Conflicts of interest in randomized controlled trials reported in neurosurgical journals

Health Care Industry Payments to Editorial Board Members of Major Neurosurgery Journals Between 2017 and 2022

BACKGROUND AND OBJECTIVES

Financial conflicts of interest between editorial board members and industry could lead to biases and impartial editorial decisions. We aimed to evaluate the frequency, amount, and characteristics of payments to editorial board members of neurosurgery journals over a 6-year period.

METHODS

In this cross-sectional study, editorial board members were derived from the top 10 neurosurgery journals based on Google Scholar metrics. The Open Payments database by the Centers for Medicare and Medicaid Services was accessed to evaluate industry payments to editorial board members from 2017to 2022. Descriptive analyses were performed on payment data, adjusted for inflation using the consumer price indices.

RESULTS

We included 805 editorial board members. After excluding duplicate names, 342 (53.9%) of 634 had received payments between 2017 and 2022. Eight of 10 journals had more than 50% of editorial board members listed in the Open Payments database. Between 2017 and 2022, the total number of payments to editorial board members was $143 732 057, encompassing $1 323 936 in research payments, $69 122 067 in associated research funding, $5 380 926 in ownership and investment interests, and $67 905 128 in general payments. General payments decreased from $13 676 382 in 2017 to $8 528 003 in 2022. Royalties ($43 393 697) and consulting ($13 157 934) contributed the most to general payments between 2017 and 2022. Four journals had a percentage increase in total payments, whereas general payments decreased for 6 journals.

CONCLUSION

Around 54% of editorial board members of neurosurgical journals received industry payments between 2017 and 2022. We identified journal-specific trends in industry payments and highlighted the importance of transparency and disclosure of financial conflicts of interests for neurosurgery journals.

The European Robotic Spinal Instrumentation (EUROSPIN) study: protocol for a multicentre prospective observational study of pedicle screw revision surgery after robot-guided, navigated and freehand thoracolumbar spinal fusion

INTRODUCTION

Robotic guidance (RG) and computer-assisted navigation (NV) have seen increased adoption in instrumented spine surgery over the last decade. Although there exists some evidence that these techniques increase radiological pedicle screw accuracy compared with conventional freehand (FH) surgery, this may not directly translate to any tangible clinical benefits, especially considering the relatively high inherent costs. As a non-randomised, expertise-based study, the European Robotic Spinal Instrumentation Study aims to create prospective multicentre evidence on the potential comparative clinical benefits of RG, NV and FH in a real-world setting.

METHODS AND ANALYSIS

Patients are allocated in a non-randomised, non-blinded fashion to the RG, NV or FH arms. Adult patients that are to undergo thoracolumbar pedicle screw instrumentation for degenerative pathologies, infections, vertebral tumours or fractures are considered for inclusion. Deformity correction and surgery at more than five levels represent exclusion criteria. Follow-up takes place at 6 weeks, as well as 12 and 24 months. The primary endpoint is defined as the time to revision surgery for a malpositioned or loosened pedicle screw within the first postoperative year. Secondary endpoints include patient-reported back and leg pain, as well as Oswestry Disability Index and EuroQOL 5-dimension questionnaires. Use of analgesic medication and work status are recorded. The primary analysis, conducted on the 12-month data, is carried out according to the intention-to-treat principle. The primary endpoint is analysed using crude and adjusted Cox proportional hazards models. Patient-reported outcomes are analysed using baseline-adjusted linear mixed models. The study is monitored according to a prespecified monitoring plan.

ETHICS AND DISSEMINATION

The study protocol is approved by the appropriate national and local authorities. Written informed consent is obtained from all participants. The final results will be published in an international peer-reviewed journal.

TRIAL REGISTRATION NUMBER

Clinical Trials.gov registry NCT03398915; Pre-results, recruiting stage.