1
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Serban AM, Ionescu NS. Surgical patient registries: scoping study of challenges and solutions. J Public Health Policy 2023; 44:523-534. [PMID: 37726394 DOI: 10.1057/s41271-023-00442-5] [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] [Accepted: 08/25/2023] [Indexed: 09/21/2023]
Abstract
Patient surgical registries are essential tools for public health specialists, creating research opportunities through linkage of registry data with healthcare outcomes. However, little is known regarding data error sources in the management of surgical registries. In June 2022, we undertook a scoping study of the empirical literature including publications selected from the PUBMED and EMBASE databases. We selected 48 studies focussing on shared experiences centred around developing surgical patient registries. We identified seven types of data specific challenges, grouped in three categories- data capture, data analysis and result dissemination. Most studies underlined the risk for a high volume of missing data, non-uniform geographic representation, inclusion biases, inappropriate coding, as well as variations in analysis reporting and limitations related to the statistical analysis. Finally, to expand data usability, we discussed cost-effective ways of addressing these limitations, by citing aspects from the protocols followed by established exemplary registries.
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Affiliation(s)
- Andreea Madalina Serban
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474, Bucharest, Romania.
- Maria Sklodowska Curie Emergency Hospital for Children, 20 Brancoveanu Blvd., 077120, Bucharest, Romania.
| | - Nicolae Sebastian Ionescu
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474, Bucharest, Romania
- Maria Sklodowska Curie Emergency Hospital for Children, 20 Brancoveanu Blvd., 077120, Bucharest, Romania
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2
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Nie JW, Hartman TJ, MacGregor KR, Oyetayo OO, Zheng E, Federico VP, Massel DH, Sayari AJ, Singh K. Preoperative predictors of prolonged hospitalization in patients undergoing lateral lumbar interbody fusion. Acta Neurochir (Wien) 2023; 165:2615-2624. [PMID: 37318634 DOI: 10.1007/s00701-023-05648-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE We aim to examine the preoperative factors associated with increased postoperative length of stay in patients undergoing LLIF in the hospital setting. METHODS Patient demographics, perioperative characteristics, and patient-reported outcome measures (PROMs) were collected from a single-surgeon database. Patients undergoing LLIF in the hospital setting were separated into postoperative LOS <48 h (H) and LOS ≥ 48H. Univariate analysis for preoperative characteristics was utilized to determine covariates for multivariable logistic regression. Multivariable logistic regression was then utilized to determine significant predictors of extended postoperative length of stay. Secondary univariate analysis of inpatient complications, operative, and postoperative characteristics were calculated to determine postoperative factors associated with prolonged hospitalization. RESULTS Two-hundred and forty patients were identified with 115 patients' LOS ≥ 48H. Univariate analysis identified age/Charlson Comorbidity Index (CCI) score/gender/insurance type/number of contiguous fused levels/preoperative PROMs of Visual Analog Scale (VAS) back/VAS leg/Patient-Reported Outcomes Measurement Information System (PROMIS-PF)/Oswestry Disability Index (ODI)/degenerative spondylolisthesis diagnoses/foraminal stenosis/central stenosis for multivariable logistic regression. Multivariable logistic regression calculated significant positive predictors of LOS ≥ 48H to be age/3-level fusion/preoperative ODI scores. Negative predictors of LOS ≥ 48H were the diagnosis of foraminal stenosis/preoperative PROMIS-PF/male gender. The secondary analysis determined that patients with longer operative time/estimated blood loss/transfusion/postoperative day 0 and 1 pain and narcotic consumption/complications of altered mental status/postoperative anemia/fever/ileus/urinary retention were associated with prolonged hospitalization. CONCLUSION Older patients undergoing LLIF with greater preoperative disability and 3-level fusion were more likely to require prolonged hospitalization. Male patients with higher preoperative physical function and who were diagnosed with foraminal stenosis were less likely to require prolonged hospitalization.
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Affiliation(s)
- James W Nie
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Timothy J Hartman
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Keith R MacGregor
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Omolabake O Oyetayo
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Eileen Zheng
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Vincent P Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Dustin H Massel
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Arash J Sayari
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA.
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3
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Sherrod BA, Michalopoulos GD, Mulvaney G, Agarwal N, Chan AK, Asher AL, Coric D, Virk MS, Fu KM, Foley KT, Park P, Upadhyaya CD, Knightly JJ, Shaffrey ME, Potts EA, Shaffrey CI, Gottfried ON, Than KD, Wang MY, Tumialán LM, Chou D, Mummaneni PV, Bydon M, Bisson EF. Development of new postoperative neck pain at 12 and 24 months after surgery for cervical spondylotic myelopathy: a Quality Outcomes Database study. J Neurosurg Spine 2023; 38:357-365. [PMID: 36308471 DOI: 10.3171/2022.9.spine22611] [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: 05/31/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Patients who undergo surgery for cervical spondylotic myelopathy (CSM) will occasionally develop postoperative neck pain that was not present preoperatively, yet the incidence of this phenomenon is unclear. The authors aimed to elucidate patient and surgical factors associated with new-onset sustained pain after CSM surgery. METHODS The authors reviewed data from the Quality Outcomes Database (QOD) CSM module. The presence of neck pain was defined using the neck pain numeric rating scale (NRS). Patients with no neck pain at baseline (neck NRS score ≤ 1) were then stratified based on the presence of new postoperative pain development (neck NRS score ≥ 2) at 12 and 24 months postoperatively. RESULTS Of 1141 patients in the CSM QOD, 224 (19.6%) reported no neck pain at baseline. Among 170 patients with no baseline neck pain and available 12-month follow-up, 46 (27.1%) reported new postoperative pain. Among 184 patients with no baseline neck pain and available 24-month follow-up, 53 (28.8%) reported new postoperative pain. The mean differences in neck NRS scores were 4.3 for those with new postoperative pain compared with those without at 12 months (4.4 ± 2.2 vs 0.1 ± 0.3, p < 0.001) and 3.9 at 24 months (4.1 ± 2.4 vs 0.2 ± 0.4, p < 0.001). The majority of patients reporting new-onset neck pain reported being satisfied with surgery, but their satisfaction was significantly lower compared with patients without pain at the 12-month (66.7% vs 94.3%, p < 0.001) and 24-month (65.4% vs 90.8%, p < 0.001) follow-ups. The baseline Neck Disability Index (NDI) was an independent predictor of new postoperative neck pain at both the 12-month and 24-month time points (adjusted OR [aOR] 1.04, 95% CI 1.01-1.06; p = 0.002; and aOR 1.03, 95% CI 1.01-1.05; p = 0.026, respectively). The total number of levels treated was associated with new-onset neck pain at 12 months (aOR 1.34, 95% CI 1.09-1.64; p = 0.005), and duration of symptoms more than 3 months was a predictor of 24-month neck pain (aOR 3.22, 95% CI 1.01-10.22; p = 0.048). CONCLUSIONS Increased NDI at baseline, number of levels treated surgically, and duration of symptoms longer than 3 months preoperatively correlate positively with the risk of new-onset neck pain following CSM surgery. The majority of patients with new-onset neck pain still report satisfaction from surgery, suggesting that the risk of new-onset neck pain should not hinder indicated operations from being performed.
