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Background: Limited literature is available to define the impact of the longus colli muscle, a deep flexor of the spine, on cervical spine stability despite its close proximity to the vertebrae. Aims and Objectives: The purpose of this study was to determine if longus colli cross-sectional area (CSA) is associated with the severity preoperative cervical degenerative spondylolisthesis. Materials and Methods: Patients undergoing elective anterior cervical discectomy and fusion (ACDF) for cervical spondylolisthesis between 2010-2021 were retrospectively identified. Longus colli cross-sectional areas (CSA) were measured from preoperative MRI images at the C5 level. Preoperative spondylolisthesis measurements were recorded with cervical radiographs. Patients were grouped by quartiles respectively according to longus colli CSAs. Statistical tests compared patient demographics, surgical characteristics, and surgical outcomes between groups. Multiple linear regression analysis was utilized to assess if longus colli CSA predicted cervical spondylolisthesis. Results: A total of 157 patients met inclusion criteria. Group 1 (first quartile) was the oldest (60.4 ± 12.0 years, P = 0.024) and was predominantly female (59.0%, P = 0.001). Group 1 also had the highest maximum spondylolisthesis (0.19 mm, P = 0.031) and highest proportion of grade 2 spondylolisthesis (23.1%, P = 0.003). On regression analysis, lowest quartile of longus colli CSA was an independent predictor of larger measured maximum spondylolisthesis (β: 0.04, P = 0.012). Conclusion: Smaller longus colli CSA is independently associated with a higher grade and degree of preoperative cervical spondylolisthesis, but this finding does not result in adverse postsurgical outcomes.

Study Design: Prospective cohort study. Objectives: The purpose of this study was to prospectively evaluate the impact of a preoperative diagnosis of gastroesophageal reflux disease on the incidence and severity of postoperative dysphagia in a multicenter population. Methods: After Institutional Review Board approval, written informed consent was obtained from all participating patients. Patients over 18 years of age who underwent an elective anterior cervical discectomy and fusion for a degenerative condition were prospectively enrolled at two academic centers from the years 2018 to 2020. Patients were separated into two groups: those with and without a preoperative diagnosis of GERD. Continuous variables were assessed using either an independent t-test or Mann Whitney U-test for parametric and non-parametric data. All categorical variables were compared using a chi-square test. Results: A total of 116 patients met study criteria and were subsequently enrolled. Overall rates of postoperative dysphagia increased to 47.3% (n = 53) at 2-weeks but eventually decreased towards the preoperative prevalence of 25.0% at the 24-week mark. Patients with preoperative diagnosis of GERD had lower dysphagia severity scores on a continuous variable analysis in both the DSQ and EAT-10 surveys at 2-week follow-up in addition to the Bazaz survey at 24-week follow-up. Our follow up at 24-weeks was 85.7%. Conclusions: Our study shows that having a preoperative diagnosis of GERD has no significant effect on the incidence of dysphagia following ACDF. Nevertheless, having a preoperative diagnosis of GERD does seem to provide some protective effect on the severity of dysphagia that this patient population develops at multiple intervals over a 24-week postoperative period. [ABSTRACT FROM AUTHOR]

Study Design: Systematic Review. Objective: To review the literature for complications and outcomes after the implantation of cellular bone matrix (CBM) during spine fusion. Methods: The PubMed database was queried from inception to January 31, 2023 for any articles that discussed the role of and identified a specific CBM in spinal fusion procedures. Adverse events, reoperations, methods, and fusion rates were collected from all studies and reported. Results: Six hundred articles were identified, of which 19 were included that reported outcomes of 7 different CBM products. Seven studies evaluated lumbar fusion, 11 evaluated cervical fusion, and 1 study reported adverse events of a single CBM product. Only 4 studies were comparative studies while others were limited to case series. Fusion rates ranged from 68% to 98.7% in the lumbar spine and 87% to 100% in the cervical spine, although criteria for radiographic fusion was variable. While 7 studies reported no adverse events, there was no strict consensus on what constituted a complication. One study reported catastrophic disseminated tuberculosis from donor contaminated CBM. The authors of 14 studies had conflicts of interest with either the manufacturer or distributor for their analyzed CBM. Conclusions: Current evidence regarding the use of cellular bone matrix as an osteobiologic during spine surgery is weak and limited to low-grade non-comparative studies subject to industry funding. While reported fusion rates are high, the risk of severe complications should not be overlooked. Further large clinical trials are required to elucidate whether the CBMs offer any benefits that outweigh the risks. [ABSTRACT FROM AUTHOR]

