Are Guidelines Important? Results of a Prospective Quality Improvement Lumbar Fusion Project

James Harrop; Alexandra Emes; Ameet Chitale; Chengyuan Wu; Fadi Al Saiegh; Geoffrey Stricsek; Glenn A. Gonzalez; Jack Jallo; Josh Heller; Kevin Hines; Lucas Philipp; Sara Thalheimer; Srinivas K. Prasad; Thiago S. Montenegro; Umma Fatema; Ashwini Sharan

doi:10.1093/neuros/nyab062

Are Guidelines Important? Results of a Prospective Quality Improvement Lumbar Fusion Project

James Harrop, Alexandra Emes, Ameet Chitale, Chengyuan Wu, Fadi Al Saiegh, Geoffrey Stricsek, Glenn A. Gonzalez, Jack Jallo, Josh Heller, Kevin Hines, Lucas Philipp, Sara Thalheimer, Srinivas K. Prasad, Thiago S. Montenegro, Umma Fatema, Ashwini Sharan

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	77-84
Number of pages	8
Journal	Neurosurgery
Volume	89
Issue number	1
DOIs	https://doi.org/10.1093/neuros/nyab062
State	Published - Jun 15 2021
Externally published	Yes

Keywords

Evidence-based medicine criteria
Lumbar fusion
Oswestry Disability Index
Quality improvement

ASJC Scopus subject areas

Surgery
Clinical Neurology

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10.1093/neuros/nyab062

Cite this

Harrop, J., Emes, A., Chitale, A., Wu, C., Al Saiegh, F., Stricsek, G., Gonzalez, G. A., Jallo, J., Heller, J., Hines, K., Philipp, L., Thalheimer, S., Prasad, S. K., Montenegro, T. S., Fatema, U., & Sharan, A. (2021). Are Guidelines Important? Results of a Prospective Quality Improvement Lumbar Fusion Project. Neurosurgery, 89(1), 77-84. https://doi.org/10.1093/neuros/nyab062

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title = "Are Guidelines Important? Results of a Prospective Quality Improvement Lumbar Fusion Project",

abstract = "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.",

keywords = "Evidence-based medicine criteria, Lumbar fusion, Oswestry Disability Index, Quality improvement",

author = "James Harrop and Alexandra Emes and Ameet Chitale and Chengyuan Wu and {Al Saiegh}, Fadi and Geoffrey Stricsek and Gonzalez, {Glenn A.} and Jack Jallo and Josh Heller and Kevin Hines and Lucas Philipp and Sara Thalheimer and Prasad, {Srinivas K.} and Montenegro, {Thiago S.} and Umma Fatema and Ashwini Sharan",

note = "Publisher Copyright: {\textcopyright} Congress of Neurological Surgeons 2021.",

year = "2021",

month = jun,

day = "15",

doi = "10.1093/neuros/nyab062",

language = "English (US)",

volume = "89",

pages = "77--84",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Lippincott Williams and Wilkins",

number = "1",

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TY - JOUR

T1 - Are Guidelines Important? Results of a Prospective Quality Improvement Lumbar Fusion Project

AU - Harrop, James

AU - Emes, Alexandra

AU - Chitale, Ameet

AU - Wu, Chengyuan

AU - Al Saiegh, Fadi

AU - Stricsek, Geoffrey

AU - Gonzalez, Glenn A.

AU - Jallo, Jack

AU - Heller, Josh

AU - Hines, Kevin

AU - Philipp, Lucas

AU - Thalheimer, Sara

AU - Prasad, Srinivas K.

AU - Montenegro, Thiago S.

AU - Fatema, Umma

AU - Sharan, Ashwini

PY - 2021/6/15

Y1 - 2021/6/15

N2 - 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.

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.

KW - Evidence-based medicine criteria

KW - Lumbar fusion

KW - Oswestry Disability Index

KW - Quality improvement

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Are Guidelines Important? Results of a Prospective Quality Improvement Lumbar Fusion Project

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