Functional Neurosurgery, CHU Timone, Marseille, France
| | - EANS Frontiers in Neurosurgery Committee
- Department of Neurosurgery, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany
- Comprehensive Cancer Center Central Germany (CCCG), Jena University Hospital, Jena, Germany
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- UOC Neurochirurgia, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
- Alma Mater Studiorum Università di Bologna, Bologna, Italy
- Department of Neurosurgery, University Hospital of Neurology and Neurosurgery, Hospices Civils de Lyon, University Lyon 1, Lyon, France
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
- Department of Neurosurgery, University Hospital Center Zagreb, School of Medicine, Zagreb, Croatia
- Endovascular Neurosurgery, Unicamillus-Saint Camillus International University of Health Sciences, Rome, Italy
- Department of Neurosurgery, St. Barbara-Klinik Hamm-Heessen, Hamm, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
- European Radiosurgery Center Munich, Munich, Germany
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontatio, Canada
- Lausanne University Hospital (CHUV), Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne, Switzerland
- University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM), Lausanne, Switzerland
- UOC Neurochirurgia, Ospedale Moriggia Pelascini, Gravedona e Uniti, Italy
- Aix Marseille University, Department of Functional Neurosurgery, CHU Timone, Marseille, France
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Pham MH, Hernandez NS, Stone LE. Preoperative Robotics Planning Facilitates Complex Construct Design in Robot-Assisted Minimally Invasive Adult Spinal Deformity Surgery-A Preliminary Experience. J Clin Med 2024; 13:1829. [PMID: 38610594 PMCID: PMC11012283 DOI: 10.3390/jcm13071829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: The correction of adult spinal deformity (ASD) can require long, complex constructs with multiple rods which traverse important biomechanical levels to achieve multi-pelvic fixation. Minimally invasive (MIS) placement of these constructs has historically been difficult. Advanced technologies such as spinal robotics platforms can facilitate the design and placement of these constructs and further enable these surgical approaches in MIS deformity surgery. (2) Methods: A retrospective study was performed on a series of ASD patients undergoing MIS deformity correction with ≥eight fusion levels to the lower thoracic spine with preoperative robotic construct planning and robot-assisted pedicle screw placement. (3) Results: There were 12 patients (10 female, mean age 68.6 years) with a diagnosis of either degenerative scoliosis (8 patients) or sagittal imbalance (4 patients). All underwent preoperative robotic planning to assist in MIS robot-assisted percutaneous or transfascial placement of pedicle and iliac screws with multiple-rod constructs. Mean operative values per patient were 9.9 levels instrumented (range 8-11), 3.9 interbody cages (range 2-6), 3.3 iliac fixation points (range 2-4), 3.3 rods (range 2-4), 18.7 screws (range 13-24), estimated blood loss 254 cc (range 150-350 cc), and operative time 347 min (range 242-442 min). All patients showed improvement in radiographic sagittal, and, if applicable, coronal parameters. Mean length of stay was 5.8 days with no ICU admissions. Ten patients ambulated on POD 1 or 2. Of 224 screws placed minimally invasively, four breaches were identified on intraoperative CT and repositioned (three lateral, one medial) for a robot-assisted screw accuracy of 98.2%. (4) Conclusions: Minimally invasive long-segment fixation for adult spinal deformity surgery has historically been considered laborious and technically intensive. Preoperative robotics planning facilitates the design and placement of even complex multi-rod multi-pelvic fixation for MIS deformity surgery.
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Affiliation(s)
- Martin H. Pham
- Department of Neurosurgery, UC San Diego School of Medicine, University of California, San Diego, CA 92037, USA (L.E.S.)
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Vaswani R. Editorial Commentary: Nonoperative Management Is the First Line of Treatment for Hip Femoroacetabular Impingement in Adolescents: Children Are Not Little Adults! Arthroscopy 2023; 39:2474-2476. [PMID: 37981389 DOI: 10.1016/j.arthro.2023.05.009] [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: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 11/21/2023]
Abstract
Adult patients undergoing hip arthroscopy who experience preoperative symptoms for a longer duration have worse outcomes postoperatively compared with those symptomatic for a shorter duration. Ongoing femoroacetabular impingement (FAI) may lead to worse damage that may not be fully reparable and could be used as evidence for early surgery. However, the same reasoning may not be applicable to adolescents for whom nonoperative treatment remains the first line of treatment for FAI. Many newly symptomatic FAI patients may actually have biomechanically treatable pathology of their hip, core, or spine, making their FAI symptomatic, and if these biomechanical factors can be corrected, the FAI may become asymptomatic. Patients with low pelvic incidence are "hip users" who compensate for their pelvic issue by increasing hip range of motion, making them more prone to symptomatic FAI and leading to degenerative changes from impingement. Only after failure to improve after a full course of physical therapy is established should adolescent patients and parents be counseled on hip arthroscopy as an appropriate treatment option.