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Affiliation(s)
- Brandon A Sherrod
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | | | - Graham Mulvaney
- 3Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas Health Care System, Charlotte, North Carolina
| | - Nitin Agarwal
- 4Department of Neurosurgery, University of California, San Francisco, California
| | - Andrew K Chan
- 5Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Anthony L Asher
- 3Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas Health Care System, Charlotte, North Carolina
| | - Domagoj Coric
- 3Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas Health Care System, Charlotte, North Carolina
| | - Michael S Virk
- 6Department of Neurosurgery, Weill Cornell Medical College, New York, New York
| | - Kai-Ming Fu
- 6Department of Neurosurgery, Weill Cornell Medical College, New York, New York
| | - Kevin T Foley
- 7Department of Neurosurgery, University of Tennessee and Semmes Murphey Clinic, Memphis, Tennessee
| | - Paul Park
- 8Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Cheerag D Upadhyaya
- 9Saint Luke's Neurological and Spine Surgery, Kansas City, Missouri
- 10Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina
| | - John J Knightly
- 11Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Mark E Shaffrey
- 12Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Eric A Potts
- 13Department of Neurosurgery, Indiana University; Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | | | - Oren N Gottfried
- 5Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Khoi D Than
- 5Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Michael Y Wang
- 14Department of Neurosurgery, University of Miami, Florida; and
| | | | - Dean Chou
- 4Department of Neurosurgery, University of California, San Francisco, California
| | - Praveen V Mummaneni
- 4Department of Neurosurgery, University of California, San Francisco, California
| | - Mohamad Bydon
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Erica F Bisson
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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4
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Pande A, Ghosh S. The Hawthorne Effect: Quality and Outcomes in Neurosurgery. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 130:207-216. [PMID: 37548741 DOI: 10.1007/978-3-030-12887-6_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Measure something, and it gets better-this is what is called as the Hawthorne effect (also known as the observer effect). The Hawthorne factory experiments in 1920s were remarkable industrial data collection and analysis exercises that lead to Edwards Deming's quality revolution. The Harvard Medical Practice Study (1991), Leape's "Error in Medicine" (1994), and the Bristol pediatric cardiac report (2001) are among many documents that have revealed the huge gap between best practices and actual medical practice. Alarmed by the poor standards of quality at the most respected institutions, the medical fraternity therefore began visiting facilities in different fields and observing their quality assessment processes. The next leap for neurosurgery is to realize that it is unacceptable to treat patients with no regard for the standard of clinical outcomes. The traditional neurosurgery residency training has long ignored the most important issues of self-assessment, reappraisal, relearning, and measurement of skill and surgical outcomes. However, the experience taken from disparate fields, especially cardiac surgery, may encourage research and progress in measurement and improvement of quality in neurosurgery. Like cardiac surgeons, neurosurgeons must examine and analyze the results of their interventions. The concept of quality measurement is the most important single advance we can make in neurosurgery practice. Meticulous and precise measurement of outcomes will allow future progress of our specialty.
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Affiliation(s)
- Anil Pande
- Institute of Neurosciences, Apollo Hospitals OMR and Vanagaram, Chennai, Tamil Nadu, India.
| | - Siddhartha Ghosh
- Institute of Neurosciences, Apollo Hospitals OMR and Vanagaram, Chennai, Tamil Nadu, India
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5
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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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6
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Rolle ML, Garba DL, Griswold DP, Fernández LL, Sánchez DM, Clavijo A, Rubiano AM. Implementing a Neurotrauma Registry in Latin America and the Caribbean. J Neurosci Rural Pract 2022; 13:525-528. [PMID: 35946020 PMCID: PMC9357496 DOI: 10.1055/s-0042-1745816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background
Traumatic brain injury (TBI) has a disproportionately greater impact in low- and middle-income countries (LMICs). One strategy to reduce the burden of disease in LMICs is through the implementation of a trauma registry that standardizes the assessment of each patient's management of care.
Objective
This study aims to ascertain the interest of Latin America and the Caribbean (LAC) nations in establishing a shared neurotrauma registry in the regional block, based on an existing framework for collaboration.
Methods
A descriptive review was performed regarding the interests of LAC nations in implementing a shared neurotrauma registry in their region. We convened a meeting with seven Caribbean and five Latin American nations.
Results
One hundred percent (
n
= 12) of the LAC representatives including neurosurgeons, neurointensivists, ministers of health, and chief medical officers/emergency medical technicians (EMTs) agreed to adopt the registry for tracking the burden of TBI and associated pathologies within the region.
Conclusion
The implementation of a neurotrauma registry can benefit the region through a shared database to track disease, improve outcomes, build research, and ultimately influence policy.
