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Patient-reported outcomes (PROs) are increasingly utilized to evaluate the efficacy and value of spinal procedures. Among patients with cervical myelopathy, the modified Japanese Orthopaedic Association (mJOA) remains the standard instrument, with Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and patient satisfaction also frequently assessed. These outcomes have not all been directly compared using a large spine registry at 2 years follow-up for cervical myelopathic patients undergoing surgery.To determine the correlation and association of PROMIS PF, mJOA, and patient satisfaction outcomes in patients undergoing surgery for cervical myelopathy.Retrospective review of a multicenter spine registry database.Adult patients with cervical myelopathy who underwent cervical spine surgery between 2/26/2018 and 4/17/2021.PROMIS PF, mJOA, and North American Spine Society (NASS) patient satisfaction index.The MSSIC database was accessed to gather pre- and postoperative outcome data on patients with cervical myelopathy. Spearman's correlation coefficients relating mJOA and PROMIS PF were quantified up to 2 years postoperatively. The correlations between patient satisfaction with mJOA and PROMIS were determined. Kappa statistics were used to evaluate for agreement between those reaching the minimum clinically important difference (MCID) for mJOA and PROMIS PF. Odds ratios were calculated to determine the association between patient satisfaction and those reaching MCID for mJOA and PROMIS PF. Support for MSSIC is provided by BCBSM and Blue Care Network as part of the BCBSM Value Partnerships program.Data from 2,023 patients were included. Moderate to strong correlations were found between mJOA and PROMIS PF at all time points (p.001). These outcomes had fair agreement at all postoperative time points when comparing those who reached MCID. Satisfaction was strongly related to changes from baseline for both mJOA and PROMIS PF at all time points (p.001). Odds ratios associating satisfaction with PROMIS PF MCID were higher at all time points compared with mJOA, although the differences were not significant.PROMIS PF has a strong positive correlation with mJOA up to 2 years postoperatively in patients undergoing surgery for cervical myelopathy, with similar odds of achieving MCID with both instruments. Patient satisfaction is predicted similarly by these outcome measures by 2 years postoperatively. These results affirm the validity of PROMIS PF in the cervical myelopathic population. Given its generalizability and ease of use, PROMIS PF may be a more practical outcome measure for clinical use compared with mJOA.

Reoperation following cervical spinal surgery negatively impacts patient outcomes and increases health care system burden. To date, most studies have evaluated reoperations within 30 days after spine surgery and have been limited in scope and focus. Evaluation within the 90-day period, however, allows a more comprehensive assessment of factors associated with reoperation.The purpose of this study is to assess the rates and reasons for reoperations after cervical spine surgery within 30 and 90 days.We performed a retrospective analysis of a state-wide prospective, multi-center, spine-specific database of patients surgically treated for degenerative disease.Patients 18 years of age or older who underwent cervical spine surgery for degenerative pathologies from February 2014 to May 2019. Operative criteria included all degenerative cervical spine procedures, including those with cervical fusions with contiguous extension down to T3.We determined causes for reoperation and independent surgical and demographic risk factors impacting reoperation.Patient-specific and surgery-specific data was extracted from the registry using ICD-10-DM codes. Reoperations data was obtained through abstraction of medical records through 90 days. Univariate analysis was done using chi-square tests for categorical variables, t-tests for normally distributed variables, and Wilcoxon rank-sum tests for variables with skewed distributions. Odds ratios for return to the operating room (OR) were evaluated in multivariate analysis.A total of 13,435 and 13,440 patients underwent cervical spine surgery and were included in the 30 and 90-day analysis, respectively. The overall reoperation rate was 1.24% and 3.30% within 30 and 90 days, respectively. Multivariate analysis showed within 30 days, procedures involving four or more levels, posterior only approach, and longer length of stay had increased odds of returning to the OR (p.05), whereas private insurance had a decreased odds of return to OR (p.05). Within 90 days, male sex, coronary artery disease (CAD), previous spine surgery, procedures with 4 or more levels, and longer length of stay had significantly increased odds of returning to the OR (p.05). Non-white race, independent ambulatory status pre-operatively, and having private insurance had decreased odds of return to the OR (p.05). The most common specified reasons for return to the OR within 30 days was hematoma (19%), infection (17%), and wound dehiscence (11%). Within 90 days, reoperation reasons were pain (10%), infection (9%), and hematoma (8%).Reoperation rates after elective cervical spine surgery are 1.24% and 3.30% within 30 and 90 days, respectively. Within 30 days, four or more levels, posterior approach, and longer length of stay were risk factors for reoperation. Within 90 days, male sex, CAD, four or more levels, and longer length of hospital stay were risk factors for reoperation. Non-white demographic and independent preoperative ambulatory status were associated with decreased reoperation rates.