Objective: To evaluate how preoperative anemia severity affects 90-day outcomes of spinal fusion surgery. Methods: A retrospective cohort study was conducted on adult lumbar fusion patients at a tertiary medical center. Patients were classified by World Health Organization anemia severity definitions for comparisons. Multivariate regression models were created to control for confounding variables, for all primary outcomes of transfusion requirements, non-home discharge, readmissions, complications, and length of stay. Results: A total of 2582 patients were included: 2.7% with moderate-severe anemia, 11.0% with mild anemia, and 86.3% without anemia. Moderate-severe patients had the longest hospital stay (5.03 days vs 4.14 and 3.59 days, p < 0.001) and highest risk of transfusion (52.2% vs 13.0% vs 2.69%, p < 0.001), non-home discharge (39.1% vs 27.8% vs 15.4%, p < 0.001), readmission (7.25% vs 5.99% vs 3.36%, p = 0.023), and complications (13.0% vs 9.51% vs 6.20%, p = 0.012). On multivariable logistic regression, both patients with mild and moderate-severe anemia had an increased risk of transfusion (OR: 37.3, p < 0.001; OR: 5.25, p < 0.001, respectively) and non-home discharge (OR: 2.00, p = 0.021; OR: 1.71, p = 0.001, respectively) compared to patients without anemia. Anemia severity was not independently associated with complications or 90-day readmission. On multivariable linear regression, mild anemia (β: 0.37, p = 0.001) and moderate-severe anemia (β: 1.07, p < 0.001) were independently associated with length of hospital stay. Conclusion: Patients with moderate-severe preoperative anemia are at increased risk for longer length of stay, transfusions, and non-home discharge. Improved optimization of preoperative anemia may significantly reduce healthcare utilization, and surgeons should consider these risks in preoperative planning. Level of Evidence: III [ABSTRACT FROM AUTHOR]

Background: Prescription drug costs have risen considerably in the United States and are projected to reach $560 billion by 2028. Objective: To evaluate brand and generic drug utilization and cost proportions within Medicare Part D. Methods: Prescription data for dermatology providers were obtained from the Centers for Medicare and Medicaid Services 2013–2019 Medicare Part D Prescribers by Provider datasets. Percentage of brand vs. generic drug claims and costs and cumulative annual growth rates (CAGRs) were calculated. For the most recent year of data (2019), we conducted additional sub-analyses for calculated percentages by prescriber variables. Results: The proportion of brand drug claims increased from 7.4% (in 2013) to 10.5% (2019) with a CAGR of 8.66%. In comparison, generic drug claims increased at a lower rate (CAGR 4.47%). The percentage of brand drug costs increased from 27.5% (in 2013) to 75.1% (2019). Limitations: Inability to assess and generalize data for prescription patterns under non-Medicare plans. Conclusions: Our study demonstrates a disproportionate rise in dermatologic brand drug claims and a substantial increase in costs associated with brand drugs. Brand-name drugs are associated with higher out-of-pocket expenses for patients, which can lead to decreased access and adherence to treatment. [ABSTRACT FROM AUTHOR]