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Affiliation(s)
- Myron L. Rolle
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
| | - Deen L. Garba
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
| | - Dylan P. Griswold
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Laura L. Fernández
- INUB-MEDITECH Research Group, Institute of Neurosciences, Universidad El Bosque, Bogotá, Colombia
| | - Diana M. Sánchez
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
- INUB-MEDITECH Research Group, Institute of Neurosciences, Universidad El Bosque, Bogotá, Colombia
- Fellow Global Neurosurgery and Trauma, Cambridge University and Meditech Foundation, Cambridge, United Kindom and Cali, Colombia
| | - Angelica Clavijo
- INUB-MEDITECH Research Group, Institute of Neurosciences, Universidad El Bosque, Bogotá, Colombia
| | - Andrés M. Rubiano
- INUB-MEDITECH Research Group, Institute of Neurosciences, Universidad El Bosque, Bogotá, Colombia
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7
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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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8
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Iihara K, Saito N, Suzuki M, Date I, Fujii Y, Houkin K, Inoue T, Iwama T, Kawamata T, Kim P, Kinouchi H, Kishima H, Kohmura E, Kurisu K, Maruyama K, Matsumaru Y, Mikuni N, Miyamoto S, Morita A, Nakase H, Narita Y, Nishikawa R, Nozaki K, Ogasawara K, Ohata K, Sakai N, Sakamoto H, Shiokawa Y, Takahashi JC, Ueki K, Wakabayashi T, Yoshimoto K, Arai H, Tominaga T. The Japan Neurosurgical Database: Statistics Update 2018 and 2019. Neurol Med Chir (Tokyo) 2021; 61:675-710. [PMID: 34732592 PMCID: PMC8666296 DOI: 10.2176/nmc.st.2021-0254] [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] [Indexed: 11/20/2022] Open
Abstract
Each year, the Japan Neurosurgical Society (JNS) reports up-to-date statistics from the Japan Neurosurgical Database regarding case volume, patient demographics, and in-hospital outcomes of the overall cohort and neurosurgical subgroup according to the major classifications of main diagnosis. We hereby report patient demographics, in-hospital mortality, length of hospital stay, purpose of admission, number of medical management, direct surgery, endovascular treatment, and radiosurgery of the patients based on the major classifications and/or main diagnosis registered in 2018 and 2019 in the overall cohort (523283 and 571143 patients, respectively) and neurosurgical subgroup (177184 and 191595 patients, respectively). The patient demographics, disease severity, proportion of purpose of admission (e.g., operation, 33.9-33.5%) and emergent admission (68.4-67.8%), and in-hospital mortality (e.g., cerebrovascular diseases, 6.3-6.5%; brain tumor, 3.1-3%; and neurotrauma, 4.3%) in the overall cohort were comparable between 2018 and 2019. In total, 207783 and 225217 neurosurgical procedures were performed in the neurosurgical subgroup in 2018 and 2019, respectively, of which endovascular treatment comprised 19.1% and 20.3%, respectively. Neurosurgical management of chronic subdural hematoma (19.4-18.9%) and cerebral aneurysm (15.4-14.8%) was most common. Notably, the proportion of management of ischemic stroke/transient ischemic attack, including recombinant tissue plasminogen activator infusion and endovascular acute reperfusion therapy, increased from 7.5% in 2018 to 8.8% in 2019. The JNS statistical update represents a critical resource for the lay public, policy makers, media professionals, neurosurgeons, healthcare administrators, researchers, health advocates, and others seeking the best available data on neurosurgical practice.
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Affiliation(s)
- Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | | | - Michiyasu Suzuki
- Department of Advanced ThermoNeuroBiology, Yamaguchi University Graduate School of Medicine
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University School of Medicine
| | - Toru Iwama
- Department of Neurosurgery, Gifu University School of Medicine
| | | | - Phyo Kim
- Department of Neurologic Surgery, Utsunomiya Neurospine Center
| | - Hiroyuki Kinouchi
- Department of Neurosurgery, University of Yamanashi Interdisciplinary Graduate School of Medicine
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Eiji Kohmura
- Kinki Central Hospital of the Mutual Aid Association of Public School Teachers
| | - Kaoru Kurisu
- Department of Neurosurgery, Chugoku Rosai Hospital
| | - Keisuke Maruyama
- Department of Neurosurgery, Kyorin University, School of Medicine
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | | | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School
| | | | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science
| | | | | | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital
| | - Hiroaki Sakamoto
- Department of Pediatric Neurosurgery, Osaka City General Hospital
| | | | - Jun C Takahashi
- Department of Neurosurgery, Kindai University Faculty of Medicine
| | - Keisuke Ueki
- Department of Neurologic Surgery, Dokkyo Medical University
| | | | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University
| | | | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine
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9
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Tsolinas RE, Burke JF, DiGiorgio AM, Thomas LH, Duong-Fernandez X, Harris MH, Yue JK, Winkler EA, Suen CG, Pascual LU, Ferguson AR, Huie JR, Pan JZ, Hemmerle DD, Singh V, Torres-Espin A, Omondi C, Kyritsis N, Haefeli J, Weinstein PR, de Almeida Neto CA, Kuo YH, Taggard D, Talbott JF, Whetstone WD, Manley GT, Bresnahan JC, Beattie MS, Dhall SS. Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI): an overview of initial enrollment and demographics. Neurosurg Focus 2021; 48:E6. [PMID: 32357323 DOI: 10.3171/2020.2.focus191030] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/14/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Traumatic spinal cord injury (SCI) is a dreaded condition that can lead to paralysis and severe disability. With few treatment options available for patients who have suffered from SCI, it is important to develop prospective databases to standardize data collection in order to develop new therapeutic approaches and guidelines. Here, the authors present an overview of their multicenter, prospective, observational patient registry, Transforming Research and Clinical Knowledge in SCI (TRACK-SCI). METHODS Data were collected using the National Institute of Neurological Disorders and Stroke (NINDS) common data elements (CDEs). Highly granular clinical information, in addition to standardized imaging, biospecimen, and follow-up data, were included in the registry. Surgical approaches were determined by the surgeon treating each patient; however, they were carefully documented and compared within and across study sites. Follow-up visits were scheduled for 6 and 12 months after injury. RESULTS One hundred sixty patients were enrolled in the TRACK-SCI study. In this overview, basic clinical, imaging, neurological severity, and follow-up data on these patients are presented. Overall, 78.8% of the patients were determined to be surgical candidates and underwent spinal decompression and/or stabilization. Follow-up rates to date at 6 and 12 months are 45% and 36.3%, respectively. Overall resources required for clinical research coordination are also discussed. CONCLUSIONS The authors established the feasibility of SCI CDE implementation in a multicenter, prospective observational study. Through the application of standardized SCI CDEs and expansion of future multicenter collaborations, they hope to advance SCI research and improve treatment.
