Insurance Type is Associated with Baseline Patient-Reported Outcome Measures in Patients with Lumbar Stenosis

Crawford, Alexander M; Xiong, Grace; Lightsey, Harry M.; Goh, Brian C.; Smith, Jeremy T.; Hershman, Stuart H.; Schoenfeld, Andrew J.; Simpson, Andrew K.

doi:10.1097/brs.0000000000004326

Cited by 10 publications

(3 citation statements)

References 22 publications

(68 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients included in this investigation were identified through a query of the Research Patient Data Registry (RPDR) at our institution. In brief, the RPDR is a utility that pools medical and billing information for all patients in our system and has been utilized in numerous prior works [19][20][21][22] . We included adults who underwent rotator cuff repair, lumbar discectomy, lumbar fusion, total knee arthroplasty (TKA), total hip arthroplasty (THA), open reduction and internal fixation (ORIF) of ankle fracture, ORIF of distal radial fracture, or anterior cruciate ligament (ACL) reconstruction between January 1, 2018, and March 31, 2022.…”

Section: Methodsmentioning

confidence: 99%

Validation of the Stopping Opioids After Surgery (SOS) Score for the Sustained Use of Prescription Opioids Following Orthopaedic Surgery

Crawford

Striano

Gong

et al. 2023

Journal of Bone and Joint Surgery

Self Cite

View full text Add to dashboard Cite

Background: The Stopping Opioids after Surgery (SOS) score was developed to identify patients at risk for sustained opioid use following surgery. The SOS score has not been specifically validated for patients in a general orthopaedic context. Our primary objective was to validate the SOS score within this context. Methods: In this retrospective cohort study, we considered a broad array of representative orthopaedic procedures performed between January 1, 2018, and March 31, 2022. These procedures included rotator cuff repair, lumbar discectomy, lumbar fusion, total knee and total hip arthroplasty, open reduction and internal fixation (ORIF) of ankle fracture, ORIF of distal radial fracture, and anterior cruciate ligament reconstruction. The performance of the SOS score was evaluated by calculating the c-statistic, receiver operating characteristic curve, and the observed rates of sustained prescription opioid use (defined as uninterrupted prescriptions of opioids for ≥90 days) following surgery. For our sensitivity analysis, we compared these metrics among various time epochs related to the COVID-19 pandemic. Results: A total of 26,114 patients were included, of whom 51.6% were female and 78.1% were White. The median age was 63 years. The observed prevalence of sustained opioid use was 1.3% (95% confidence interval [CI], 1.2% to 1.5%) in the low-risk group (SOS score of <30), 7.4% (95% CI, 6.9% to 8.0%) in the medium-risk group (SOS score of 30 to 60), and 20.8% (95% CI, 17.7% to 24.2%) in the high-risk group (SOS score of >60). The performance of the SOS score in the overall group was strong, with a c-statistic of 0.82. The performance of the SOS score showed no evidence of worsening over time. The c-statistic was 0.79 before the COVID-19 pandemic and ranged from 0.77 to 0.80 throughout the waves of the pandemic. Conclusions: We validated the use of the SOS score for sustained prescription opioid use following a diverse array of orthopaedic procedures across subspecialties. This tool is easy to implement for the purpose of prospectively identifying patients in musculoskeletal service lines who are at higher risk for sustained opioid use, thereby enabling the future implementation of upstream interventions and modifications to avert opioid abuse and to combat the opioid epidemic. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

show abstract

Section: Methodsmentioning

confidence: 99%

Validation of the Stopping Opioids After Surgery (SOS) Score for the Sustained Use of Prescription Opioids Following Orthopaedic Surgery

Crawford

Striano

Gong

et al. 2023

Journal of Bone and Joint Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…Potentially eligible patients were initially identified through a query of the Research Patient Data Registry (RPDR), an internal database that links billing and electronic health records information to aggregate demographic and clinical information from patients treated through our health system. RPDR has been utilized previously in numerous investigations within the spine field [17][18][19] and outside of it. 20,21 Our RPDR query identified 1261 unique adult patients from January 2015 to January 2022 who underwent lumbar fusions for an indication of isthmic or degenerative spondylolisthesis.…”

Section: Participantsmentioning

confidence: 99%

Projected Lifetime Cancer Risk Associated with Intraoperative Computed Tomography for Lumbar Spine Surgery

