Kooperativer Bibliotheksverbund

Berlin Brandenburg

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  • 1
    In: Spine, 1994, Vol.19(12), pp.1329-1334
    Description: STUDY DESIGN: A cohort study was undertaken using medical claims of Medicare beneficiaries. OBJECTIVES: Factors associated with reoperation after lumbar spine surgery were identified. SUMMARY OF BACKGROUND DATA: Repeat spine surgery is one outcome measure of surgical success, but little is known about clinical or demographic factors associated with repeat surgery. METHODS: Medicare beneficiaries who had surgery in 1985 were included in follow-up through 1989. Time between the first operation and a lumbar spine reoperation, death, or end of follow-up period was recorded. Survival analysis (time-to-event) techniques were used to test the association of baseseline characteristics with reoperation. RESULTS: Higher reoperation rates were associated (P 〈 0.05) with previous back surgery, younger age, recent hospitalization, white race, and diagnosis of herniated disc (compared with other diagnoses). Fusion alone or combined with other procedures did not lower the reoperation rate. CONCLUSION: Reoperation rates are affected not only by technical factors, but also by demographic and clinical characteristics that are often omitted from reports of surgical case series.
    Keywords: Back Pain -- Surgery ; Lumbar Vertebrae -- Surgery ; Reoperation -- Statistics & Numerical Data ; Spinal Diseases -- Surgery;
    ISSN: 0362-2436
    E-ISSN: 15281159
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  • 2
    In: Spine, 2007, Vol.32(3), pp.342-347
    Description: STUDY DESIGN.: Retrospective cohort. OBJECTIVES.: To describe the incidence of complications and mortality associated with surgery for degenerative disease of the cervical spine using population-based data. To evaluate the associations between complications and mortality and age, primary diagnosis and type of surgical procedure. SUMMARY OF BACKGROUND DATA.: Recent studies have shown an increase in the number of cervical spine surgeries performed for degenerative disease in the United States. However, the associations between complications and mortality and age, primary diagnosis and type of surgical procedure are not well described using population-based data. METHODS.: We created an algorithm defining degenerative cervical spine disease and associated complications using the International Classification of Diseases-ninth revision Clinical Modification codes. Using the Nationwide Inpatient Sample, we determined the primary diagnoses, surgical procedures, and associated in-hospital complications and mortality from 1992 to 2001. RESULTS.: From 1992 to 2001, the Nationwide Inpatient Sample included an estimated 932,009 (0.3%) hospital discharges associated with cervical spine surgery for degenerative disease. The majority of admissions were for herniated disc (56%) and cervical spondylosis with myelopathy (19%). Complications and mortality were more common in the elderly, and after posterior fusions or surgical procedures associated with a primary diagnosis of cervical spondylosis with myelopathy. CONCLUSIONS.: There are significant differences in outcome associated with age, primary diagnosis, and type of surgical procedure. Administrative databases may underestimate the incidence of complications, but these population-based studies may provide information for comparison with surgical case series and help evaluate rare or severe complications.
    Keywords: Adult–Pathology ; Age Factors–Surgery ; Aged–Mortality ; Cervical Vertebrae–Trends ; Cohort Studies–Mortality ; Decompression, Surgical–Classification ; Female–Mortality ; Hospital Mortality–Surgery ; Humans–Mortality ; Male–Epidemiology ; Middle Aged–Epidemiology ; Postoperative Complications–Epidemiology ; Retrospective Studies–Epidemiology ; Spinal Diseases–Epidemiology ; Spinal Fusion–Epidemiology ; United States–Epidemiology;
    ISSN: 0362-2436
    E-ISSN: 15281159
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  • 3
    In: Spine, 2009, Vol.34(9), pp.955-961
    Description: STUDY DESIGN.: Retrospective cohort. OBJECTIVE.: To describe population-based trends and variations in surgery for degenerative changes of the cervical spine among Medicare beneficiaries, 1992 to 2005. SUMMARY OF BACKGROUND DATA.: Degenerative changes of the cervical spine are seen radiographically in over half of the population aged 55 years or greater, and rates of cervical spine surgery have increased over time. Prior studies examined anterior cervical discectomy and fusion procedures in the general population up to 1999, and showed regional variations in care, with the highest rates in the South. The purpose of this study is to explore population-based trends and variations in surgery for degenerative changes of the cervical spine in the elderly. METHODS.: From 1992 to 2005, hospital admissions associated with surgery for degenerative changes of the cervical spine were selected from Medicare Part A using ICD9 CM codes. We excluded beneficiaries under 65 years of age, in a capitated health plan, or enrolled for Social Security Disability Income. Diagnosis and type of surgery were defined using ICD9 CM codes. Rates were directly adjusted to age, sex, and race of 2005 Medicare beneficiaries. RESULTS.: Of 156,820 qualifying admissions, 52% were men, 88% were white, and 41% were aged 65 to 69 years. The most common primary diagnosis and procedure were cervical spondylosis with myelopathy (36%) and fusion (70%); of the fusions, 58% were anterior. Rates of cervical fusions rose from 1992 to 2005 even after adjustment for age, sex, and race (14.7 to 45 cervical fusions/100,000 beneficiaries). Rates of cervical fusions varied by geographic location, with the highest rates in the Northwest and South Central regions. In 2005, the highest rate of cervical fusions was 140/100,000 beneficiaries in Idaho, compared with 4/100,000 beneficiaries in Washington, DC. CONCLUSION.: In the elderly, adjusted rates of cervical spine fusions rose 206% from 1992 to 2005. Marked geographic variation was noted. Future studies should evaluatethe efficacy and complications associated with these procedures in the elderly, and better define surgical indications and patient outcome.