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Affiliation(s)
- Rachel E Tsolinas
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of
| | - John F Burke
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery
| | - Anthony M DiGiorgio
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery
| | - Leigh H Thomas
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - Xuan Duong-Fernandez
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - Mark H Harris
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - John K Yue
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery
| | - Ethan A Winkler
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery
| | - Catherine G Suen
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery
| | - Lisa U Pascual
- 4Orthopaedic Surgery and Orthopedic Trauma Institute, Zuckerberg San Francisco General Hospital.,5Orthopedic Surgery
| | - Adam R Ferguson
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience.,6San Francisco Veterans Affairs Healthcare System
| | - J Russell Huie
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - Jonathan Z Pan
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,7Anesthesia and Perioperative Care
| | - Debra D Hemmerle
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - Vineeta Singh
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,3Weill Institutes for Neuroscience.,8Neurology, and
| | - Abel Torres-Espin
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery
| | - Cleopa Omondi
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - Nikos Kyritsis
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - Jenny Haefeli
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery
| | - Philip R Weinstein
- 2Neurological Surgery.,3Weill Institutes for Neuroscience.,9Institute for Neurodegenerative Diseases, Spine Center, University of California San Francisco
| | - Carlos A de Almeida Neto
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - Yu-Hung Kuo
- 12Department of Neurological Surgery, University of California San Francisco-Fresno, Fresno, California
| | - Derek Taggard
- 12Department of Neurological Surgery, University of California San Francisco-Fresno, Fresno, California
| | - Jason F Talbott
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,10Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital, San Francisco; and
| | | | - Geoffrey T Manley
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery
| | - Jacqueline C Bresnahan
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - Michael S Beattie
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery.,3Weill Institutes for Neuroscience
| | - Sanjay S Dhall
- 1Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital; Departments of.,2Neurological Surgery
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10
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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).
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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
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11
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Algattas H, Talentino SE, Eichar B, Williams AA, Murphy JM, Zhang X, Garcia RM, Newhouse D, Jaman E, Safonova A, Fields D, Chow I, Engh J, Amankulor NM. Venous Thromboembolism Anticoagulation Prophylaxis Timing in Patients Undergoing Craniotomy for Tumor. NEUROSURGERY OPEN 2021. [DOI: 10.1093/neuopn/okaa018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Regional Variance in Disability and Quality-of-Life Outcomes After Surgery for Grade I Degenerative Lumbar Spondylolisthesis: A Quality Outcomes Database Analysis. World Neurosurg 2020; 138:e336-e344. [PMID: 32113995 DOI: 10.1016/j.wneu.2020.02.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Regional differences in outcomes after spine surgery are poorly understood. We assessed disability and quality-of-life outcomes by geographic region in the United States using the NeuroPoint Alliance Quality Outcomes Database. METHODS We queried the prospective Quality Outcomes Database patient registry to identify patients who underwent elective 1- or 2-level lumbar surgery for grade I degenerative spondylolisthesis from July 2014 through June 2016. Primary outcome measures included Oswestry Disability Index (ODI) and EuroQOL-5D (EQ-5D) reported at 24 months postoperatively. Differences in EQ-5D and ODI were compared across geographic regions of the United States (Northeast, Midwest, South, West). RESULTS We identified 608 patients from 12 centers who underwent surgery. Of these, 517 (85.0%) had ODI data and 492 (80.9%) had EQ-5D data at 24 months. Southern states had the largest representation (304 patients; 5 centers), followed by Northeastern (114 patients; 3 centers), Midwestern (96 patients; 2 centers), and Western (94 patients; 2 centers) states. Baseline ODI scores were significantly different among regions, with the South having the greatest baseline disability burden (Northeast: 40.9 ± 16.9, South: 51.2 ± 15.8, Midwest: 40.9 ± 17.8, West: 45.0 ± 17.1, P < 0.001). The change in ODI at 24 months postoperatively was significantly different among regions, with the South showing the greatest ODI improvement (Northeast: -21.1 ± 18.2, South: -26.5 ± 20.2, Midwest: -18.2 ± 22.9, West: -21.7 ± 19.6, P < 0.001). All regions had ≥60% achievement of the minimum clinically important difference in ODI at 24 months postoperatively. No regional differences were observed for EQ-5D. CONCLUSION Significant regional variation exists for disability outcomes, but not quality of life, at 24 months after spinal surgery for grade I degenerative spondylolisthesis.
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13
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Rybkin I, Azizkhanian I, Gary J, Cole C, Schmidt M, Gandhi C, Al-Mufti F, Anderson P, Santarelli J, Bowers C. Unique Neurosurgical Morbidity and Mortality Conference Characteristics: A Comprehensive Literature Review of Neurosurgical Morbidity and Mortality Conference Practices with Proposed Recommendations. World Neurosurg 2020; 135:48-57. [DOI: 10.1016/j.wneu.2019.11.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022]
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14
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Reponen E, Tuominen H, Korja M. Quality of British and American Nationwide Quality of Care and Patient Safety Benchmarking Programs: Case Neurosurgery. Neurosurgery 2019; 85:500-507. [PMID: 30165390 DOI: 10.1093/neuros/nyy380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 07/19/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Multiple nationwide outcome registries are utilized for quality benchmarking between institutions and individual surgeons. OBJECTIVE To evaluate whether nationwide quality of care programs in the United Kingdom and United States can measure differences in neurosurgical quality. METHODS This prospective observational study comprised 418 consecutive adult patients undergoing elective craniotomy at Helsinki University Hospital between December 7, 2011 and December 31, 2012.We recorded outcome event rates and categorized them according to British Neurosurgical National Audit Programme (NNAP), American National Surgical Quality Improvement Program (NSQIP), and American National Neurosurgery Quality and Outcomes Database (N2QOD) to assess the applicability of these programs for quality benchmarking and estimated sample sizes required for reliable quality comparisons. RESULTS The rate of in-hospital major and minor morbidity was 18.7% and 38.0%, respectively, and 30-d mortality rate was 2.4%. The NSQIP criteria identified 96.2% of major but only 38.4% of minor complications. N2QOD performed better, but almost one-fourth (23.2%) of all patients with adverse outcomes, mostly minor, went unnoticed. For NNAP, a sample size of over 4200 patients per surgeon is required to detect a 50.0% increase in mortality rates between surgeons. The sample size required for reliable comparisons between the rates of complications exceeds 600 patients per center per year. CONCLUSION The implemented benchmarking programs in the United Kingdom and United States fail to identify a considerable number of complications in a high-volume center. Health care policy makers should be cautious as outcome comparisons between most centers and individual surgeons are questionable if based on the programs.
