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Anthony L. Asher, Panagiotis Kerezoudis, Praveen V. Mummaneni, Erica F. Bisson, Steven D. Glassman, Kevin T. Foley, Jonathan R. Slotkin, Eric A. Potts, Mark E. Shaffrey, Christopher I. Shaffrey, Domagoj Coric, John J. Knightly, Paul Park, Kai-Ming Fu, Clinton J. Devin, Kristin R. Archer, Silky Chotai, Andrew K. Chan, Michael S. Virk and Mohamad Bydon

T he enactment of the Patient Protection and Affordable Care Act in 2010 established the foundation for the national standardization of health care delivery, ultimately leading to wide-ranging legislative oversight and determination of health care value. 18 Given the rapid growth and associated cost of surgical procedures, there is increasing interest in producing objective data to determine the quality of care and inform the allocation of health care resources. Patient-reported outcomes (PROs) are gaining a central role in evaluating the effectiveness of

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Praveen V. Mummaneni, Erica F. Bisson, Panagiotis Kerezoudis, Steven Glassman, Kevin Foley, Jonathan R. Slotkin, Eric Potts, Mark Shaffrey, Christopher I. Shaffrey, Domagoj Coric, John Knightly, Paul Park, Kai-Ming Fu, Clinton J. Devin, Silky Chotai, Andrew K. Chan, Michael Virk, Anthony L. Asher and Mohamad Bydon

proposed a focused project to determine the impact of fusion on patient-reported outcomes (PROs). Preoperative radiographs, standing or dynamic, were evaluated by surgeons at the participating site to confirm the diagnosis of Grade I spondylolisthesis. All surgical variables, including laminectomy performed, fusion performed, and number of levels of fusion or laminectomy, MIS versus open surgery, were audited for all eligible patients. Patients who underwent elective lumbar spine surgery for Grade I spondylolisthesis (according to the Meyerding classification 17 (via a

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

fusion (TLIF; Fig. 1 ) and MIS decompression for symptomatic, single-level, grade 1 degenerative lumbar spondylolisthesis. Fig. 1. Illustration depicting an L4–5 TLIF. Reprinted from Chan AK, et al: J Neurosurg Spine 30: 234–241, 2019. Artist: Kenneth Probst. Copyright Department of Neurological Surgery, University of California, San Francisco. Published with permission. Methods The Quality Outcomes Database (QOD) is a prospective, multicenter, multidisciplinary registry that includes demographic, clinical, and patient-reported outcome (PRO) data to measure the

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

, and nonuniform surgical techniques. Indeed, results pulled from randomized clinical trials may be difficult to generalize due to the stringent inclusion criteria used in those studies. Where trials fall short in the ability to capture the variability of “real-world” spine surgery practice, prospective registry data fill in the knowledge gap of a wide range of practice patterns. The AANS launched the Quality Outcomes Database (QOD), a prospective longitudinal registry that includes demographic, clinical, and patient-reported outcome (PRO) data to measure the safety

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Erica F. Bisson, Praveen V. Mummaneni, John Knightly, Mohammed Ali Alvi, Anshit Goyal, Andrew K. Chan, Jian Guan, Michael Biase, Andrea Strauss, Steven Glassman, Kevin Foley, Jonathan R. Slotkin, Eric Potts, Mark Shaffrey, Christopher I. Shaffrey, Regis W. Haid Jr., Kai-Ming Fu, Michael Y. Wang, Paul Park, Anthony L. Asher and Mohamad Bydon

(PROs) and clinical outcomes in order to establish a data-driven mechanism of providing insight into improving quality of care for routinely performed spine surgeries in the United States. 19 , 25 As of February 2019, more than 78,879 patients undergoing any lumbar surgery for degenerative disease across 105 participating sites throughout the nation have been enrolled in the lumbar spine surgery QOD module. 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

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

the outcomes of surgery for degenerative lumbar spondylolisthesis. In the Spinal Laminectomy versus Instrumental Pedicle Screw (SLIP) trial by Ghogawala and colleagues, the addition of fusion, as compared with laminectomy alone, was associated with a significant improvement in quality of life as well as a lower rate of reoperation (14% vs 34%). 12 However, in a subgroup analysis of patients with degenerative spondylolisthesis, Försth and colleagues found no significant benefit to the addition of fusion in any patient-reported outcome (PRO) metric at the 2-year

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

D egenerative lumbar spondylolisthesis is one of the most common causes of low-back pain, with a reported prevalence of 11.5% in the United States. 27 Surgical intervention may be considered for carefully selected patients in whom conservative management has failed, and it has been found to be associated with superior outcomes compared to nonsurgical therapy for this subset of patients. 41 However, it remains unclear what factors are associated with optimum patient-reported outcomes (PROs). Since the enactment of the Patient Protection and the Affordable Care

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Praveen V. Mummaneni, Mohamad Bydon, John Knightly, Mohammed Ali Alvi, Anshit Goyal, Andrew K. Chan, Jian Guan, Michael Biase, Andrea Strauss, Steven Glassman, Kevin T. Foley, Jonathan R. Slotkin, Eric Potts, Mark Shaffrey, Christopher I. Shaffrey, Regis W. Haid Jr., Kai-Ming Fu, Michael Y. Wang, Paul Park, Anthony L. Asher and Erica F. Bisson

-adjusted expected morbidity and 30-day and 12-month patient-reported outcomes (PROs) and clinical outcomes, which would facilitate a data-driven mechanism of providing insights into improving quality of care for routinely performed spine surgeries in the US. 6 , 12 , 29 As of February 2019, almost 80,000 patients across 220 participating sites nationwide had been enrolled in the Lumbar Spine Surgery QOD module ( https://www.neuropoint.org/registries/qod/ ). Among these, 12 of the highest-enrolling sites came together for a focused project to assess the impact of fusion on PROs

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Praveen V. Mummaneni, Mohamad Bydon, John Knightly, Mohammed Ali Alvi, Anshit Goyal, Andrew K. Chan, Jian Guan, Michael Biase, Andrea Strauss, Steven Glassman, Kevin T. Foley, Jonathan R. Slotkin, Eric Potts, Mark Shaffrey, Christopher I. Shaffrey, Regis W. Haid Jr., Kai-Ming Fu, Michael Y. Wang, Paul Park, Anthony L. Asher and Erica F. Bisson

-adjusted expected morbidity and 30-day and 12-month patient-reported outcomes (PROs) and clinical outcomes, which would facilitate a data-driven mechanism of providing insights into improving quality of care for routinely performed spine surgeries in the US. 6 , 12 , 29 As of February 2019, almost 80,000 patients across 220 participating sites nationwide had been enrolled in the Lumbar Spine Surgery QOD module ( https://www.neuropoint.org/registries/qod/ ). Among these, 12 of the highest-enrolling sites came together for a focused project to assess the impact of fusion on PROs

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included. Mean age was higher in public insurance group(p <0.001). Significant racial disparity was seen between two groups(p=0.03). Public insurance group comprised of significantly comorbid(p <0.001) and unemployed patients(p <0.001). There was no difference in baseline PROs between groups. Number of motion segments involved was higher in public insurance group(p <0.001). There was significant difference in the types of surgeries between the two groups(p <0.001). Length of surgery(p=0.004) and hospital stay(p=0.006) was significantly higher in public insurance group