Impact of surgeon and hospital factors on surgical decision-making for grade 1 degenerative lumbar spondylolisthesis: a Quality Outcomes Database analysis

2021 ◽  
pp. 1-11
Author(s):  
Meng Huang ◽  
Avery Buchholz ◽  
Anshit Goyal ◽  
Erica Bisson ◽  
Zoher Ghogawala ◽  
...  
Keyword(s):  
Degenerative Spondylolisthesis ◽  
Treatment Selection ◽  
Quality Outcomes ◽  
Site Specific ◽  
Decompressive Laminectomy ◽  
Patient Level ◽  
Clinical Covariates ◽  
Predictor Importance ◽  
Multivariable Regression ◽  
Specific Factors

OBJECTIVESurgical treatment for degenerative spondylolisthesis has been proven to be clinically challenging and cost-effective. However, there is a range of thresholds that surgeons utilize for incorporating fusion in addition to decompressive laminectomy in these cases. This study investigates these surgeon- and site-specific factors by using the Quality Outcomes Database (QOD).METHODSThe QOD was queried for all cases that had undergone surgery for grade 1 spondylolisthesis from database inception to February 2019. In addition to patient-specific covariates, surgeon-specific covariates included age, sex, race, years in practice (0–10, 11–20, 21–30, > 30 years), and fellowship training. Site-specific variables included hospital location (rural, suburban, urban), teaching versus nonteaching status, and hospital type (government, nonfederal; private, nonprofit; private, investor owned). Multivariable regression and predictor importance analyses were performed to identify predictors of the treatment performed (decompression alone vs decompression and fusion). The model was clustered by site to account for site-specific heterogeneity in treatment selection.RESULTSA total of 12,322 cases were included with 1988 (16.1%) that had undergone decompression alone. On multivariable regression analysis clustered by site, adjusting for patient-level clinical covariates, no surgeon-specific factors were found to be significantly associated with the odds of selecting decompression alone as the surgery performed. However, sites located in suburban areas (OR 2.32, 95% CI 1.09–4.84, p = 0.03) were more likely to perform decompression alone (reference = urban). Sites located in rural areas had higher odds of performing decompression alone than hospitals located in urban areas, although the results were not statistically significant (OR 1.33, 95% CI 0.59–2.61, p = 0.49). Nonteaching status was independently associated with lower odds of performing decompression alone (OR 0.40, 95% CI 0.19–0.97, p = 0.04). Predictor importance analysis revealed that the most important determinants of treatment selection were dominant symptom (Wald χ2 = 34.7, accounting for 13.6% of total χ2) and concurrent diagnosis of disc herniation (Wald χ2 = 31.7, accounting for 12.4% of total χ2). Hospital teaching status was also found to be relatively important (Wald χ2 = 4.2, accounting for 1.6% of total χ2) but less important than other patient-level predictors.CONCLUSIONSNonteaching centers were more likely to perform decompressive laminectomy with supplemental fusion for spondylolisthesis. Suburban hospitals were more likely to perform decompression only. Surgeon characteristics were not found to influence treatment selection after adjustment for clinical covariates. Further large database registry experience from surgeons at high-volume academic centers at which surgically and medically complex patients are treated may provide additional insight into factors associated with treatment preference for degenerative spondylolisthesis.

Effects of preoperative obesity and psychiatric comorbidities on minimum clinically important differences for lumbar fusion in grade 1 degenerative spondylolisthesis: analysis from the prospective Quality Outcomes Database registry

2020 ◽  
Vol 33 (5) ◽  
pp. 635-642
Author(s):  
Joseph Laratta ◽  
Leah Y. Carreon ◽  
Avery L. Buchholz ◽  
Andrew Y. Yew ◽  
Erica F. Bisson ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Preoperative Diagnosis ◽  
Rating Scale ◽  
Lumbar Fusion ◽  
Degenerative Spondylolisthesis ◽  
Leg Pain ◽  
Quality Outcomes ◽  
Medical Comorbidities ◽  
Fusion Procedure ◽  
Patient Reported

