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Matthew J. McGirt, Giannina L. Garces Ambrossi, Judy Huang and Rafael J. Tamargo

least 14 days after aSAH in addition to the usual care. Before this date, patients taking statins at baseline discontinued statin therapy on admission for aSAH. Throughout the 5-year study period, our standard of care consisted of at least a 14-day hospital stay to monitor for delayed neurological decline. All inpatient outcome measures were prospectively recorded throughout the study period. The assessment of all end points was standardized between the prestatin and poststatin eras, with the a priori plan to determine the effect of simvastatin on the incidence of

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Matthew J. McGirt, Robert Blessing, Michael J. Alexander, Shahid M. Nimjee, Graeme F. Woodworth, Allan H. Friedman, Carmelo Graffagnino, Daniel T. Laskowitz and John R. Lynch

-CoA reductase inhibitors would be less likely to experience cerebral vasospasm following aneurysmal SAH. The purpose of this study was to assess, using multivariate logistic regression analysis, factors predictive of symptomatic vasospasm after aneurysmal SAH in a cohort of patients given long-term statin therapy compared with those not so treated. We also sought to determine whether long-term statin treatment independently decreased the odds of subsequent symptomatic vasospasm onset. Clinical Material and Methods Patient Population and Data Collection All

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Christopher I. Shaffrey and Justin S. Smith

effective as and far less expensive than surgical intervention for most spinal disorders. Several recent studies have called these beliefs into question. 3 , 14–17 Nonoperative management can be costly, particular if there are not demonstrable improvements in pain and function. 8 Glassman and associates evaluated 55 scoliosis patients who received only nonoperative care and collected utilization data for 8 specific treatment methods: medication, physical therapy, exercise, injections/blocks, chiropractic care, pain management, bracing, and bed rest. 6 The authors found

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Scott A. Meyer and Praveen V. Mummaneni

Adogwa et al. 1 retrospectively evaluated 45 patients undergoing transforaminal lumbar interbody fusion (TLIF) for back and leg pain associated with Grade I degenerative spondylolisthesis. Conservative therapy had already failed after 6–12 months. Patients were entered into an electronic registry from which pre-, intra-, and perioperative data were recorded. Preoperative patient-reported metrics including EuroQol 5 Dimensions (EQ-5D), Oswestry Disability Index, and visual analog scale (VAS) scores were retrospectively assessed. Two-year resource

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John R. W. Kestle

. Bias is a risk in everything that we study and write about. In addition to these well-known and identifiable sources of bias, there is evidence that the funding source may introduce additional bias. Bhandari et al. 1 looked at 332 randomized trials of medical and surgical therapies and compared 122 with industry funding to those with other sources of funding. Industry funding almost doubled the odds (OR 1.9 [95% CI 1.3–3.0]) of a statistically significant result in favor of the industry product. This remained true even after the analysis was adjusted to account

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Matthew J. McGirt, Shlomi Constantini and George I. Jallo

and 34 (21%) the thoracolumbar spine. Six tumors (4%) involved both the cervicothoracic and thoracolumbar spine. Forty-one (25%) patients underwent preoperative radiation therapy, and 42 (26%) underwent postoperative adjuvant radiation therapy. One hundred twenty-five patients (76%) underwent radical resection, 33 (20%) underwent subtotal resection, and 6 (4%) underwent biopsy. The mean number of surgical levels was 6 ± 3. Pathologically, 66 tumors (40%) were Grade I or II, 14 (9%) were Grade III, and 4 (2%) were Grade IV astrocytoma. In addition, there were 44

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Scott L. Parker, David N. Shau, Stephen K. Mendenhall and Matthew J. McGirt

steroids, narcotics, muscle relaxants, and antidepressants), and physical therapy days were assessed. Two-year direct medical costs were estimated by multiplying medical resource use by unit costs based on current Medicare national allowable payment amounts. Surgeon costs were based on Medicare allowable amounts using the resource-based relative value scale. Therefore, the cost analyzed was that to the third-party payer, which represents the overall cost to the medical system. The costs of surgery depend on the procedure being performed, severity of the individual case

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Natalie C. Edwards, Luella Engelhart, Eva M. H. Casamento and Matthew J. McGirt

- sults showed that the economic model was most sensitive to the rate of decrease in infection with non-AICs. Cost analyses are inherently proprietary, and published models may provide a starting point for appraising the value of alternate therapies. Limitations There are some limitations associated with this analysis. Most of the available evidence comes from nonrandomized studies. Comparisons of baseline characteristics indicated that patients in the AIC and non-AIC groups were similar; however, it is possible that results are confounded, and observed

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

wasteful care. 1 , 6 Patients, physicians, hospital systems, and third-party payers all aim to identify which patients or disease subgroups are least likely to respond to surgery, are prone to costly complications, and are associated with over-utilization of services. Randomized controlled trials are ideally suited to determine whether therapies, on average, provide improved outcome per disease process. However, their high costs and selective patient enrollment prohibit the comprehensive, diverse, and high-volume patient enrollment needed to analyze individual outcomes

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Matthew J. McGirt, Khoi D. Than, Jon D. Weingart, Kaisorn L. Chaichana, Frank J. Attenello, Alessandro Olivi, John Laterra, Lawrence R. Kleinberg, Stuart A. Grossman, Henry Brem and Alfredo Quiñones-Hinojosa

extend median survival by 2–4 months for patients with newly diagnosed and recurrent malignant astrocytoma, resulting in a median survival of 13.9 months after initial tumor resection. 2 , 3 , 16 , 19 , 20 More recently, adding the systemic chemotherapeutic agent TMZ (Temodar, Schering Corp.) to standard radiation therapy was reported to increase median survival by 2.5 months versus radiotherapy alone, further extending median survival to 14.6 months after primary esection. 14 However, postoperative radiotherapy plus concomitant and adjuvant TMZ alone (Stupp protocol