Government-backed medical insurance plans have undergone significant changes in the last decade, but more information is needed to understand reimbursement trends, particularly for specialist medical services. The objective of this study was to identify the ratios of submitted dermatology service charges to allowed Medicare payments over the years. Further variables studied include regional or state variations, gender of provider, hierarchical condition category (HCC) risk scores of patient complexity, and number of services. Data were collected from publicly available Medicare Part B Provider Utilization and Payment Data: Physician and Other Supplier 2012–2017 datasets. All data analysis was performed on SAS 9.4 Statistical Software. Total dermatology related medicare charges-to-payment ratios steadily increased over the years (1.77 [in 2012], 1.82 [2013], 1.87 [2014], 1.95 [2015], 2.02 [2016], and 2.06 [2017]). This suggests that for every $2.06 charged in 2017, dermatology providers could expect $1 of actual payment. When further stratified into medical services vs. drug services, this upward trend remained for medical charges but drug service ratios have remained constant. There was also significant geographic variation in total medicare charges-to-payment ratios as states in the Midwest (mean total ratio: 2.48) had higher charges to payment gaps than states in the Northeast (2.26), West (2.16), and South (1.99; p = 0.01). This study identifies trends and variables associated with dermatology medicare payments. Providers may use this information to better understand changing payment structures in their own practices and hopefully these results can be valuable in future policy discussions. [ABSTRACT FROM AUTHOR]

Background: Limited literature is available to define the impact of the longus colli muscle, a deep flexor of the spine, on cervical spine stability despite its close proximity to the vertebrae. Aims and Objectives: The purpose of this study was to determine if longus colli cross-sectional area (CSA) is associated with the severity preoperative cervical degenerative spondylolisthesis. Materials and Methods: Patients undergoing elective anterior cervical discectomy and fusion (ACDF) for cervical spondylolisthesis between 2010-2021 were retrospectively identified. Longus colli cross-sectional areas (CSA) were measured from preoperative MRI images at the C5 level. Preoperative spondylolisthesis measurements were recorded with cervical radiographs. Patients were grouped by quartiles respectively according to longus colli CSAs. Statistical tests compared patient demographics, surgical characteristics, and surgical outcomes between groups. Multiple linear regression analysis was utilized to assess if longus colli CSA predicted cervical spondylolisthesis. Results: A total of 157 patients met inclusion criteria. Group 1 (first quartile) was the oldest (60.4 ± 12.0 years, P = 0.024) and was predominantly female (59.0%, P = 0.001). Group 1 also had the highest maximum spondylolisthesis (0.19 mm, P = 0.031) and highest proportion of grade 2 spondylolisthesis (23.1%, P = 0.003). On regression analysis, lowest quartile of longus colli CSA was an independent predictor of larger measured maximum spondylolisthesis (β: 0.04, P = 0.012). Conclusion: Smaller longus colli CSA is independently associated with a higher grade and degree of preoperative cervical spondylolisthesis, but this finding does not result in adverse postsurgical outcomes. [ABSTRACT FROM AUTHOR]

Dear Editor, Healthcare workers are at high risk of workplace violence; between 19 and 30% of hospital employees experienced violence within the past year, and there has been a 12% increase in violence against healthcare workers from 2011 to 2013.[[1], [3]] Specialty- and center-specific studies have shown significant heterogeneity in the prevalence of workplace violence. Workplace violence in academic dermatology practices across the United States: a cross-sectional pilot study Specifically, prospective studies of new dermatology trainees and qualitative, semi-structured interview studies with dermatologists who have experienced violence are important in helping further characterize the epidemiology and impact of violence in dermatology. [Extracted from the article]

Although tanning is widespread, the use of both indoor and outdoor tanning most often begins in adolescence and young adulthood and is more prevalent in adolescents and young adults (AYA) than any other age group. Despite this, information regarding sun safety education in high school curricula is limited. In this pilot study, we sought to characterize the presence of education regarding sun safety in the curricula of US public high schools. Cross-sectional survey administered to random sample stratified by state of public high schools in the US. 31 high schools from 22 states submitted survey responses (Fig. 1). Ten high schools (32.2%) provided curricula regarding sun safety. Southern high schools were less likely to provide sun safety education (p = 0.01). The lack of an association between sociodemographic characteristics of the high school and the provision of sun safety curricula suggests that the lack of sun safety education may be widespread. These findings support a call to action regarding further research to better characterize the efficacy of implementing sun safety education in high school curricula. Educational interventions designed to inform high school students about sun safety present a unique opportunity to intervene in the rising skin cancer rates in the AYA population. As rates of skin cancer in AYA continue to rise, it is vital to develop strategies to implement education regarding sun safety and skin cancer risk factors in high school curricula. [ABSTRACT FROM AUTHOR]

