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Anthony L. Asher

TO THE EDITOR: We appreciate the publication of our article, “Inadequacy of 3-month Oswestry Disability Index outcome for assessing individual longer-term patient experience after lumbar spine surgery” ( J Neurosurg Spine [epub ahead of print March 18, 2016; DOI: 10.3171/2015.11.SPINE15872]). On viewing the paper online, however, we noted that one of the departmental affiliations was incorrectly listed as “Orthopedics Surgery” when it should have been “Orthopaedic Surgery,” and Dr. Kristin Archer was listed as having only one affiliation when in fact she

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Matthew J. McGirt, Scott L. Parker, Silky Chotai, Deborah Pfortmiller, Jeffrey M. Sorenson, Kevin Foley and Anthony L. Asher

. To date, there has been no comprehensive, prospective analysis of patient data with the primary intent of understanding the factors associated with increased risk of hospital LOS, need for inpatient rehabilitation, and hospital readmission after lumbar spine surgery. We set out to develop a grading scale that effectively stratifies risk of these costly events after elective surgery for degenerative lumbar pathologies. Methods Patient Population The Quality and Outcomes Database (QOD) is a prospective patient-reported outcomes registry that enrolls patients

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Ikemefuna Onyekwelu, Steven D. Glassman, Anthony L. Asher, Christopher I. Shaffrey, Praveen V. Mummaneni and Leah Y. Carreon

literature reporting satisfactory outcomes with lumbar fusion in obese patients, 5 , 14 , 15 , 22 , 25 , 29 we hypothesized that obese and nonobese patients would have comparable clinical benefit following lumbar spine surgery regardless of whether lumbar fusion was part of the procedure. Therefore, the purpose of the current study was to compare the outcomes of obese versus nonobese patients who had undergone surgical treatment for the diagnosis of lumbar spinal stenosis (LSS). In particular, we hoped to ascertain any differences in outcomes and complication rates when

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Anthony L. Asher, Clinton J. Devin, Brandon McCutcheon, Silky Chotai, Kristin R. Archer, Hui Nian, Frank E. Harrell Jr., Matthew McGirt, Praveen V. Mummaneni, Christopher I. Shaffrey, Kevin Foley, Steven D. Glassman and Mohamad Bydon

data” approach to clinical research. The QOD national project includes a diverse network of health care institutions and patient types, which allows for a true representative sampling of patients undergoing elective lumbar spine surgery. Furthermore, this is the first study to characterize smokers undergoing surgery for lumbar degenerative pathologies and to determine if smoking status has any impact on the other risk factors associated with PROs. Conclusions Using a large, national, multiinstitutional registry, we described the profile of patients who undergo lumbar

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Rishi K. Wadhwa, Junichi Ohya, Todd D. Vogel, Leah Y. Carreon, Anthony L. Asher, John J. Knightly, Christopher I. Shaffrey, Steven D. Glassman and Praveen V. Mummaneni

which patients may be at high risk for additional expenditures. We sought to use the QOD registry to identify which clinical factors are associated with reoperation within 30 days and readmission within 90 days after lumbar spine surgery. We also aimed to assess if there were more readmissions and reoperations in the Medicare population stratified by age (≥ 65-year-old and < 65-year-old subgroups of the Medicare covered population) than in the privately insured population. We suspected that younger patients with Medicare insurance may have unique medical comorbidities

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Charles H. Crawford III, Leah Y. Carreon, Mohamad Bydon, Anthony L. Asher and Steven D. Glassman

.1097/00007632-200011150-00017 7 Fekete TF , Haschtmann D , Kleinstück FS , Porchet F , Jeszenszky D , Mannion AF : What level of pain are patients happy to live with after surgery for lumbar degenerative disorders? . Spine J 16 : 4 Suppl S12 – S18 , 2016 8 Glassman SD , Copay AG , Berven SH , Polly DW , Subach BR , Carreon LY : Defining substantial clinical benefit following lumbar spine arthrodesis . J Bone Joint Surg Am 90 : 1839 – 1847 , 2008 18762642 10.2106/JBJS.G.01095 9 McCaffery M , Beebe A : Pain: Clinical Manual for Nursing Practice

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Matthew J. McGirt, Mohamad Bydon, Kristin R. Archer, Clinton J. Devin, Silky Chotai, Scott L. Parker, Hui Nian, Frank E. Harrell Jr., Theodore Speroff, Robert S. Dittus, Sharon E. Philips, Christopher I. Shaffrey, Kevin T. Foley and Anthony L. Asher

D egenerative lumbar spine pathology is a common indication for spine surgery, particularly with the aging US population. Over the past 2 decades, there has been a 300% increase in the number of low-back surgeries and a corresponding increase in the incidence and prevalence of lumbar fusion operations. 24 , 54 , 59 , 64 A recent analysis from the Agency for Healthcare Research and Quality found that the greatest proportion of overall health care expenditure in US hospitals is spent on spinal fusion, costing $12.8 billion in 2011. 66 The safety and

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Anthony L. Asher, Silky Chotai, Clinton J. Devin, Theodore Speroff, Frank E. Harrell Jr., Hui Nian, Robert S. Dittus, Praveen V. Mummaneni, John J. Knightly, Steven D. Glassman, Mohamad Bydon, Kristin R. Archer, Kevin T. Foley and Matthew J. McGirt

Index (ODI); 19 , 23 and 3) health-related quality of life–the EQ-5D questionnaire. 8 , 18 For the purposes of this analysis, we enrolled all lumbar surgery cases into the N 2 QOD database from August 2012 to October 2013 with complete 3-months and 1-year follow-up information spanning from August 2013 to October 2014. We chose to compare the 3- and 12-month outcomes for the back pain–related disability metric ODI, as several studies have shown that ODI is the most relevant and important determinant of pain and disability outcomes following lumbar spine surgery. 17

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Matthew J. McGirt, Ahilan Sivaganesan, Anthony L. Asher and Clinton J. Devin

decades. 3 , 4 , 13 , 18 Surgical treatment for the most common lumbar spine diagnoses have been confirmed to be efficacious in several randomized controlled trials. 11 , 16 , 19 , 20 Nonetheless, its safety and effectiveness have been found to vary widely at the patient-level, with up to 25% of patients experiencing minimal improvement in quality of life and up to 10% experiencing a major complication or hospital readmission. 12 To date, a validated prediction model for lumbar spine surgery has yet to be introduced to provide individualized estimations of the risks

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Matthew J. McGirt, Theodore Speroff, Robert S. Dittus, Frank E. Harrell Jr. and Anthony L. Asher

more valuable care. As these methods evolve, there exists an opportunity for physicians to impact the form and method by which the quality and value of health care is defined. In March 2012, the AANS launched the National Neurosurgery Quality and Outcomes Database (N 2 QOD) ( http://www.neuropoint.org/NPA%20N2QOD.html ). 2 The lumbar module was released as the initial 12-month pilot project to determine the feasibility of a nationwide, prospective longitudinal neurosurgical outcomes registry and assess the utility of its data. While the N 2 QOD lumbar spine pilot