    Keywords: Cervical Vertebrae -- Surgery ; Medicare -- Economics ; Spinal Fusion -- Methods;
    ISSN: 0362-2436
    E-ISSN: 15281159
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  • 4
    In: Spine, 2006, Vol.31(17), pp.1957-1963
    Description: STUDY DESIGN.: Sequential cross-sectional study. OBJECTIVES.: To quantify patterns of outpatient lumbar spine surgery. SUMMARY OF BACKGROUND DATA.: Outpatient lumbar spine surgery patterns are undocumented. METHODS.: We used CPT-4 and ICD-9-CM diagnosis/procedure codes to identify lumbar spine operations in 20+ year olds. We combined sample volume estimates from the National Hospital Discharge Survey (NHDS), the National Survey of Ambulatory Surgery (NSAS), and the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) with complete case counts from HCUPʼs State Inpatient Databases (SIDs) and State Ambulatory Surgery Databases (SASDs) for four geographically diverse states. We excluded pregnant patients and those with vertebral fractures, cancer, trauma, or infection. We calculated age- and sex-adjusted rates. RESULTS.: Ambulatory cases comprised 4% to 13% of procedures performed from 1994 to 1996 (NHDS/NSAS data), versus 9% to 17% for 1997 to 2000 (SID/SASD data). Discectomies comprised 70% to 90% of outpatient cases. Conversely, proportions of discectomies performed on outpatients rose from 4% in 1994 to 26% in 2000. Outpatient fusions and laminectomies were uncommon. NIS data indicate that nationwide inpatient surgery rates were stable (159 cases/100,000 in 1994 vs. 162/100,000 in 2000). However, combined data from all sources suggest that inpatient and outpatient rates rose from 164 cases/100,000 in 1994 to 201/100,000 in 2000. CONCLUSIONS.: While inpatient lumbar surgery rates remained relatively stable for 1994 to 2000, outpatient surgery increased over time.
    Keywords: Adult–Statistics & Numerical Data ; Ambulatory Care–Trends ; Cross-Sectional Studies–Statistics & Numerical Data ; Diskectomy–Trends ; Humans–Statistics & Numerical Data ; Inpatients–Statistics & Numerical Data ; Laminectomy–Trends ; Lumbar Vertebrae–Surgery ; Orthopedics–Statistics & Numerical Data ; Spinal Fusion–Trends ; United States–Statistics & Numerical Data ; United States–Trends;
    ISSN: 0362-2436
    E-ISSN: 15281159
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  • 5
    Language: English
    In: Spine, 15 January 2001, Vol.26(2), pp.206-11;discussion 212
    Description: A randomized trial of 100 patients with low back pain who were potential surgical candidates. To determine whether an interactive videodisc with a booklet is superior to a booklet alone for informing patients about back surgery. Substantial geographic variation has been observed in lumbar spine surgery. Informed patient preferences should play an important role in decisions about surgery. However, little is known about optimal strategies for informing patients. Subjects were randomized to receive an interactive videodisc (with a booklet) or a booklet alone. A knowledge test administered at baseline and follow-up was used to measure improvement in knowledge about treatment options for lumbar spine problems. Patients' reactions to the videodisc and booklet and preferences for treatment were also assessed. The patients' knowledge improved after exposure to either intervention. Multivariate analyses adjusted for baseline score, age, education, gender, and diagnosis showed a significant advantage for the videodisc with booklet over the booklet alone. The videodisc-booklet group showed significantly greater gains in knowledge among subjects with the worst baseline knowledge scores. A larger proportion of subjects in the videodisc-booklet group rated the materials easy to understand (93% vs.- 72%,P = 0.04), containing the right amount of information (93% vs.- 80%,P = 0.3), and adequate to assist in choice of treatment (75% vs.- 51%,P = 0.2). Those who viewed the videodisc expressed a somewhat lower preference for surgery than those who received the booklet alone (23% vs.- 42%,P = 0.4). Both the booklet alone and the combination of videodisc and booklet improved knowledge. The combination produced greater knowledge gains than the booklet alone for the subgroup with the least knowledge at baseline. Patients preferred the combination and had a slightly lower preference for surgery if they had viewed the video presentation. For some patients, the video may enhance involvement in clinical decisions.
    Keywords: Back Pain -- Psychology ; Orthopedic Procedures -- Psychology
    ISSN: 0362-2436
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