Crawford

Striano

Giberson-Chen

et al. 2023

Spine

Self Cite

View full text Add to dashboard Cite

Study Design. Retrospective cross-sectional study. Objective. (1) To determine the incremental increase in intraoperative ionizing radiation conferred by computed tomography (CT) as compared with conventional radiography; and (2) to model different lifetime cancer risks contextualized by the intersection between age, sex, and intraoperative imaging modality. Summary of Background Data. Emerging technologies in spine surgery, like navigation, automation, and augmented reality, commonly utilize intraoperative CT. Although much has been written about the benefits of such imaging modalities, the inherent risk profile of increasing intraoperative CT has not been well evaluated. Materials and Methods. Effective doses of intraoperative ionizing radiation were extracted from 610 adult patients who underwent single-level instrumented fusion for lumbar degenerative or isthmic spondylolisthesis from January 2015 through January 2022. Patients were divided into those who received intraoperative CT (n=138) and those who underwent conventional intraoperative radiography (n=472). Generalized linear modeling was utilized with intraoperative CT use as a primary predictor and patient demographics, disease characteristics, and preference-sensitive intraoperative considerations (e.g. surgical approach and surgical invasiveness) as covariates. The adjusted risk difference in radiation dose calculated from our regression analysis was used to prognosticate the associated cancer risk across age and sex strata. Results. (1) After adjusting for covariates, intraoperative CT was associated with 7.6 mSv (interquartile range: 6.8–8.4 mSv; P<0.001) more radiation than conventional radiography. (2) For the median patient in our population (a 62-year-old female), intraoperative CT use increased lifetime cancer risk by 2.3 incidents (interquartile range: 2.1–2.6) per 10,000. Similar projections for other age and sex strata were also appreciated. Conclusions. Intraoperative CT use significantly increases cancer risk compared with conventional intraoperative radiography for patients undergoing lumbar spinal fusions. As emerging technologies in spine surgery continue to proliferate and leverage intraoperative CT for cross-sectional imaging data, strategies must be developed by surgeons, institutions, and medical technology companies to mitigate long-term cancer risks.

show abstract

“…The correlation between an individual’s SES, treatment options, and PROs is poorly understood. Crawford et al revealed that Medicaid patients with lumbar spinal stenosis had systematically worse baseline PROs when compared to Medicare or private insurance [ 10 ]. It has also been shown that lower SES can predict worse outcomes in lumbar spine surgery [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic Status Correlates With Initial Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) Scores but Not the Likelihood of Spine Surgery

Lawlor,

Rubery,

Thirukumaran

et al. 2024

Cureus

View full text Add to dashboard Cite

Objective To explore how socioeconomic status and patient characteristics may be associated with initial self-reports of pain and determine if there was an increased association with undergoing spine surgery. Methods Patients at an academic center between 2015 and 2021 who completed the Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) questionnaire were included. Multivariable linear regression models were used to determine the association between insurance type and patient factors with initial reports of pain. Multivariable logistic regression models were used to determine the association between PI and the likelihood of surgery in two time periods, three and 12 months. Results The study included 9,587 patients. The mean PROMIS-PI scores were 61.93 (SD 7.82) and 63.74 (SD 6.93) in the cervical and lumbar cohorts, respectively. Medicaid and Workers’ Compensation insurance patients reported higher pain scores compared to those with private insurance: Medicaid (cervical: 2.77, CI (1.76-3.79), p<0.001; lumbar (2.05, CI (1.52-2.59), p<0.001); Workers’ Compensation (cervical: 2.12, CI (0.96-3.27), p<0.001; lumbar: 1.51, CI (0.79-2.23), p<0.001). Black patients reported higher pain compared to White patients (cervical: 1.50, CI (0.44-2.55), p=0.01; lumbar: 1.51, CI (0.94-2.08), p<0.001). Higher PROMIS-PI scores were associated with a higher likelihood of surgery. There was no increased association of likelihood of surgery in Black, Medicaid, or Workers’ Compensation patients when controlling for pain severity. Conclusion Black patients and patients with Medicaid and Workers’ compensation insurance were likely to report higher pain scores. Higher initial pain scores were associated with an increased likelihood of surgery. However, despite increased pain scores, Black patients and those with Medicaid and Workers’ Compensation insurance did not have a higher likelihood of undergoing surgery.

show abstract

Insurance Type is Associated with Baseline Patient-Reported Outcome Measures in Patients with Lumbar Stenosis

Cited by 10 publications

References 22 publications

Validation of the Stopping Opioids After Surgery (SOS) Score for the Sustained Use of Prescription Opioids Following Orthopaedic Surgery

Validation of the Stopping Opioids After Surgery (SOS) Score for the Sustained Use of Prescription Opioids Following Orthopaedic Surgery

Projected Lifetime Cancer Risk Associated with Intraoperative Computed Tomography for Lumbar Spine Surgery

Socioeconomic Status Correlates With Initial Patient-Reported Outcomes Measurement Information System-Pain Interference (PROMIS-PI) Scores but Not the Likelihood of Spine Surgery

Contact Info

Product

Resources

About