Decreased health literacy is associated with worse outcomes for a variety of dermatologic conditions. Hispanic adults have the lowest average health literacy of any racial or ethnic group in the United Sates. Although patients are increasingly using online patient education materials (PEMs) for dermatologic care, limited information exists regarding the readability of these resources. The objective of this study is to evaluate the readability of online Spanish language PEMs in dermatology. Online Spanish language PEMs relevant to dermatology were gathered from the United States National Library of Medicine (USNLM) MedlinePlus health library and top Google, Yahoo, and Bing search results for "Spanish patient education dermatology." Spanish text was analyzed for readability using two validated programs: Spanish Lexile Analyzer and Índice Flesch-Szigriszt (INFLESZ). Pearson's correlation coefficient was used to examine the association between the two readability measures. ANOVA without post hoc correction was performed to determine variability between PEMs. A total of 254 Spanish language PEMs were collected and analyzed from nine online sources. The average article length was 601 words. The average Lexile measure was 1005 L (SD = 144 L) and the average INFLESZ score was 64.60 (SD = 7.53). Readability scores equated to an 8–10th grade reading level and was varied based on the source of information (p < 0.001). Online Spanish language PEMs related to dermatology are generally written at a reading level that exceeds national recommendations and may reduce comprehension for Hispanic patients. Targeted initiatives to address and improve online health information for Spanish-speaking patients are warranted. [ABSTRACT FROM AUTHOR]

Background: Longer time from diagnosis to definitive surgery (TTDS) is associated with increased melanoma-specific mortality. Although black patients present with later-stage melanoma and have worse survival than non-Hispanic white patients, the association between race and TTDS is unknown.Objective: To investigate racial differences in time to melanoma treatment.Methods: Retrospective review of the National Cancer Database (2004-2015). Multivariable logistic regression was used to evaluate the association of race with TTDS, controlling for sociodemographic/disease characteristics.Results: Of the 233,982 patients with melanoma identified, 1221 (0.52%) were black. Black patients had longer TTDS for stage I to III melanoma (P < .001) and time to immunotherapy (P = .01), but not for TTDS for stage IV melanoma or time to chemotherapy (P > .05 for both). When sociodemographic characteristics were controlled for, black patients had over twice the odds of having a TTDS between 41 and 60 days, over 3 times the odds of having a TTDS between 61 and 90 days, and over 5 times the odds of having a TTDS over 90 days. Racial differences in TTDS persisted within each insurance type. Patients with Medicaid had the longest TTDS (mean, 60.4 days), and those with private insurance had the shortest TTDS (mean, 44.6 days; P < .001 for both).Conclusions: Targeted approaches to improve TTDS for black patients are integral in reducing racial disparities in melanoma outcomes. [ABSTRACT FROM AUTHOR]

While prison medicine is a heavily researched area for quality improvement, little is known regarding prisoner access to dermatologists. The goal of this study was to characterize the claims related to a lack of dermatologist access in prison malpractice cases. We searched the LexisNexis Academic database of legal records from 1970 to 2018 using the terms "medical malpractice and dermatologist" to yield federal malpractice cases involving dermatologists. Ultimately, 89 distinct cases in which a prisoner was not able to see a dermatologist were included in the final analysis. Data relating to year, location, anatomical site, symptoms, dermatologist related claim, specialty of treating physician, and final diagnosis were extracted for each case. The 89 cases involving prisoners who were not able to see a dermatologist for their skin condition ranged from 1982 to 2018, with California (n = 12) and Pennsylvania (n = 11) containing the largest number of cases. 76% of the prisoners were only treated by primary care prison physicians for their dermatologic concerns. Several issues regarding dermatologist access were categorized in this study. This study reveals limited access to dermatologists for prisoners in need of dermatologic care. Improved collaboration between prison officials, prison medical staff, and dermatologists could help improve prisoner care and limit malpractice risk. [ABSTRACT FROM AUTHOR]

