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Judith M. Wong, John E. Ziewacz, Jaykar R. Panchmatia, Angela M. Bader, Aditya S. Pandey, B. Gregory Thompson, Kai Frerichs and Atul A. Gawande

systematic, nationwide approaches to measuring and improving outcomes. As part of a project funded by the US Agency for Healthcare Research and Quality to devise evidence-based checklists and protocols for specialty surgery, we sought to review current evidence in neurosurgery concerning the frequency of adverse events in practice, their patterns, and the state of knowledge about how to improve them. We hypothesized that this consolidation of existing data, even if commonly known to neurosurgeons, will not only highlight the need for devising system-wide policies and

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Judith M. Wong, Angela M. Bader, Edward R. Laws, A. John Popp and Atul A. Gawande

N eurosurgery is a high-risk surgical specialty and has begun to pursue systematic approaches to measuring and improving outcomes for the national neurosurgical population. In the other 4 papers in this series, 63–66 we review the current evidence in 4 distinct areas of neurosurgery concerning the frequency of adverse events in practice and the state of knowledge about how to improve them. Here we describe the patterns revealed from analysis of these data, describe current safety practices in other medical fields, including other surgical specialties, and

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Judith M. Wong, Jaykar R. Panchmatia, John E. Ziewacz, Angela M. Bader, Ian F. Dunn, Edward R. Laws and Atul A. Gawande

systematic, nationwide approaches to measuring and improving outcomes. As part of a project funded by the US Agency for Healthcare Research and Quality to devise evidence-based checklists and protocols for specialty surgery, we sought to review current evidence in neurosurgery concerning the frequency of adverse events in practice, their patterns, and the state of knowledge about how to improve them. We hypothesized that this consolidation of existing data, even if commonly known to neurosurgeons, will not only highlight the need for devising system-wide policies and

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Judith M. Wong, John E. Ziewacz, Allen L. Ho, Jaykar R. Panchmatia, Albert H. Kim, Angela M. Bader, B. Gregory Thompson, Rose Du and Atul A. Gawande

pursue systematic, nationwide approaches to measuring and improving outcomes and developing evidence-based guidelines for a variety of neurosurgical disorders. As part of a project funded by the US Agency for Healthcare Research and Quality to devise evidence-based checklists and protocols for specialty surgery, we sought to review current evidence in neurosurgery concerning the frequency of adverse events in practice, their patterns, and the state of knowledge about how to improve them. We hypothesized that this consolidation of existing data, even if commonly known

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Judith M. Wong, John E. Ziewacz, Allen L. Ho, Jaykar R. Panchmatia, Angela M. Bader, Hugh J. Garton, Edward R. Laws and Atul A. Gawande

beginning to pursue systematic, nationwide approaches to measuring and improving outcomes and to developing evidence-based guidelines for a variety of neurosurgical disorders. As part of a project funded by the US Agency for Healthcare Research and Quality to devise evidence-based checklists and protocols for specialty surgery, we sought to review current evidence in neurosurgery concerning the frequency of adverse events in practice, their patterns, and the state of knowledge about how to improve them. This review represents part of a series of papers written to

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Nicolas Dea, Anne Versteeg, Charles Fisher, Adrienne Kelly, Dennis Hartig, Michael Boyd, Scott Paquette, Brian K. Kwon, Marcel Dvorak and John Street

H istorically , most reports on adverse events (AEs) in the literature are retrospective in nature or are from studies that do not include AE compilation as a primary outcome. Emerging prospective studies with AEs as the targeted outcome 3 , 17 suggest that when prospectively collected, AE rates are significantly higher than previously reported. This discrepancy is multifactorial but explained primarily by complication studies that relied on hospital-based administrative databases that lack sufficient detail and are populated retrospectively. Street et

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Hormuzdiyar H. Dasenbrock, Robert F. Rudy, Timothy R. Smith, William B. Gormley, Nirav J. Patel, Kai U. Frerichs, M. Ali Aziz-Sultan and Rose Du

Nevertheless, additional predictors of complications (including patient demographics, comorbidities, and laboratory values) may optimize preoperative risk stratification, thereby potentially improving outcomes. The National Surgical Quality Improvement Program (NSQIP) is a large, multiinstitutional prospectively collected registry that accrues patients from across the United States. The goals of this analysis were to 1) evaluate the predictors of adverse events after microsurgical clipping of unruptured aneurysms and 2) create (and validate) a simple predictive scale of

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Christina L. Goldstein, Kevin Macwan, Kala Sundararajan and Y. Raja Rampersaud

degenerative disorders. We hypothesize that the current evidence will suggest equivalent clinical outcomes and no differences in adverse event rates between open and MIS cohorts. Methods Systematic Review and Data Collection Guidelines proposed by the Meta-analysis of Observational Studies in Epidemiology (MOOSE) Group 49 and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement 30 were consulted prior to undertaking our systematic review. The exact methods used during our literature search have been described elsewhere. 15

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The effect of C2–3 disc angle on postoperative adverse events in cervical spondylotic myelopathy

Presented at the 2018 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Bryan S. Lee, Kevin M. Walsh, Daniel Lubelski, Konrad D. Knusel, Michael P. Steinmetz, Thomas E. Mroz, Richard P. Schlenk, Iain H. Kalfas and Edward C. Benzel

postoperative adverse events. We hypothesized that, in addition to the previously defined cervical alignment variables, an increased angle at the C2–3 disc space would predict postoperative adverse events. By identifying predictors of radiographic and clinical postoperative failure, spine surgeons can minimize the risk of complications and need for reoperation and can aim for optimal surgical outcomes. Methods Population/Data Collection An institutional review board protocol was obtained prior to conducting the study. The electronic medical records were retrospectively

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Y. Raja Rampersaud, Paul A. Anderson, John R. Dimar II, Charles G. Fisher and on behalf of the Spine Trauma Study Group and Degenerative Spine Study Group

T he Institute of Medicine reports on patient safety have raised numerous concerns from the public, health care providers, and other stakeholders regarding patient safety. 12 , 13 At a basic level, a standard language and consistent definitions for what constitutes an adverse event (AE) have been lacking. 3 , 5 , 9 , 11 , 15 Current terminology, such as “complication,” “AE,” “adverse occurrence,” or “near misses,” can have different meanings but are often used interchangeably. Furthermore, most AE studies use undefined terms, such as “major” or “minor