Ahilan Sivaganesan

Patient-Specific Factors Associated With Dissatisfaction After Elective Surgery for Degenerative Spine Diseases.

BACKGROUND Patient satisfaction metrics are emerging as determinants of quality of care and reimbursement after spine surgery. Identifying modifiable factors that improve satisfaction is of utmost importance. OBJECTIVE To evaluate whether patient-related factors or patient-reported outcomes could predict dissatisfaction after spine surgery. METHODS Patients undergoing elective surgery for degenerative lumbar and cervical disease over a period of 2 years were enrolled in a prospective longitudinal registry. Patient-reported outcome, the Oswestry Disability Index (ODI)/Neck Disability Index (NDI), and numeric rating scale for back/neck (BP/NP) and leg/arm pain (LP/AP), were recorded at baseline and the 12-month follow-up. Previously published values of minimal clinically important differences of 14.9% for ODI, 17.3% for NDI, 2.1/2.6 for BP/NP, and 2.8/4.1 for LP/AP were used. Patient satisfaction was assessed with the North American Spine Society Satisfaction Questionnaire. RESULTS A total of 1645 patients underwent elective spine surgery (811 male patients; age, 57 ± 13 years). Eighty-three percent of patients (1362) reported satisfaction with outcome 12 months after surgery. In a multivariable analysis, after controlling for an array of patient-specific factors, the inability to achieve minimal clinically important difference for ODI/NDI (P < .001; odds ratio [OR] = 4.215; 95% confidence interval [CI], 2.7-6.5), BP/NP pain (P < .001; OR = 3.1; 95% CI, 2.188-4.43), and LP/NP (P < .001; OR = 2.6, 95% CI, 1.8-3.6); Medicaid/uninsured payer status (P = .04; OR = 1.39; 95% CI, 1.01-1.93); and higher baseline ODI/NDI (P = .002; OR = 1.11; 95% CI, 1.04-1.19) and BP/NP scores (P = .002; OR = 1.03; 95% CI, 1.01-1.06) were the independent predictors of patient dissatisfaction at 12 months after surgery. CONCLUSION Patient satisfaction with outcome may accurately represent the effectiveness of surgical spine care in terms of 1-year improvement in pain and disability. However, healthcare stakeholders relying on satisfaction as a proxy of overall quality or effectiveness of care need to account for Medicaid/uninsured payer status and worse baseline pain and disability scores as confounders.

Informatics for Neurocritical Care: Challenges and Opportunities

Neurocritical care relies on the continuous, real-time measurement of numerous physiologic parameters. While our capability to obtain such measurements from patients has grown markedly with multimodal monitoring in many neurologic or neurosurgical intensive care units (ICUs), our ability to transform the raw data into actionable information is limited. One reason is that the proprietary nature of medical devices and software often prevents neuro-ICUs from capturing and centrally storing high-density data. Also, ICU alarm systems are often unreliable because the data that are captured are riddled with artifacts. Informatics is the process of acquiring, processing, and interpreting these complex arrays of data. The development of next-generation informatics tools allows for detection of complex physiologic events and brings about the possibility of decision support tools to improve neurocritical care. Although many different approaches to informatics are discussed and considered, here we focus on the Bayesian probabilistic paradigm. It quantifies the uncertainty inherent in neurocritical care instead of ignoring it, and formalizes the natural clinical thought process of updating prior beliefs using incoming patient data. We review this and other opportunities, as well as challenges, for the development and refinement of informatics tools in neurocritical care.

Effect of Obesity on Cost per Quality Adjusted Life Years Gained following Anterior Cervical Discectomy and Fusion in Elective Degenerative Pathology

BACKGROUND Obese patients have greater comorbidities along with higher risk of complications and greater costs after spine surgery, which may result in increased cost and lower quality of life compared with their non-obese counterparts. PURPOSE The aim of the present study was to determine cost-utility following anterior cervical discectomy and fusion (ACDF) in obese patients. STUDY DESIGN This study analyzed prospectively collected data. PATIENT SAMPLE Patients undergoing elective ACDF for degenerative cervical pathology at a single academic institution were included in the study. OUTCOME MEASURES Cost and quality-adjusted life years (QALYs) were the outcome measures. METHODS One- and two-year medical resource utilization, missed work, and health state values (QALYs) were assessed. Two-year resource use was multiplied by unit costs based on Medicare national payment amounts (direct cost). Patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Total cost (direct+indirect) was used to compute cost per QALY gained. Patients were defined as obese for body mass index (BMI) ≥35 based on the WHO definition of class II obesity. A subgroup analysis was conducted in morbidly obese patients (BMI≥40). RESULTS There were significant improvements in pain (neck pain or arm pain), disability (Neck Disability Index), and quality of life (EuroQol-5D and Short Form-12) at 2 years after surgery (p<.001). There was no significant difference in post-discharge health-care resource utilization, direct cost, indirect cost, and total cost between obese and non-obese patients at postoperative 1-year and 2-year follow-up. Mean 2-year direct cost for obese patients was

Traumatic atlantooccipital dislocation: comprehensive assessment of mortality, neurologic improvement, and patient-reported outcomes at a Level 1 trauma center over 15 years

19,225±

Erratum to: Impact of old age on patient-report outcomes and cost utility for anterior cervical discectomy and fusion surgery for degenerative spine disease

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Maximizing efficiency and diagnostic accuracy triage of acute stroke patients: A case-control study

17,635±

Drivers of Cost in Adult Thoracolumbar Spine Deformity Surgery

6,413 for non-obese patients (p=.14). There was no significant difference in the mean total 2-year cost between obese (

Effect of Depression on Patient-Reported Outcomes Following Cervical Epidural Steroid Injection for Degenerative Spine Disease

23,144±

Is There a Preoperative Morphine Equianalgesic Dose that Predicts Ability to Achieve a Clinically Meaningful Improvement Following Spine Surgery

9,216) and non-obese (

Comparison of Outcomes Following Anterior vs Posterior Fusion Surgery for Patients With Degenerative Cervical Myelopathy: An Analysis From Quality Outcomes Database

22,183±