Current studies show similar in-hospital outcomes following percutaneous coronary intervention (PCI) between Black and White patients. Long-term outcomes and the role of individual and community-level socioeconomic factors in differential risk are less understood.We linked clinical registry data from PCIs performed between January, 2013 and March, 2018 at 48 Michigan hospitals to Medicare Fee-for-service claims. We analyzed patients of Black and White race. We used propensity score matching and logistic regression models to estimate the odds of 90-day readmission and Cox regression to evaluate the risk of postdischarge mortality. We used mediation analysis to evaluate the proportion of association mediated by socioeconomic factors.Of the 29,317 patients included in this study, 10.28% were Black and 89.72% were White. There were minimal differences between groups regarding post-PCI in-hospital outcomes. Compared with White patients, Black patients were more likely to be readmitted within 90-days of discharge (adjusted OR 1.62, 95% CI [1.32-2.00]) and had significantly higher risk of all-cause mortality (adjusted HR 1.45, 95% CI 1.30-1.61) when adjusting for age and gender. These associations were significantly mediated by dual eligibility (proportion mediated [PM] for readmission: 11.0%; mortality: 21.1%); dual eligibility and economic well-being of the patient's community (PM for readmission: 22.3%; mortality: 43.0%); and dual eligibility, economic well-being of the community, and baseline clinical characteristics (PM for readmission: 45.0%; mortality: 87.8%).Black patients had a higher risk of 90-day readmission and cumulative mortality following PCI compared with White patients. Associations were mediated by dual eligibility, community economic well-being, and traditional cardiovascular risk factors. Our study highlights the need for improved upstream care and streamlined postdischarge care pathways as potential strategies to improve health care disparities in cardiovascular disease.

Early ambulation is considered a key element to Enhanced Recovery After Surgery protocol after spine surgery.To investigate whether ambulation less than 8 hours after elective spine surgery is associated with improved outcome.The Michigan Spine Surgery Improvement Collaborative database was queried to track all elective cervical and lumbar spine surgery between July 2018 and April 2021. In total, 7647 cervical and 17 616 lumbar cases were divided into 3 cohorts based on time to ambulate after surgery: (1)8 hours, (2) 8 to 24 hours, and (3)24 hours.For cervical cases, patients who ambulated 8 to 24 hours (adjusted odds ratio [aOR] 1.38; 95% CI 1.11-1.70; P = .003) and24 hours (aOR 2.20; 95% CI 1.20-4.03; P = .011) after surgery had higher complication rate than those who ambulated within 8 hours of surgery. Similar findings were noted for lumbar cases with patients who ambulated 8 to 24 hours (aOR 1.31; 95% CI 1.12-1.54; P.001) and24 hours (aOR 1.96; 95% CI 1.50-2.56; P.001) after surgery having significantly higher complication rate than those ambulated8 hours after surgery. Analysis of secondary outcomes for cervical cases demonstrated that8-hour ambulation was associated with home discharge, shorter hospital stay, lower 90-day readmission, and lower urinary retention rate. For lumbar cases,8-hour ambulation was associated with shorter hospital stay, satisfaction with surgery, lower 30-day readmission, home discharge, and lower urinary retention rate.Ambulation within 8 hours after surgery is associated with significant improved outcome after elective cervical and lumbar spine surgery.

Introduction: Smoking is a well established risk factor for acute myocardial infarction (AMI). The potential impact of a nationwide comprehensive smoking ban (CSB) legislation on the incidence of AMI hospital admissions is not known. The aim of this analysis is to determine the impact of a nationwide CSB legislation on the incidence of AMI hospitalizations. Methods: We contacted the department of health at states with no CSB law for information on the total number of AMI discharges (ICD-9-CM 410), length of stay and charges in dollars for 2007. Expected decrease in the number of AMI in the year following a potential implementation of a nationwide CSB was calculated by multiplying the current number of AMI by the pooled relative risk reduction (RRR) obtained from a recent published meta analysis (RR 0.89). Results: In 2007, 37 States had CSB laws. There were 169,043 AMI hospitalizations in states without CSB. A nationwide smoking ban would result in 18,596 less AMI hospitalizations in the year following such a ban. This is associated with more than 92 million dollars in direct cost savings. Conclusion: A nationwide CSB legislation would result in significant reduction in the number of AMI hospitalizations. This is associated with significant cost saving. Further studies are needed to evaluate the impact of CSB on admission from other disease states.

The Cancer Research Network (CRN) was formed in 1999 with funding from the National Cancer Institute. The CRN represents a collaboration of 10 health plans across the United States, with a combined total of approximately 9 million enrollees. The goal of the CRN is to promote collaborative research, which will ultimately increase the effectiveness of preventive, curative, and supportive interventions for major cancers. Special emphasis is placed upon diverse populations, and racial and ethnic differences in outcomes, costs, and cost effectiveness.There is increasing awareness in the research literature of the relationship between race and ethnicity and health outcomes. However, the majority of the health maintenance organizations represented in the CRN, similar to other health plans and organizations, do not routinely collect race and ethnicity data on their members. In order to compare data and outcomes across the CRN sites, consensus is needed in the measurement of race and ethnicity.This review discusses terminology used in the research literature to describe race and ethnicity and the manner in which these constructs have been measured in previous studies.This review concludes with suggestions for standardized measures of race and ethnicity.It is hoped that shared conceptualizations of race and ethnicity will lead to improved data quality and precision in measurement.