OBJECTIVEMedical comorbidities, particularly preoperatively diagnosed anxiety, depression, and obesity, may influence how patients perceive and measure clinical benefit after a surgical intervention. The current study was performed to define and compare the minimum clinically important difference (MCID) thresholds in patients with and without preoperative diagnoses of anxiety or depression and obesity who underwent spinal fusion for grade 1 degenerative spondylolisthesis.METHODSThe Quality Outcomes Database (QOD) was queried for patients who underwent lumbar fusion for grade 1 degenerative spondylolisthesis during the period from January 2014 to August 2017. Collected patient-reported outcomes (PROs) included the Oswestry Disability Index (ODI), health status (EQ-5D), and numeric rating scale (NRS) scores for back pain (NRS-BP) and leg pain (NRS-LP). Both anchor-based and distribution-based methods for MCID calculation were employed.RESULTSOf 462 patients included in the prospective registry who underwent a decompression and fusion procedure, 356 patients (77.1%) had complete baseline and 12-month PRO data and were included in the study. The MCID values for ODI scores did not significantly differ in patients with and those without a preoperative diagnosis of obesity (20.58 and 20.69, respectively). In addition, the MCID values for ODI scores did not differ in patients with and without a preoperative diagnosis of anxiety or depression (24.72 and 22.56, respectively). Similarly, the threshold MCID values for NRS-BP, NRS-LP, and EQ-5D scores were not statistically different between all groups. Based on both anchor-based and distribution-based methods for determination of MCID thresholds, there were no statistically significant differences between all cohorts.CONCLUSIONSMCID thresholds were similar for ODI, EQ-5D, NRS-BP, and NRS-LP in patients with and without preoperative diagnoses of anxiety or depression and obesity undergoing spinal fusion for grade 1 degenerative spondylolisthesis. Preoperative clinical and shared decision-making may be improved by understanding that preoperative medical comorbidities may not affect the way patients experience and assess important clinical changes postoperatively.

The influence of roost closure on the roosting and foraging behaviour of Eptesicus fuscus (Chiroptera: Vespertilionidae)

1986 ◽  
Vol 64 (5) ◽  
pp. 1128-1133 ◽  
Author(s):  
R. Mark Brigham ◽  
M. Brock Fenton
Keyword(s):  
Reproductive Success ◽  
Direct Observation ◽  
Foraging Behaviour ◽  
Eptesicus Fuscus ◽  
Maximum Distance ◽  
Radio Tracking ◽  
Site Specific ◽  
Big Brown Bats ◽  
Specific Factors ◽  
Foraging Flight

We used radio tracking and direct observation to determine the effect of roost closure on the roosting and foraging behaviour of big brown bats (Eptesicus fuscus) in maternity colonies near Ottawa. Individuals were site loyal, but after eviction they moved short distances to new roosts where they tended to produce fewer offspring. The time spent on the first foraging flight, the maximum distance travelled, and the use of feeding areas did not change with exclusion. The results suggest that bats roost to take advantage of site-specific factors that may increase reproductive success.

Lack of relationship between simulated fish population responses and their life history traits: inadequate models, incorrect analysis, or site-specific factors?

2005 ◽  
Vol 62 (4) ◽  
pp. 886-902 ◽  
Author(s):  
Kenneth A Rose
Keyword(s):  
Life History ◽  
Life History Traits ◽  
Lake Trout ◽  
Fish Population ◽  
Population Models ◽  
Site Specific ◽  
Density Dependent ◽  
Population Responses ◽  
Adult Growth ◽  
Specific Factors