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Affiliation(s)
- Elina Reponen
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Tuominen
- Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Chotai S, Khan I, Nian H, Archer KR, Harrell FE, Weisenthal BM, Bydon M, Asher AL, Devin CJ. Utility of Anxiety/Depression Domain of EQ-5D to Define Psychological Distress in Spine Surgery. World Neurosurg 2019; 126:e1075-e1080. [DOI: 10.1016/j.wneu.2019.02.211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 12/11/2022]
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16
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A Strategy for Risk-adjusted Ranking of Surgeons and Practices Based on Patient-reported Outcomes After Elective Lumbar Surgery. Spine (Phila Pa 1976) 2019; 44:670-677. [PMID: 30312268 DOI: 10.1097/brs.0000000000002894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This study retrospectively analyzes prospectively collected data. OBJECTIVE The primary aim of this study is to present a scheme for patient-reported outcome (PRO)-based, risk-adjusted rankings of spine surgeons and sites that perform elective lumbar surgery, using the Quality and Outcomes Database (QOD). SUMMARY OF BACKGROUND DATA There is currently no means of determining which spine surgeons or centers are positive or negative outliers with respect to PROs for elective lumbar surgery. This is a critical gap as we move toward a value-based model of health care in which providers assume more accountability for the effectiveness of their treatments. METHODS Random effects regression models were fit for the following outcomes, with QOD site as a fixed effect but surgeon ID as a random effect: Oswestry Disability Index, EQ-5D, back pain and leg pain, and satisfaction. Hierarchical Bayesian models were also fit for each outcome, with QOD site as a random effect and surgeon as a nested random effect. RESULTS Our study cohort consists of 8834 patients who underwent surgery by 124 QOD surgeons, for the degenerative lumbar diseases. Nonoverlapping Bayesian credible intervals demonstrate that the variance attributed to QOD site was greater than the nested variance attributed to surgeon ID for the included PROs. CONCLUSION This study presents a novel strategy for the risk-adjusted, PRO-based ranking of spine surgeons and practices. This can help identify positive and negative outliers, thereby forming the basis for large-scale quality improvement. Assuming adequate coverage of baseline risk adjustment, the choice of surgeon matters when considering PROs after lumbar surgery; however, the choice of site appears to matter more. LEVEL OF EVIDENCE 3.
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Rock AK, Opalak CF, Workman KG, Broaddus WC. Safety Outcomes Following Spine and Cranial Neurosurgery: Evidence From the National Surgical Quality Improvement Program. J Neurosurg Anesthesiol 2018; 30:328-336. [PMID: 29135700 DOI: 10.1097/ana.0000000000000474] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was used to establish predictors for 30-day postoperative complications following spine and cranial neurosurgery. MATERIALS AND METHODS The ACS-NSQIP participant use files were queried for neurosurgical cases between 2005 and 2015. Prevalence of postoperative complications following neurosurgery was determined. Nested multivariable logistic regression analysis was used to identify demographic, comorbidity, and perioperative characteristics associated with any complication and mortality for spine and cranial surgery. RESULTS There were 175,313 neurosurgical cases (137,029 spine, 38,284 cranial) identified. A total of 23,723 (13.5%) patients developed a complication and 2588 (1.5%) patients died. Compared with spine surgery, cranial surgery had higher likelihood of any complication (22.2% vs. 11.1%; P<0.001) and mortality (4.8% vs. 0.5%; P<0.001). In multivariable analysis, cranial surgery had 2.73 times higher likelihood for mortality compared with spine surgery (95% confidence interval, 2.46-3.03; P<0.001), but demonstrated lower odds of any complication (odds ratio, 0.93; 95% confidence interval, 0.90-0.97; P<0.001). There were 6 predictors (race, tobacco use, dyspnea, chronic obstructive pulmonary disease, chronic heart failure, and wound classification) significantly associated with any complication, but not mortality. Paradoxically, tobacco use had an unexplained protective effect on at least one complication or any complication. Similarly, increasing body mass index was protective for any complication and mortality, which suggests there may be a newly observed "obesity paradox" in neurosurgery. CONCLUSIONS After controlling for demographic characteristics, preoperative comorbidities, and perioperative factors, cranial surgery had higher risk for mortality compared with spine surgery despite lower risk for other complications. These findings highlight a discrepancy in the risk for postoperative complications following neurosurgical procedures that requires emphasis within quality improvement initiatives.
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Affiliation(s)
- Andrew K Rock
- Departments of Neurosurgery
- Physiology and Biophysics, Virginia Commonwealth University, Richmond, VA
| | | | | | - William C Broaddus
- Departments of Neurosurgery
- Physiology and Biophysics, Virginia Commonwealth University, Richmond, VA
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18
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Twitchell S, Karsy M, Reese J, Guan J, Couldwell WT, Dailey A, Bisson EF. Assessment of cost drivers and cost variation for lumbar interbody fusion procedures using the Value Driven Outcomes database. Neurosurg Focus 2018; 44:E10. [DOI: 10.3171/2018.1.focus17724] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEEfforts to examine the value of care—combining both costs and quality—are gaining importance in the current health care climate. This thrust is particularly evident in treating common spinal disease where both incidences and costs are generally high and practice patterns are variable. It is often challenging to obtain direct surgical costs for these analyses, which hinders the understanding of cost drivers and cost variation. Using a novel tool, the authors sought to understand the costs of posterior lumbar arthrodesis with interbody devices.METHODSThe Value Driven Outcomes (VDO) database at the University of Utah was used to evaluate the care of patients who underwent open or minimally invasive surgery (MIS), 1- and 2-level lumbar spine fusion (Current Procedural Terminology code 22263). Patients treated from January 2012 through June 2017 were included.RESULTSA total of 276 patients (mean age 58.9 ± 12.4 years) were identified; 46.7% of patients were men. Most patients (82.2%) underwent 1-level fusion. Thirteen patients (4.7%) had major complications and 11 (4.1%) had minor complications. MIS (β = 0.16, p = 0.002), length of stay (β = 0.47, p = 0.0001), and number of operated levels (β = 0.37, p = 0.0001) predicted costs in a multivariable analysis. Supplies and implants (55%) and facility cost (36%) accounted for most of the expenditure. Other costs included pharmacy (7%), laboratory (1%), and imaging (1%).CONCLUSIONSThese results provide direct cost accounting for lumbar fusion procedures using the VDO database. Efforts to improve the value of lumbar surgery should focus on high cost areas, i.e., facility and supplies/implant.