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Singh A, Schooley B, Floyd SB, Pill SG, Brooks JM. Patient preferences as human factors for health data recommender systems and shared decision making in orthopaedic practice. Front Digit Health 2023; 5:1137066. [PMID: 37408539 PMCID: PMC10318339 DOI: 10.3389/fdgth.2023.1137066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/05/2023] [Indexed: 07/07/2023] Open
Abstract
Background A core set of requirements for designing AI-based Health Recommender Systems (HRS) is a thorough understanding of human factors in a decision-making process. Patient preferences regarding treatment outcomes can be one important human factor. For orthopaedic medicine, limited communication may occur between a patient and a provider during the short duration of a clinical visit, limiting the opportunity for the patient to express treatment outcome preferences (TOP). This may occur despite patient preferences having a significant impact on achieving patient satisfaction, shared decision making and treatment success. Inclusion of patient preferences during patient intake and/or during the early phases of patient contact and information gathering can lead to better treatment recommendations. Aim We aim to explore patient treatment outcome preferences as significant human factors in treatment decision making in orthopedics. The goal of this research is to design, build, and test an app that collects baseline TOPs across orthopaedic outcomes and reports this information to providers during a clinical visit. This data may also be used to inform the design of HRSs for orthopaedic treatment decision making. Methods We created a mobile app to collect TOPs using a direct weighting (DW) technique. We used a mixed methods approach to pilot test the app with 23 first-time orthopaedic visit patients presenting with joint pain and/or function deficiency by presenting the app for utilization and conducting qualitative interviews and quantitative surveys post utilization. Results The study validated five core TOP domains, with most users dividing their 100-point DW allocation across 1-3 domains. The tool received moderate to high usability scores. Thematic analysis of patient interviews provides insights into TOPs that are important to patients, how they can be communicated effectively, and incorporated into a clinical visit with meaningful patient-provider communication that leads to shared decision making. Conclusion Patient TOPs may be important human factors to consider in determining treatment options that may be helpful for automating patient treatment recommendations. We conclude that inclusion of patient TOPs to inform the design of HRSs results in creating more robust patient treatment profiles in the EHR thus enhancing opportunities for treatment recommendations and future AI applications.
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Affiliation(s)
- Akanksha Singh
- Department of Integrated Information Technology, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
- Center for Effectiveness Research in Orthopaedics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Benjamin Schooley
- Center for Effectiveness Research in Orthopaedics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Electrical and Computer Engineering, Ira A. Fulton College of Engineering, Brigham Young University, Provo, UT, United States
| | - Sarah B. Floyd
- Center for Effectiveness Research in Orthopaedics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Stephen G. Pill
- Orthopedic Sports Medicine, Shoulder Orthopedic Surgery, PRISMA Health, Greenville, SC, United States
| | - John M. Brooks
- Center for Effectiveness Research in Orthopaedics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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Comparison of full-endoscopic foraminoplasty and lumbar discectomy (FEFLD), unilateral biportal endoscopic (UBE) discectomy, and microdiscectomy (MD) for symptomatic lumbar disc herniation. 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 2023; 32:542-554. [PMID: 36571643 DOI: 10.1007/s00586-022-07510-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/14/2022] [Accepted: 12/15/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE This study aimed to evaluate the clinical outcomes of full-endoscopic foraminoplasty and lumbar discectomy (FEFLD), unilateral biportal endoscopic (UBE) discectomy, and microdiscectomy (MD) in the treatment of symptomatic lumbar disc herniation (LDH). METHODS From January 2020 and May 2021, 128 patients with single-level LDH at L4-5 or L5-S1 received FEFLD, UBE discectomy or MD. Patients were divided into three groups according to surgical method: the FEFLD group (n = 43), the UBE group (n = 42), and the MD group (n = 43). Operative time, fluoroscopy frequency, in-bed time, length of hospital stays, total expenses, complications, visual analogue scale (VAS, 0-10), and Oswestry Disability Index (ODI, 0-100%) were assessed and compared among three groups. RESULTS There were no significant differences in VAS or ODI scores at 12 months after surgery among three groups. In comparison with the MD group, the FEFLD and UBE group yield better VAS scores for back pain on the first day following surgery (P < 0.05). The FEFLD group was superior to the UBE group or MD group with less time in bed and shorter hospital stay (P < 0.05). The operation time and total expenses in the UBE group were significantly longer and higher than those in the FEFLD group or MD group (P < 0.05). CONCLUSIONS FEFLD and UBE discectomy yield comparable results to conventional MD concerning pain relief and functional outcomes. In addition, FEFLD and UBE discectomy enable less back pain in the immediate postoperative period. FEFLD offers advantages in rapid recovery. Conventional MD is still an efficient and cost-effective surgical procedure.
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Tang J, White CA, Arvind V, Cho S, Kim JS, Steinberger J. What Are Patients Saying About Minimally Invasive Spine Surgeons Online: A Sentiment Analysis of 2,235 Physician Review Website Reviews. Cureus 2022; 14:e24113. [PMID: 35573577 PMCID: PMC9106264 DOI: 10.7759/cureus.24113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/05/2022] Open
Abstract
Objective Physician review websites are becoming increasingly popular for patients to find and review healthcare providers. The goal of this study was to utilize quantitative analyses to understand trends in ratings and written comments on physician review websites for Society of Minimally Invasive Spine Surgery (SMISS) members. Methods This is a cross-sectional study. The reviews of SMISS surgeons were obtained from healthgrades.com, and sentiment analysis was used to obtain compound scores of each physicians' reviews. SMISS surgeons who were international or had fewer than three written reviews, often consisting of residents and fellows, were excluded. Inferential statistics were utilized, and word frequency analysis reported the phrases used to characterize reviews. Results One hundred sixty-nine surgeons met the inclusion criteria. 98.6% were males and the mean age was 51.7 years old. A total of 2,235 written reviews were analyzed. Younger surgeons were significantly more likely to receive higher star ratings (p<0.01). Positive behavioral characteristics, such as “kind” and “bedside manner,” conferred significantly improved odds of receiving positive reviews (p<0.01). Ancillary “staff” conferred a 2x greater odds of receiving a positive review whereas a comment on “wait” times halved a surgeon’s odds (p<0.01). Sentences describing pain drove down the odds of positive reviews whereas those describing pain relief produced greater odds of positive reviews (p<0.01). Conclusion Physicians who were younger, personable, provided sufficient pain relief, and who worked in favorable offices received the most positive reviews. This study informs SMISS members on the traits deemed important by patients who ultimately review surgeons online.
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