Obese Patients Benefit, but do not Fare as Well as Nonobese Patients, Following Lumbar Spondylolisthesis Surgery: An Analysis of the Quality Outcomes Database

Chan, Andrew K.; Bisson, Erica F.; Bydon, Mohamad; Glassman, Steven D.; Foley, Kevin T.; Potts, Eric A; Shaffrey, Christopher I.; Shaffrey, Mark E.; Coric, Domagoj; Knightly, John J; Park, Paul; Wang, Michael Y.; Fu, Kai-Ming; Slotkin, Jonathan R.; Asher, Anthony L.; Virk, Michael S.; Kerezoudis, Panagiotis; DiGiorgio, Anthony M; Haid, Regis W.; Mummaneni, Praveen V.

doi:10.1093/neuros/nyy589

Cited by 40 publications

(27 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…11 However, it is important to note that several independent observational studies have demonstrated the beneficial role of adding instrumented fusion for patients undergoing surgical intervention for degenerative spondylolisthesis. 1,3,8,9,17 Some notable associations with patient satisfaction previously identified but not found to be significant in our cohort are worth discussing here. A preoperative diagnosis of depression has been found to be associated with lower odds of satisfaction in previous studies, which was not found to be significantly associated in our cohort.…”

Section: Discussionmentioning

confidence: 51%

“…Among these sites, 12 sites came together to initiate a focused project to assess the impact of fusion on PROs in patients undergoing surgery for grade I lumbar spondylolisthe-sis. [7][8][9][10]35 This focused group consisted of 1) sites with a study coordinator and 2) a centralized auditing mechanism to ensure data accuracy. To determine the diagnosis of grade I spondylolisthesis, surgeons at each of the participating sites evaluated preoperative standing or dynamic radiographs.…”

Section: Cohortmentioning

confidence: 99%

“…To determine the diagnosis of grade I spondylolisthesis, surgeons at each of the participating sites evaluated preoperative standing or dynamic radiographs. [7][8][9][10]35 Intraoperative variables, including laminectomy performed, fusion performed, and number of levels of fusion or laminectomy, and minimally invasive versus open surgery, were also abstracted for all eligible patients. [7][8][9][10]35 For the current article, we only included patients who underwent elective 1-or 2-level decompression or 1-level decompression and fusion for grade I spondylolisthesis, according to the Meyerding classification, 33 and who had available data for North American Spine Surgery (NASS) satisfaction after 2 years.…”

Section: Cohortmentioning

confidence: 99%

See 2 more Smart Citations

Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database

Mummaneni

Bydon

Alvi

et al. 2019

Neurosurgical Focus

Self Cite

View full text Add to dashboard Cite

OBJECTIVESince the enactment of the Affordable Care Act in 2010, providers and hospitals have increasingly prioritized patient-centered outcomes such as patient satisfaction in an effort to adapt the “value”-based healthcare model. In the current study, the authors queried a prospectively maintained multiinstitutional spine registry to construct a predictive model for long-term patient satisfaction among patients undergoing surgery for Meyerding grade I lumbar spondylolisthesis.METHODSThe authors queried the Quality Outcomes Database for patients undergoing surgery for grade I lumbar spondylolisthesis between July 1, 2014, and June 30, 2016. The primary outcome of interest for the current study was patient satisfaction as measured by the North American Spine Surgery patient satisfaction index, which is measured on a scale of 1–4, with 1 indicating most satisfied and 4 indicating least satisfied. In order to identify predictors of higher satisfaction, the authors fitted a multivariable proportional odds logistic regression model for ≥ 2 years of patient satisfaction after adjusting for an array of clinical and patient-specific factors. The absolute importance of each covariate in the model was computed using an importance metric defined as Wald chi-square penalized by the predictor degrees of freedom.RESULTSA total of 502 patients, out of a cohort of 608 patients (82.5%) with grade I lumbar spondylolisthesis, undergoing either 1- or 2-level decompression (22.5%, n = 113) or 1-level decompression and fusion (77.5%, n = 389), met the inclusion criteria; of these, 82.1% (n = 412) were satisfied after 2 years. On univariate analysis, satisfied patients were more likely to be employed and working (41.7%, n = 172, vs 24.4%, n = 22; overall p = 0.001), more likely to present with predominant leg pain (23.1%, n = 95, vs 11.1%, n = 10; overall p = 0.02) but more likely to present with lower Numeric Rating Scale score for leg pain (median and IQR score: 7 [5–9] vs 8 [6–9]; p = 0.05). Multivariable proportional odds logistic regression revealed that older age (OR 1.57, 95% CI 1.09–2.76; p = 0.009), preoperative active employment (OR 2.06, 95% CI 1.27–3.67; p = 0.015), and fusion surgery (OR 2.3, 95% CI 1.30–4.06; p = 0.002) were the most important predictors of achieving satisfaction with surgical outcome.CONCLUSIONSCurrent findings from a large multiinstitutional study indicate that most patients undergoing surgery for grade I lumbar spondylolisthesis achieved long-term satisfaction. Moreover, the authors found that older age, preoperative active employment, and fusion surgery are associated with higher odds of achieving satisfaction.

show abstract

Section: Discussionmentioning

confidence: 51%

Section: Cohortmentioning

confidence: 99%

Section: Cohortmentioning

confidence: 99%

See 1 more Smart Citation

Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database

Mummaneni

Bydon

Alvi

et al. 2019

Neurosurgical Focus

Self Cite

View full text Add to dashboard Cite

show abstract

“…28 Among these sites, the 12 highest-enrolling sites that were enrolling patients into the lumbar spine module came together to initiate a focused project to assess the impact of fusion on PROs in patients undergoing surgery for grade I lumbar spondylolisthesis. 1,8,9,10,26 In order to determine the diagnosis of grade I spondylolisthesis, surgeons at each of the participating sites evaluated preoperative standing or dynamic radiographs. 1,8,9,10,26 The primary outcome of in-terest for this study was Oswestry Disability Index (ODI).…”