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Bock HC, Kanzler M, Thomale UW, Ludwig HC. Implementing a digital real-time Hydrocephalus and Shunt Registry to evaluate contemporary pattern of care and surgical outcome in pediatric hydrocephalus. Childs Nerv Syst 2018; 34:457-464. [PMID: 29124391 DOI: 10.1007/s00381-017-3654-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/01/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Treatment monitoring and outcome evaluation in pediatric hydrocephalus require gapless documentation regarding surgical and clinical follow-up data beginning from day 1 of treatment in order to apply high quality of care. Endoscopic procedures, shunt insertion and revision surgeries, and individual modifications of valve hardware or pressure settings during follow-up as well as established outcome measurements are highly relevant for complete illustration of the patient's hydrocephalus histories. A digital tool to capture, organize, and analyze comprehensive treatment-related data was estimated long overdue, consequentially developed, and implemented in daily pediatric neurosurgical routine. METHODS We established a self-contained, network-capable database application to supply and back up clinical information of complete surgical treatment history with implant status and follow up for all institutional pediatric hydrocephalus patients from 1995 to date. The application content has been prospectively complemented since 2012 during daily pediatric neurosurgical routine. Beside surgical data, neurological outcome and quality of life assessment were integrated according to validated scales to be recordable 2, 3, and 5 years after initial surgical intervention for prospective administration. The application is in continuous and problem-free use since implementation offering homogeneous and structured real-time information of surgical and corresponding neurological hydrocephalus-related data. By using an automatized data extraction tool, an exemplary surgical outcome evaluation reviewing institutional ventriculo-peritoneal shunt (VPS) treatment in infants over a period of more than 20 years was performed. To validate applicability, the Registry was successfully implemented in an external institution under identical conditions continuously serving for the same purpose until today. RESULTS Upon completion of the developing process, the application was successfully implemented into routine clinical workflow of our institution. In total, 579 pediatric hydrocephalus patients entered into the Registry with collectively 1874 corresponding hydrocephalus-related surgeries (9% neuro-endoscopic procedures, 18% temporary CSF-diversions, 73% shunt surgeries) so far. For exemplary surgical outcome analysis, the total volume of complex data sets could easily be reduced stepwise in regard to requested inclusion criteria. The selection process generated conclusive data of 256 institutional pediatric VPS patients providing a median follow-up of 8.5 years. Surgical outcome was evaluated in regard to hydrocephalus etiology, applied valve design, valve augmentation, cause of initial malfunction, time to initial shunt revision, and number of total revisions. CONCLUSION The pediatric hydrocephalus registry application delivers easy access to contemporary and up-to-date clinical information during daily clinical routine and proves comprehensive value for various scientific purposes. Institutional hydrocephalus etiologies, treatment modalities, and surgical outcome could be reviewed for a selected pediatric patient collective during an interval of more than 20 years and confirmed initial shunt treatment within the first year of age, communicating hydrocephalus and a history of prematurity as significant variables for unfavorable shunt survival and long-term revision rate. At our institution, the Registry emerged to an essential and sustainable tool to capture, organize, and analyze patterns of care in pediatric hydrocephalus patients of all etiologies and treatment modalities. Because of its adaptable and reliable predicate, a prospective multi-center utilization is currently in preparation.
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Affiliation(s)
- Hans Christoph Bock
- Department of Neurosurgery, Section Pediatric Neurosurgery, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany. .,Abteilung Neurochirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany. .,Pediatric Neurosurgery, Charité University Medical Center Berlin, Augustenburger Platz 1, 13533, Berlin, Germany.
| | - Maximilian Kanzler
- Department of Neurosurgery, Section Pediatric Neurosurgery, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Ulrich-Wilhelm Thomale
- Pediatric Neurosurgery, Charité University Medical Center Berlin, Augustenburger Platz 1, 13533, Berlin, Germany
| | - Hans Christoph Ludwig
- Department of Neurosurgery, Section Pediatric Neurosurgery, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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20
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Brown DA, Himes BT, Major BT, Mundell BF, Kumar R, Kall B, Meyer FB, Link MJ, Pollock BE, Atkinson JD, Van Gompel JJ, Marsh WR, Lanzino G, Bydon M, Parney IF. Cranial Tumor Surgical Outcomes at a High-Volume Academic Referral Center. Mayo Clin Proc 2018; 93:16-24. [PMID: 29304919 DOI: 10.1016/j.mayocp.2017.08.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 08/15/2017] [Accepted: 08/30/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine adverse event rates for adult cranial neuro-oncologic surgeries performed at a high-volume quaternary academic center and assess the impact of resident participation on perioperative complication rates. PATIENTS AND METHODS All adult patients undergoing neurosurgical intervention for an intracranial neoplastic lesion between January 1, 2009, and December 31, 2013, were included. Cases were categorized as biopsy, extra-axial/skull base, intra-axial, or transsphenoidal. Complications were categorized as neurologic, medical, wound, mortality, or none and compared for patients managed by a chief resident vs a consultant neurosurgeon. RESULTS A total of 6277 neurosurgical procedures for intracranial neoplasms were performed. After excluding radiosurgical procedures and pediatric patients, 4151 adult patients who underwent 4423 procedures were available for analysis. Complications were infrequent, with overall rates of 9.8% (435 of 4423 procedures), 1.7% (73 of 4423), and 1.4% (63 of 4423) for neurologic, medical, and wound complications, respectively. The rate of perioperative mortality was 0.3% (14 of 4423 procedures). Case performance and management by a chief resident did not negatively impact outcome. CONCLUSION In our large-volume brain tumor practice, rates of complications were low, and management of cases by chief residents in a semiautonomous manner did not negatively impact surgical outcomes.
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Affiliation(s)
- Desmond A Brown
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | | | - Brittny T Major
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - Ravi Kumar
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Bruce Kall
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Fredric B Meyer
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Bruce E Pollock
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - John D Atkinson
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | | | - W Richard Marsh
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | | | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Ian F Parney
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN.
