1. Are Guidelines Important? Results of a Prospective Quality Improvement Lumbar Fusion Project
- Author
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James S. Harrop, Thiago S. Montenegro, Umma Fatema, Alexandra Emes, Srinivas Prasad, Kevin Hines, Ashwini Sharan, Lucas R Philipp, Sara Thalheimer, Fadi Al Saiegh, Josh Heller, Glenn A Gonzalez, Geoffrey Stricsek, Ameet Md Chitale, Chengyuan Wu, and Jack Jallo
- Subjects
medicine.medical_specialty ,Concordance ,education ,Preoperative care ,Disability Evaluation ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,health services administration ,Internal medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Lumbar Vertebrae ,business.industry ,Minimal clinically important difference ,Lumbosacral Region ,Guideline ,Odds ratio ,Evidence-based medicine ,Quality Improvement ,humanities ,Oswestry Disability Index ,Spinal Fusion ,Treatment Outcome ,Multivariate Analysis ,Surgery ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - 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
- Published
- 2021