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Health care systems have augmented the role that patients have in their care through the adoption of patient portals like MyChart. Studies across subspecialties have shown that these portals are associated with improved clinical outcomes. The purpose of this study was to compare clinical outcomes between patient portal users and non-users specifically in the surgical spine patient population. A retrospective clinical outcome analysis in adult spine patients at Duke University Medical Center between January 1, 2019, and June 30, 2021 was performed. The association between patient portal utilization and clinical outcomes was assessed using multivariable generalized linear mixed effects models including covariates for social risk variables (age, employment status, language, sex, marital status, race, ethnicity, insurance type and urbanicity of residence). Outcomes measured were 30-day readmission, 30-day return to the emergency room, discharge to places other than home, and length of hospital stay during procedure. Fixed effects estimates (odds ratios for binary outcomes and rate ratios for continuous outcomes) and 95% confidence intervals were reported. Patients who did not use the patient portal had higher odds of 30-day readmission (OR: 1.59; 95% CI: 1.26, 2.00), being discharged somewhere other than home (OR: 2.41, 95% CI: 1.95, 2.99), and had 1.21 times the length of stay compared to those who utilized the patient portal at the time of the procedure (Rate Ratio: 1.21; 95% CI: 1.12, 1.30). The difference in 30-day return to Emergency department rate was not statistically different between those who did and did not utilize the patient portal (OR: 1.10; 95% CI; 0.92,1.32) Our analysis of the association between patient portal utilization and clinical outcomes revealed that patients who use patient portals may have better clinical outcomes. Although additional studies need to be done to understand the underlying drivers of this association, this study is a promising preliminary look and may inform us of the value of patient portals in improving patient care. Additionally, it stresses the importance of identifying gaps in patient portal uptake as their use has been shown to positively impact health outcomes. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Spinal cord ependymomas (SCEs) represent the most common intramedullary spinal cord tumors among adults. Research shows that access to neurosurgical care and patient outcomes can be greatly influenced by patient location. This study investigates the association between the outcomes of patients with SCE in metropolitan and nonmetropolitan areas. Cases of SCE between 2004 and 2019 were identified within the Central Brain Tumor Registry of the United States, a combined dataset including the Centers for Disease Control and Prevention's National Program of Cancer Registries and National Cancer Institute's Surveillance, Epidemiology, and End Results Program data. Multivariable logistic regression models were constructed to evaluate the association between urbanicity and SCE treatment, adjusted for age at diagnosis, sex, race and ethnicity. Survival data was available from 42 National Program of Cancer Registries (excluding Kansas and Minnesota, for which county data are unavailable), and Cox proportional hazard models were used to understand the effect of surgical treatment, county urbanicity, age at diagnosis, and the interaction effect between age at diagnosis and surgery, on the survival time of patients. Overall, 7577 patients were identified, with 6454 (85%) residing in metropolitan and 1223 (15%) in nonmetropolitan counties. Metropolitan and nonmetropolitan counties had different age, sex, and race/ethnicity compositions; however, demographics were not associated with differences in the type of surgery received when stratified by urbanicity. Irrespective of metropolitan status, individuals who were American Indian/Alaska Native non-Hispanic and Hispanic (all races) were associated with reduced odds of receiving surgery. Individuals who were Black non-Hispanic and Hispanic were associated with increased odds of receiving comprehensive treatment. Diagnosis of SCE at later ages was linked with elevated mortality (hazard ratio = 4.85, P < 0.001). Gross total resection was associated with reduced risk of death (hazard ratio = 0.37, P = 0.004), and age did not interact with gross total resection to influence risk of death. The relationship between patients' residential location and access to neurosurgical care is critical to ensuring equitable distribution of care. This study represents an important step in delineating areas of existing disparities. [ABSTRACT FROM AUTHOR]