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Assessment of Cost Drivers in Transsphenoidal Approaches for Resection of Pituitary Tumors Using the Value-Driven Outcome Database. World Neurosurg 2017; 105:818-823. [DOI: 10.1016/j.wneu.2017.05.148] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 02/07/2023]
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Karhade AV, Larsen AMG, Cote DJ, Dubois HM, Smith TR. National Databases for Neurosurgical Outcomes Research: Options, Strengths, and Limitations. Neurosurgery 2017; 83:333-344. [DOI: 10.1093/neuros/nyx408] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 06/21/2017] [Indexed: 01/12/2023] Open
Affiliation(s)
- Aditya V Karhade
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexandra M G Larsen
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David J Cote
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Heloise M Dubois
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy R Smith
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Capó-Lugo CE, Kho AN, O'Dwyer LC, Rosenman MB. Data Sharing and Data Registries in Physical Medicine and Rehabilitation. PM R 2017; 9:S59-S74. [PMID: 28527505 DOI: 10.1016/j.pmrj.2017.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/04/2017] [Accepted: 04/06/2017] [Indexed: 11/26/2022]
Abstract
The field of physical medicine & rehabilitation (PM&R), along with all the disciplines it encompasses, has evolved rapidly in the past 50 years. The number of controlled trials, systematic reviews, and meta-analyses in PM&R increased 5-fold from 1998 to 2013. In recent years, professional, private, and governmental institutions have identified the need to track function and functional status across providers and settings of care and on a larger scale. Because function and functional status are key aspects of PM&R, access to and sharing of reliable data will have an important impact on clinical practice. We reviewed the current landscape of PM&R databases and data repositories, the clinical applicability and practice implications of data sharing, and challenges and future directions. We included articles that (1) addressed any aspect of function, disability, or participation; (2) focused on recovery or maintenance of any function; and (3) used data repositories or research databases. We identified 398 articles that cited 244 data sources. The data sources included 66 data repositories and 179 research databases. We categorized the data sources based on their purposes and uses, geographic distribution, and other characteristics. This study collates the range of databases, data repositories, and data-sharing mechanisms that have been used in PM&R internationally. In recent years, these data sources have provided significant information for the field, especially at the population-health level. Implications and future directions for data sources also are discussed.
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Affiliation(s)
- Carmen E Capó-Lugo
- Center for Education in Health Sciences, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair St, 20th Floor, Chicago, IL 60611(∗).
| | - Abel N Kho
- Center for Health Information Partnerships, Institute for Public Health and Medicine and Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL(†)
| | - Linda C O'Dwyer
- Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, Chicago, IL(‡)
| | - Marc B Rosenman
- Center for Health Information Partnerships, Institute for Public Health and Medicine and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL(§)
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McGirt MJ, Parker SL, Chotai S, Pfortmiller D, Sorenson JM, Foley K, Asher AL. Predictors of extended length of stay, discharge to inpatient rehab, and hospital readmission following elective lumbar spine surgery: introduction of the Carolina-Semmes Grading Scale. J Neurosurg Spine 2017; 27:382-390. [PMID: 28498068 DOI: 10.3171/2016.12.spine16928] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Extended hospital length of stay (LOS), unplanned hospital readmission, and need for inpatient rehabilitation after elective spine surgery contribute significantly to the variation in surgical health care costs. As novel payment models shift the risk of cost overruns from payers to providers, understanding patient-level risk of LOS, readmission, and inpatient rehabilitation is critical. The authors set out to develop a grading scale that effectively stratifies risk of these costly events after elective surgery for degenerative lumbar pathologies. METHODS The Quality and Outcomes Database (QOD) registry prospectively enrolls patients undergoing surgery for degenerative lumbar spine disease. This registry was queried for patients who had undergone elective 1- to 3-level lumbar surgery for degenerative spine pathology. The association between preoperative patient variables and extended postoperative hospital LOS (LOS ≥ 7 days), discharge status (inpatient facility vs home), and 90-day hospital readmission was assessed using stepwise multivariate logistic regression. The Carolina-Semmes grading scale was constructed using the independent predictors for LOS (0-12 points), discharge to inpatient facility (0-18 points), and 90-day readmission (0-6 points), and its performance was assessed using the QOD data set. The performance of the grading scale was then confirmed separately after using it in 2 separate neurosurgery practice sites (Carolina Neurosurgery & Spine Associates [CNSA] and Semmes Murphey Clinic). RESULTS A total of 6921 patients were analyzed. Overall, 290 (4.2%) patients required extended LOS, 654 (9.4%) required inpatient facility care/rehabilitation on hospital discharge, and 474 (6.8%) were readmitted to the hospital within 90 days postdischarge. Variables that remained as independently associated with these unplanned events in multivariate analysis included age ≥ 70 years, American Society of Anesthesiologists Physical Classification System class > III, Oswestry Disability Index score ≥ 70, diabetes, Medicare/Medicaid, nonindependent ambulation, and fusion. Increasing point totals in the Carolina-Semmes scale effectively stratified the incidence of extended LOS, discharge to facility, and readmission in a stepwise fashion in both the aggregate QOD data set and when subsequently applied to the CNSA/Semmes Murphey practice groups. CONCLUSIONS The authors introduce the Carolina-Semmes grading scale that effectively stratifies the risk of prolonged hospital stay, need for postdischarge inpatient facility care, and 90-day hospital readmission for patients undergoing first-time elective 1- to 3-level degenerative lumbar spine surgery. This grading scale may be helpful in identifying patients who may require additional resource utilization within a global period after surgery.