Relationships between fish population responses to changes in their vital rates and commonly available life history traits would be a powerful screening tool to guide management about species vulnerability, to focus future data collection on species and life stages of concern, and to aid in designing effective habitat enhancements. As an extension of previous analyses by others, I analyzed the responses to changes in fecundity and yearling survival of age-structured matrix and individual-based population models of 17 populations comprising 10 species. Simulations of the matrix models showed that the magnitude of population responses, but not the relative order of species sensitivity, depended on the state (sustainable or undergoing excessive removals) of the population. Matrix and individual-based models predicted population responses that appeared to be unrelated to their species-level life history traits when responses were plotted on a three-end-point life history surface. Density-dependent adult growth was added to the lake trout (Salvelinus namaycush) matrix model, and simulations demonstrated the potential importance to predicted responses of density-dependent processes outside the usual spawner–recruit relationship. Four reasons for the lack of relationship between population responses and life history traits related to inadequate population models, incorrect analysis, inappropriate life history model, and important site-specific factors are discussed.

scholarly journals Mapping global shifts in Saccharomyces cerevisiae gene expression across asynchronous time trajectories with diffusion maps

2021 ◽  
Author(s):  
Taylor Reiter ◽  
Rachel Montpetit ◽  
Ron Runnebaum ◽  
C. Titus Brown ◽  
Ben Montpetit
Keyword(s):  
Gene Expression ◽  
Saccharomyces Cerevisiae ◽  
Expression Patterns ◽  
Pinot Noir ◽  
Wine Fermentation ◽  
Gene Expression Patterns ◽  
Expression Data ◽  
Site Specific ◽  
Time Series Gene Expression ◽  
Specific Factors

AbstractGrapes grown in a particular geographic region often produce wines with consistent characteristics, suggesting there are site-specific factors driving recurrent fermentation outcomes. However, our understanding of the relationship between site-specific factors, microbial metabolism, and wine fermentation outcomes are not well understood. Here, we used differences in Saccharomyces cerevisiae gene expression as a biosensor for differences among Pinot noir fermentations from 15 vineyard sites. We profiled time series gene expression patterns of primary fermentations, but fermentations proceeded at different rates, making analyzes of these data with conventional differential expression tools difficult. This led us to develop a novel approach that combines diffusion mapping with continuous differential expression analysis. Using this method, we identified vineyard specific deviations in gene expression, including changes in gene expression correlated with the activity of the non-Saccharomyces yeast Hanseniaspora uvarum, as well as with initial nitrogen concentrations in grape musts. These results highlight novel relationships between site-specific variables and Saccharomyces cerevisiae gene expression that are linked to repeated wine fermentation outcomes. In addition, we demonstrate that our analysis approach can extract biologically relevant gene expression patterns in other contexts (e.g., hypoxic response of Saccharomyces cerevisiae), indicating that this approach offers a general method for investigating asynchronous time series gene expression data.ImportanceWhile it is generally accepted that foods, in particular wine, possess sensory characteristics associated with or derived from their place of origin, we lack knowledge of the biotic and abiotic factors central to this phenomenon. We have used Saccharomyces cerevisiae gene expression as a biosensor to capture differences in fermentations of Pinot noir grapes from 15 vineyards across two vintages. We find that gene expression by non-Saccharomyces yeasts and initial nitrogen content in the grape must correlates with differences in gene expression among fermentations from these vintages. These findings highlight important relationships between site-specific variables and gene expression that can be used to understand, or possibly modify, wine fermentation outcomes. Our work also provides a novel analysis method for investigating asynchronous gene expression data sets that is able to reveal both global shifts and subtle differences in gene expression due to varied cell – environment interactions.

