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Introduction: Chronic kidney disease (CKD) has an increasing global prevalence and has previously been associated with increased complications and morbidity after spine surgery. Understanding the isolated effect of CKD on short-term patient outcomes is critical for optimizing perioperative risk management and healthcare utilization., Objective: The aim of this study is to utilize coarsened exact matching (CEM) to analyze the isolated effect of CKD on short-term patient outcomes in single-level posterior lumbar fusion surgery., Methods: A retrospective analysis of 4680 consecutive patients undergoing single-level, posterior-only lumbar fusion was performed. Univariate logistic regression comparing the odds of outcomes in patients with CKD (n=40) to patients without medical comorbidities (n=2329) was performed. CEM was then employed to match patients with CKD to those without any comorbidities 1:1 on ten patient characteristics known to affect neurosurgical outcomes. Primary outcomes included intraoperative complications, length of stay, discharge disposition, and 30-day Emergency Department (ED) visits, readmissions, reoperations, and mortality., Results: In a univariate logistic regression, CKD was associated with increased risk of 30-day ED visits (OR=3.53, p=0.003) but not complication, discharge disposition, or 30-day readmissions or reoperations. Between otherwise exactly matched patients (n=72), CKD similarly remained associated with an increased risk of 30-day ED visits (OR=7.00, p=0.034) and not with other outcomes., Conclusion: Between otherwise exactly matched patients undergoing single-level posterior lumbar fusion, CKD was related to increased risk of 30-day ED utilization but not other markers indicative of inferior surgical outcomes. Further study must investigate the reasons for increased ED visitation and implement risk-mitigation strategies for these patients., Competing Interests: Conflicts of Interest The authors have no personal or institutional conflicts of interest related to the data presented in this paper and/or the publication of this manuscript., (Copyright © 2024. Published by Elsevier B.V.)

Objective: Preoperative management requires the identification and optimization of modifiable medical comorbidities, though few studies isolate comorbid status from related patient-level variables. This study evaluates Charlson Comorbidity Index (CCI)-an easily derived measure of aggregate medical comorbidity-to predict outcomes from spinal fusion surgery. Coarsened exact matching is employed to control for key patient characteristics and isolate CCI., Methods: We retrospectively assessed 4680 consecutive patients undergoing single-level, posterior-only lumbar fusion at a single academic center. Logistic regression evaluated the univariate relationship between CCI and patient outcomes. Coarsened exact matching generated exact demographic matches between patients with high comorbid status (CCI >6) or no medical comorbidities (matched n = 524). Patients were matched 1:1 on factors associated with surgical outcomes, and outcomes were compared between matched cohorts. Primary outcomes included surgical complications, discharge status, 30- and 90-day risk of readmission, emergency department (ED) visits, reoperation, and mortality., Results: Univariate regression of increasing CCI was significantly associated with non-home discharge, as well as 30- and 90-day readmission, ED visits, and mortality (all P < 0.05). Subsequent isolation of comorbidity between otherwise exact-matched cohorts found comorbid status did not affect readmissions, reoperations, or mortality; high CCI score was significantly associated with non-home discharge (OR = 2.50, P < 0.001) and 30-day (OR = 2.44, P = 0.02) and 90-day (OR = 2.29, P = 0.008) ED evaluation., Conclusions: Comorbidity, measured by CCI, did not increase the risk of readmission, reoperation, or mortality. Single-level, posterior lumbar fusions may be safe in appropriately selected patients regardless of comorbid status. Future studies should determine whether CCI can guide discharge planning and postoperative optimization., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: The relationship between socioeconomic status and neurosurgical outcomes has been investigated with respect to insurance status or median household income, but few studies have considered more comprehensive measures of socioeconomic status. This study examines the relationship between Area Deprivation Index (ADI), a comprehensive measure of neighborhood socioeconomic disadvantage, and short-term postoperative