Purpose of Review: The field of spine surgery remains a unique target in the transition to value-based care. While spine surgery has benefited from new medical technologies, including minimally invasive surgery (MIS), these technologies may be a key driver in rising US healthcare costs. As such, MIS needs to clear an economic value threshold through a rigorous evaluation of the outcomes they provide and costs they incur. In this article, we review recent MIS surgery literature from the perspective of economic value. Recent Findings: Many studies report modest all-in cost savings and direct procedural cost equivalence for minimally invasive approaches relative to open surgeries. In terms of quality, studies found lower blood loss, length of stay, and infectious complications with MIS surgery but evidence on QALYs was mixed. Summary: In the past 5 years, there has been increasing research interest in defining economic value in MIS surgery. However, a significant amount of heterogeneity in research quality and methodology persists. Therefore, MIS surgery has the potential to be of high economic value, though this is not yet definitive. Future research should continue to focus on high-quality cost-effectiveness studies with clear methodologies to further elucidate economic value in MIS surgery. [ABSTRACT FROM AUTHOR]

The economic pressures widely discussed in health care have a large impact on spine practices. This current study is the first to look at characteristics associated with revenues from an outpatient spine clinic. All clinic visits to spine providers were identified at a single academic institution spanning the dates June 1, 2014, to June 1, 2018. All payment information was calculated using Medicare reimbursement values for Current Procedural Terminology codes. Relevant clinical, surgical, and cost structure data was collected for each patient. On average, providers had 21.9 average appointments over the course of 7.6 hours per clinic day. The average ratio of new to follow-up patients was 39.3%, with an average new patient to surgery conversion rate of 15.0%. The adjusted average total procedural revenue per new patient, controlled for scheduled appointment length and actual appointment length, was $686.02. The adjusted average procedural revenue per surgery was $3444.64 and average procedural revenue per hour in spine clinic was $552.40. With a 1% and 5% increase in new patient visits, total procedural revenue increases 2.7% and 13.5%, respectively. With a 1% and 5% increase in conversion rate, total procedural revenue increases 6.7% and 33.3%, respectively. With a decrease in new patient appointment length from 30 minutes to 25 minutes, the opportunity for 1.7 new patient appointments per day was created resulting in a net increase in procedural revenue per clinic day of $837.57. Incremental changes in practice structure can significantly affect procedural revenue. Significant heterogeneity also exists among spine providers. [ABSTRACT FROM AUTHOR]

It is estimated that 75% of dermatologists will face malpractice litigation by age 65.[1] Furthermore, 28.7% of medical malpractice cases against dermatologists between 2006 and 2015 were decided in favour of plaintiffs with an average indemnity payment of $238 135 United States dollars (USD).[2] Although psoriasis affects more than 7 million adults in the United States and impacts quality of life, limited information exists regarding psoriasis malpractice litigation.[[3]] As such, the goal of this study was to characterize state and federal malpractice cases involving psoriasis in the United States. In comparison with 28.7% of malpractice lawsuits against Mohs micrographic surgeons decided in favour of the plaintiff, only 13.1% of malpractice cases involving a diagnosis of psoriasis were decided in favour of the plaintiff in this present study.[9] Moreover, 4.8% of malpractice cases in prisons were settled outside of court compared with 21.1% of cases in other medical settings. Prison malpractice litigation involving dermatologists: A cross-sectional analysis of dermatologic medical malpractice cases involving incarcerated patients from 1970-2018. [Extracted from the article]