Effect of patient- and center-level characteristics on uptake of home dialysis in Australia and New Zealand: a multicenter registry analysis

2020 ◽  
Vol 35 (11) ◽  
pp. 1938-1949
Author(s):  
Isabelle Ethier ◽  
Yeoungjee Cho ◽  
Carmel Hawley ◽  
Elaine M Pascoe ◽  
Matthew A Roberts ◽  
...  
Keyword(s):  
New Zealand ◽  
Random Effect ◽  
Dialysis Initiation ◽  
Home Dialysis ◽  
Logistic Regression Models ◽  
Patient Level ◽  
Home Based ◽  
Specific Factors ◽  
Anzdata Registry ◽  
Registry Analysis

Abstract Background Home-based dialysis therapies, home hemodialysis (HHD) and peritoneal dialysis (PD) are underutilized in many countries and significant variation in the uptake of home dialysis exists across dialysis centers. This study aimed to evaluate the patient- and center-level characteristics associated with uptake of home dialysis. Methods The Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry was used to include incident dialysis patients in Australia and New Zealand from 1997 to 2017. Uptake of home dialysis was defined as any HHD or PD treatment reported to ANZDATA within 6 months of dialysis initiation. Characteristics associated with home dialysis uptake were evaluated using mixed effects logistic regression models with patient- and center-level covariates, era as a fixed effect and dialysis center as a random effect. Results Overall, 54 773 patients were included. Uptake of home-based dialysis was reported in 24 399 (45%) patients but varied between 0 and 87% across the 76 centers. Patient-level factors associated with lower uptake included male sex, ethnicity (particularly indigenous peoples), older age, presence of comorbidities, late referral to a nephrology service, remote residence and obesity. Center-level predictors of lower uptake included small center size, smaller proportion of patients with permanent access at dialysis initiation and lower weekly facility hemodialysis hours. The variation in odds of home dialysis uptake across centers increased by 3% after adjusting for the era and patient-level characteristics but decreased by 24% after adjusting for center-level characteristics. Conclusion Center-specific factors are associated with the variation in uptake of home dialysis across centers in Australia and New Zealand.

Effectiveness of five small Philippines’ coral reef reserves for fish populations depends on site-specific factors, particularly enforcement history

2007 ◽  
Vol 136 (4) ◽  
pp. 584-601 ◽  
Author(s):  
Melita A. Samoilys ◽  
Keith M. Martin-Smith ◽  
Brian G. Giles ◽  
Brian Cabrera ◽  
Jonathan A. Anticamara ◽  
...  
Keyword(s):  
Coral Reef ◽  
Fish Populations ◽  
Site Specific ◽  
Specific Factors

scholarly journals Association of Site-specific and Participant-specific Factors with Retention of Children in a Long-term Pediatric HIV Cohort Study

2008 ◽  
Vol 167 (11) ◽  
pp. 1375-1386 ◽  
Author(s):  
P. L. Williams ◽  
R. Van Dyke ◽  
M. Eagle ◽  
D. Smith ◽  
C. Vincent ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pediatric Hiv ◽  
Site Specific ◽  
Specific Factors

Increasing pedicle screw anchoring in the osteoporotic spine by cement injection through the implant

2007 ◽  
Vol 7 (3) ◽  
pp. 366-369 ◽  
Author(s):  
Patrick Fransen
Keyword(s):  
Pedicle Screw ◽  
Degenerative Spondylolisthesis ◽  
Elevated Risk ◽  
Severe Osteoporosis ◽  
Poor Bone Quality ◽  
Decompressive Laminectomy ◽  
Hardware Failure ◽  
Cement Injection ◽  
Fluoroscopic Control ◽  
Additional Stability

✓Instrumented spinal fusion in patients with osteoporosis is challenging because of the poor bone quality and is complicated by an elevated risk of delayed hardware failure. The author treated two patients presenting with severe osteoporosis, spinal stenosis, and degenerative spondylolisthesis. He performed decompressive laminectomy, posterolateral fusion, and pedicle screw (PS) fixation involving screws with side openings that allow cement to be injected through the implant. The cement injection was conducted under fluoroscopic control without complications. Although this technique needs validation in a larger population of patients, the author believes that the injection of cement through these PSs can be performed safely in carefully selected patients. This technique creates not only a vertebroplasty-like effect that strengthens the vertebral body but also provides the additional stability afforded by the immediate anchoring of the screw, which may allow a shorter-length construct, save mobile segments, and finally reduce the risk of hardware failure.

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