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Affiliation(s)
- Matthew J McGirt
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Scott L Parker
- Department of Neurological Surgery and Orthopaedic Surgery, Vanderbilt Spine Center, Vanderbilt University Medical Center, Nashville; and
| | - Silky Chotai
- Department of Neurological Surgery and Orthopaedic Surgery, Vanderbilt Spine Center, Vanderbilt University Medical Center, Nashville; and
| | - Deborah Pfortmiller
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Jeffrey M Sorenson
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee
| | - Kevin Foley
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Semmes Murphey Neurologic & Spine Institute, Memphis, Tennessee
| | - Anthony L Asher
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina
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Raskin JS, Hansen D, Mohan A, Pan IW, Curry DJ, Lam S. Perioperative antibiotic use in vagus nerve stimulator implantation: a clinical series. Childs Nerv Syst 2017; 33:801-804. [PMID: 28321533 DOI: 10.1007/s00381-017-3379-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 03/08/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Preoperative antibiosis contributes up to one third of total antibiotic use in major hospitals. Choice of antibiotic is not uniformly standardized, and polypharmacy regimens may be used without knowing the effect on rates of surgical site infection, nonsurgical infections, or antibiotic resistance. Careful examination of trends in surgical prophylaxis is warranted. In this study, we aimed to examine our institution's experience with vagus nerve stimulator (VNS) implantation, focusing on association between perioperative antibiotic practices and postoperative infectious outcomes. METHODS We conducted a single-center case-control study using a retrospective chart review of 50 consecutively operated patients undergoing VNS implantation over 24 months by two experienced surgeons at our institution from April 2014 to March 2016. In each surgery, the technical procedure, operating room, and surgical team were the same, while surgeon's preference in antibiotic prophylaxis differed. Group 1 received a single dose of intravenous (IV) cefazolin (n = 26), and Group 2 received IV cefazolin, paired with one or both of gentamicin/vancomycin, in addition to a 10-day outpatient oral course of clindamycin (n = 24). Patient demographics, perioperative details, and minimum 3-month follow-up for infection and healthcare utilization were recorded. Student t tests were computed for significance. RESULTS Group 1 patients on average were older than group 2 patients (10.2, 7.1 years, p = 0.01), and length of surgery was longer (115.5, 91.9 min, p = 0.007). There were no differences in number of surgeons gowned (p = 0.11), presence of tracheostomy (p = 0.43) or gastrostomy (p = 0.20) tube, nonsurgical infections (p = 0.32), and number of postoperative emergency department (ED) visits (p = 0.22) or readmissions (p = 0.23). Neither group had VNS infections in the follow-up period. CONCLUSION Single preoperative dosing of one antibiotic appropriately chosen to cover typical skin flora conferred equal benefit to perioperative prophylactic polypharmacy in this study. There were no differences in postoperative infection events or ED visits/readmissions. Restraint with preoperative antibiosis shows equipoise in postoperative infection and overall resource utilization.
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Affiliation(s)
- Jeffrey S Raskin
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA
| | - Daniel Hansen
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA
| | - Arvind Mohan
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA
| | - I-Wen Pan
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA
| | - Daniel J Curry
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA
| | - Sandi Lam
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA.
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Kim DH. “The Coming Changes in Neurosurgical Practice”: A Supplement to Neurosurgery. Neurosurgery 2017; 80:S1-S3. [DOI: 10.1093/neuros/nyw145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/13/2016] [Indexed: 11/14/2022] Open
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Abstract
Many of the studies in the spine surgical literature using national databases have been directed at examining adverse events, readmission rates, cost, and risk factors for poorer outcomes. Although such studies allow for assessment of large cohorts taken from multiple institutions, they are limited by data collection methods, short-term follow-up, and minimal assessment of functional outcomes. Furthermore, few studies are directed at producing actionable practice changes to improve patient care. Recent work aimed at producing databases with more relevance to spine surgery represent exciting developments to the rapidly growing field of health outcomes research.
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Yazdany J, Myslinski R, Miller A, Francisco M, Desai S, Schmajuk G, Lacaille D, Barber CE, Orozco C, Bunyard M, Bergman MJ, Passo M, Matteson EL, Olson R, Silverman S, Warren R, Nola K, Robbins M. Methods for Developing the American College of Rheumatology's Electronic Clinical Quality Measures. Arthritis Care Res (Hoboken) 2016; 68:1402-9. [DOI: 10.1002/acr.22985] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/05/2016] [Accepted: 06/29/2016] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Amy Miller
- American College of Rheumatology; Atlanta Georgia
| | | | - Sonali Desai
- Brigham & Women's Hospital; Boston Massachusetts
| | | | - Diane Lacaille
- Arthritis Research Centre of Canada; Vancouver British Columbia Canada
| | | | | | | | | | - Murray Passo
- Children's Hospital, Medical University of South Carolina; Charleston
| | | | | | | | | | - Kamala Nola
- Lipscomb University College of Pharmacy; Nashville Tennessee
| | - Mark Robbins
- Harvard Vanguard Medical Associates, Atrius Health; Somerville Massachusetts
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Bekelis K, McGirt MJ, Parker SL, Holland CM, Davies J, Devin CJ, Atkins T, Knightly J, Groman R, Zyung I, Asher AL. The present and future of quality measures and public reporting in neurosurgery. Neurosurg Focus 2015; 39:E3. [DOI: 10.3171/2015.8.focus15354] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Quality measurement and public reporting are intended to facilitate targeted outcome improvement, practice-based learning, shared decision making, and effective resource utilization. However, regulatory implementation has created a complex network of reporting requirements for physicians and medical practices. These include Medicare’s Physician Quality Reporting System, Electronic Health Records Meaningful Use, and Value-Based Payment Modifier programs. The common denominator of all these initiatives is that to avoid penalties, physicians must meet “generic” quality standards that, in the case of neurosurgery and many other specialties, are not pertinent to everyday clinical practice and hold specialists accountable for care decisions outside of their direct control.
The Centers for Medicare and Medicaid Services has recently authorized alternative quality reporting mechanisms for the Physician Quality Reporting System, which allow registries to become subspecialty-reporting mechanisms under the Qualified Clinical Data Registry (QCDR) program. These programs further give subspecialties latitude to develop measures of health care quality that are relevant to the care provided. As such, these programs amplify the power of clinical registries by allowing more accurate assessment of practice patterns, patient experiences, and overall health care value. Neurosurgery has been at the forefront of these developments, leveraging the experience of the National Neurosurgery Quality and Outcomes Database to create one of the first specialty-specific QCDRs.
Recent legislative reform has continued to change this landscape and has fueled optimism that registries (including QCDRs) and other specialty-driven quality measures will be a prominent feature of federal and private sector quality improvement initiatives. These physician- and patient-driven methods will allow neurosurgery to underscore the value of interventions, contribute to the development of sustainable health care solutions, and actively participate in meaningful quality initiatives for the benefit of the patients served.
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Affiliation(s)
- Kimon Bekelis
- 1Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Matthew J. McGirt
- 2Department of Neurosurgery, Carolina Neurosurgery & Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | | | | | - Jason Davies
- 5Department of Neurological Surgery, State University of New York at Buffalo, New York
| | - Clinton J. Devin
- 6Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tyler Atkins
- 2Department of Neurosurgery, Carolina Neurosurgery & Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Jack Knightly
- 7Department of Neurological Surgery, Atlantic Neurosurgical Specialists, Morristown, New Jersey
| | - Rachel Groman
- 8Clinical Affairs and Quality Improvement, Hart Health Strategies, Inc., Washington, DC; and
| | - Irene Zyung
- 9American Association of Neurological Surgeons, Rolling Meadows, Illinois
| | - Anthony L. Asher
- 2Department of Neurosurgery, Carolina Neurosurgery & Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina
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