Section: Cohortmentioning

confidence: 99%

Assessing the differences in characteristics of patients lost to follow-up at 2 years: results from the Quality Outcomes Database study on outcomes of surgery for grade I spondylolisthesis

Bisson

Mummaneni

Knightly³

et al. 2020

Journal of Neurosurgery: Spine

Self Cite

View full text Add to dashboard Cite

OBJECTIVELoss to follow-up has been shown to bias outcomes assessment among studies utilizing clinical registries. Here, the authors analyzed patients enrolled in a national surgical registry and compared the baseline characteristics of patients captured with those lost to follow-up at 2 years.METHODSThe authors queried the Quality Outcomes Database for patients with grade I lumbar degenerative spondylolisthesis undergoing a surgical intervention between July 2014 and June 2016. Only those patients enrolled in a multisite study investigating the impact of fusion on clinical and patient-reported outcomes (PROs) among patients with grade I spondylolisthesis were evaluated.RESULTSOf the 608 patients enrolled in the study undergoing 1- or 2-level decompression (23.0%, n = 140) or 1-level fusion (77.0%, n = 468), 14.5% (n = 88) were lost to follow-up at 2 years. Patients who were lost to follow-up were more likely to be younger (59.6 ± 13.5 vs 62.6 ± 11.7 years, p = 0.031), be employed (unemployment rate: 53.3% [n = 277] for successful follow-up vs 40.9% [n = 36] for those lost to follow-up, p = 0.017), have anxiety (26.1% [n = 23] vs 16.3% [n = 85], p = 0.026), have higher back pain scores (7.4 ± 2.9 vs 6.6 ± 2.8, p = 0.010), have higher leg pain scores (7.4 ± 2.5 vs 6.4 ± 2.9, p = 0.003), have higher Oswestry Disability Index scores (50.8 ± 18.7 vs 46 ± 16.8, p = 0.018), and have lower EQ-5D scores (0.481 ± 0.2 vs 0.547 ± 0.2, p = 0.012) at baseline.CONCLUSIONSTo execute future, high-quality studies, it is important to identify patients undergoing surgery for spondylolisthesis who might be lost to follow-up. In a large, prospective registry, the authors found that those lost to follow-up were more likely to be younger, be employed, have anxiety disorder, and have worse PRO scores.

show abstract

“…Obesity has been linked to increased costs of medical care [8]. Although obese patients benefit from at least some back surgeries, they do not fare as well as nonobese patients [9]. Although obesity has been linked to back pain [10], no studies were found that directly link obesity to back surgery requirements.…”

Section: Introductionmentioning

confidence: 99%

Hospital-Based Back Surgery: Geospatial-Temporal, Explanatory, and Predictive Models

Fulton

Kruse

2019

J Med Internet Res

View full text Add to dashboard Cite

BackgroundHospital-based back surgery in the United States increased by 60% from January 2012 to December 2017, yet the supply of neurosurgeons remained relatively constant. During this time, adult obesity grew by 5%.ObjectiveThis study aimed to evaluate the demand and associated costs for hospital-based back surgery by geolocation over time to evaluate provider practice variation. The study then leveraged hierarchical time series to generate tight demand forecasts on an unobserved test set. Finally, explanatory financial, technical, workload, geographical, and temporal factors as well as state-level obesity rates were investigated as predictors for the demand for hospital-based back surgery.MethodsHospital data from January 2012 to December 2017 were used to generate geospatial-temporal maps and a video of the Current Procedural Terminology codes beginning with the digit 63 claims. Hierarchical time series modeling provided forecasts for each state, the census regions, and the nation for an unobserved test set and then again for the out-years of 2018 and 2019. Stepwise regression, lasso regression, ridge regression, elastic net, and gradient-boosted random forests were built on a training set and evaluated on a test set to evaluate variables important to explaining the demand for hospital-based back surgery.ResultsWidespread, unexplained practice variation over time was seen using geographical information systems (GIS) multimedia mapping. Hierarchical time series provided accurate forecasts on a blind dataset and suggested a 6.52% (from 497,325 procedures in 2017 to 529,777 in 2018) growth of hospital-based back surgery in 2018 (529,777 and up to 13.00% by 2019 [from 497,325 procedures in 2017 to 563,023 procedures in 2019]). The increase in payments by 2019 are estimated to be US $323.9 million. Extreme gradient-boosted random forests beat constrained and unconstrained regression models on a 20% unobserved test set and suggested that obesity is one of the most important factors in explaining the increase in demand for hospital-based back surgery.ConclusionsPractice variation and obesity are factors to consider when estimating demand for hospital-based back surgery. Federal, state, and local planners should evaluate demand-side and supply-side interventions for this emerging problem.

show abstract

Obese Patients Benefit, but do not Fare as Well as Nonobese Patients, Following Lumbar Spondylolisthesis Surgery: An Analysis of the Quality Outcomes Database

Cited by 40 publications

References 33 publications

Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database

Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database

Assessing the differences in characteristics of patients lost to follow-up at 2 years: results from the Quality Outcomes Database study on outcomes of surgery for grade I spondylolisthesis

Hospital-Based Back Surgery: Geospatial-Temporal, Explanatory, and Predictive Models

Contact Info

Product

Resources

About