PMID- 33729535
OWN - NLM
STAT- MEDLINE
DCOM- 20211008
LR  - 20211008
IS  - 1524-4040 (Electronic)
IS  - 0148-396X (Linking)
VI  - 89
IP  - 1
DP  - 2021 Jun 15
TI  - Are Guidelines Important? Results of a Prospective Quality Improvement Lumbar 
      Fusion Project.
PG  - 77-84
LID - 10.1093/neuros/nyab062 [doi]
AB  - BACKGROUND: United States (U.S.) healthcare is a volume-based inefficient 
      delivery system. Value requires the consideration of quality, which is lacking in 
      most healthcare disciplines. OBJECTIVE: To assess whether patients who met 
      specific evidence-based medicine (EBM)-based criteria preoperatively for lumbar 
      fusion would achieve higher rates of achieving the minimal clinical important 
      difference (MCID) than those who did not meet the EBM indications. METHODS: All 
      elective lumbar fusion cases, March 2018 to August 2019, were prospectively 
      evaluated and categorized based on EBM guidelines for surgical indications. The 
      MCID was defined as a reduction of >/=5 points in Oswestry Disability Index (ODI). 
      Multiple logistic regression identified multivariable-adjusted odds ratio of EBM 
      concordance. RESULTS: A total of 325 lumbar fusion patients were entered with 
      6-mo follow-up data available for 309 patients (95%). The median preoperative ODI 
      score was 24.4 with median 6-mo improvement of 7.0 points (P < .0001). Based on 
      ODI scores, 79.6% (246/309) improved, 3.8% (12/309) had no change, and 16% 
      (51/309) worsened. A total of 191 patients had ODI improvement reaching the MCID. 
      93.2% (288/309) cases were EBM concordant, while 6.7% (21/309) were not.In 
      multivariate analysis, EBM concordance (P = .0338), lower preoperative ODI 
      (P < .001), lower ASA (American Society of Anesthesiologists) (P = .0056), and 
      primary surgeries (P = .0004) were significantly associated with improved 
      functional outcome. EBM concordance conferred a 3.04 (95% CI 1.10-8.40) times 
      greater odds of achieving MCID in ODI at 6 mo (P = .0322), adjusting for other 
      factors. CONCLUSION: This analysis provides validation of EBM guideline criteria 
      to establish optimal patient outcomes. The EBM concordant patients had a greater 
      than 3 times improved outcome compared to those not meeting EBM fusion criteria.
CI  - (c) Congress of Neurological Surgeons 2021.
FAU - Harrop, James
AU  - Harrop J
AD  - Department of Neurological Surgery, Thomas Jefferson University Hospital, 
      Philadelphia, Pennsylvania, USA.
FAU - Emes, Alexandra
AU  - Emes A
AD  - Department of Neurological Surgery, Thomas Jefferson University Hospital, 
      Philadelphia, Pennsylvania, USA.
FAU - Chitale, Ameet
AU  - Chitale A
AD  - Department of Neurological Surgery, Thomas Jefferson University Hospital, 
      Philadelphia, Pennsylvania, USA.
FAU - Wu, Chengyuan
AU  - Wu C
AD  - Department of Neurological Surgery, Thomas Jefferson University Hospital, 
      Philadelphia, Pennsylvania, USA.
FAU - Al Saiegh, Fadi
AU  - Al Saiegh F
AD  - Department of Neurological Surgery, Thomas Jefferson University Hospital, 
      Philadelphia, Pennsylvania, USA.
FAU - Stricsek, Geoffrey
AU  - Stricsek G
AD  - Department of Neurological Surgery, Thomas Jefferson University Hospital, 
      Philadelphia, Pennsylvania, USA.
FAU - Gonzalez, Glenn A
AU  - Gonzalez GA
AUID- ORCID: 0000-0002-5051-3141
AD  - Department of Neurological Surgery, Thomas Jefferson University Hospital, 
      Philadelphia, Pennsylvania, USA.
FAU - Jallo, Jack
AU  - Jallo J
AUID- ORCID: 0000-0002-5512-1729
AD  - Department of Neurological Surgery, Thomas Jefferson University Hospital, 
      Philadelphia, Pennsylvania, USA.
FAU - Heller, Josh
AU  - Heller J
AD  - Department of Neurological Surgery, Thomas Jefferson University Hospital, 
      Philadelphia, Pennsylvania, USA.
FAU - Hines, Kevin
AU  - Hines K
AD  - Department of Neurological Surgery, Thomas Jefferson University Hospital, 
      Philadelphia, Pennsylvania, USA.
FAU - Philipp, Lucas
AU  - Philipp L
AD  - Department of Neurological Surgery, Thomas Jefferson University Hospital, 
      Philadelphia, Pennsylvania, USA.
FAU - Thalheimer, Sara
AU  - Thalheimer S
AD  - Department of Neurological Surgery, Thomas Jefferson University Hospital, 
      Philadelphia, Pennsylvania, USA.
FAU - Prasad, Srinivas K
AU  - Prasad SK
AD  - Department of Neurological Surgery, Thomas Jefferson University Hospital, 
      Philadelphia, Pennsylvania, USA.
FAU - Montenegro, Thiago S
AU  - Montenegro TS
AD  - Department of Neurological Surgery, Thomas Jefferson University Hospital, 
      Philadelphia, Pennsylvania, USA.
FAU - Fatema, Umma
AU  - Fatema U
AD  - Department of Neurological Surgery, Thomas Jefferson University Hospital, 
      Philadelphia, Pennsylvania, USA.
FAU - Sharan, Ashwini
AU  - Sharan A
AD  - Department of Neurological Surgery, Thomas Jefferson University Hospital, 
      Philadelphia, Pennsylvania, USA.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Neurosurgery
JT  - Neurosurgery
JID - 7802914
SB  - IM
MH  - Disability Evaluation
MH  - Humans
MH  - *Lumbar Vertebrae/surgery
MH  - Lumbosacral Region
MH  - Multivariate Analysis
MH  - Prospective Studies
MH  - *Quality Improvement
MH  - *Spinal Fusion
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Evidence-based medicine criteria
OT  - Lumbar fusion
OT  - Oswestry Disability Index
OT  - Quality improvement
EDAT- 2021/03/18 06:00
MHDA- 2021/10/09 06:00
CRDT- 2021/03/17 12:36
PHST- 2020/09/09 00:00 [received]
PHST- 2020/12/26 00:00 [accepted]
PHST- 2021/03/18 06:00 [pubmed]
PHST- 2021/10/09 06:00 [medline]
PHST- 2021/03/17 12:36 [entrez]
AID - 6168873 [pii]
AID - 10.1093/neuros/nyab062 [doi]
PST - ppublish
SO  - Neurosurgery. 2021 Jun 15;89(1):77-84. doi: 10.1093/neuros/nyab062.