outcomes after lumbar fusion surgery., Methods: 1861 adult patients undergoing single-level, posterior-only lumbar fusion at a single, multihospital academic medical center were retrospectively enrolled. An ADI matching protocol was used to identify each patient's 9-digit zip code and the zip code-associated ADI data. Primary outcomes included 30- and 90-day readmission, emergency department visits, reoperation, and surgical complication. Coarsened exact matching was used to match patients on key demographic and baseline characteristics known to independently affect neurosurgical outcomes. Odds ratios (ORs) were computed to compare patients in the top 10% of ADI versus lowest 40% of ADI., Results: After matching (n = 212), patients in the highest 10% of ADI (compared to the lowest 40% of ADI) had significantly increased odds of 30- and 90-day readmission (OR = 5.00, P < 0.001 and OR = 4.50, P < 0.001), ED visits (OR = 3.00, P = 0.027 and OR = 2.88, P = 0.007), and reoperation (OR = 4.50, P = 0.039 and OR = 5.50, P = 0.013). There was no significant association with surgical complication (OR = 0.50, P = 0.63)., Conclusions: Among otherwise similar patients, neighborhood socioeconomic disadvantage (measured by ADI) was associated with worse short-term outcomes after single-level, posterior-only lumbar fusion. There was no significant association between ADI and surgical complications, suggesting that perioperative complications do not explain the socioeconomic disparities in outcomes., (Copyright © 2023. Published by Elsevier Inc.)

Objective: There are limited data evaluating the outcomes of attending neurosurgeons with different types of first assistants. This study considers a common neurosurgical procedure (single-level, posterior-only lumbar fusion surgery) and examines whether attending surgeons deliver equal patient outcomes, regardless of the type of first assistant (resident physician vs. nonphysician surgical assistant [NPSA]), among otherwise exact-matched patients., Methods: The authors retrospectively analyzed 3395 adult patients undergoing single-level, posterior-only lumbar fusion at a single academic medical center. Primary outcomes included readmissions, emergency department visits, reoperation, and mortality within 30 and 90 days after surgery. Secondary outcome measures included discharge disposition, length of stay, and length of surgery. Coarsened exact matching was used to match patients on key demographics and baseline characteristics known to independently affect neurosurgical outcomes., Results: Among exact-matched patients (n = 1402), there was no significant difference in adverse postsurgical events (readmission, emergency department visits, reoperation, or mortality) within 30 days or 90 days of the index operation between patients who had resident physicians and those who had NPSAs as first assistants. Patients who had resident physicians as first assistants demonstrated a longer length of stay (mean: 100.0 vs. 87.4 hours, P < 0.001) and a shorter duration of surgery (mean: 187.4 vs. 213.8 minutes, P < 0.001). There was no significant difference between the two groups in the percentage of patients discharged home., Conclusions: For single-level posterior spinal fusion, in the setting described, there are no differences in short-term patient outcomes delivered by attending surgeons assisted by resident physicians versus NPSAs., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: The American College of Surgeons (ACS) updated its guidelines on overlapping surgery in 2016. The objective was to examine differences in postoperative outcomes after overlapping surgery either pre-ACS guideline revision or post-guideline revision, in a coarsened exact matching sample., Methods: A total of 3327 consecutive adult patients undergoing single-level posterior lumbar fusion from 2013 to 2019 were retrospectively analyzed. Patients were separated into a pre-ACS guideline revision cohort (surgery before April 2016) or a post-guideline revision cohort (surgery after October 2016) for comparison. The primary outcomes were proportion of cases performed with any degree of overlap, and adverse events including 30-day and 90-day rates of readmission, reoperation, emergency department visit, morbidity, and mortality. Subsequently, coarsened exact matching was used among overlapping surgery patients only to assess the impact of the ACS guideline revision on overlapping outcomes, and controlling for attending surgeon and key patient characteristics known to affect surgical outcomes., Results: After the implementation of the ACS guidelines, fewer cases were performed with overlap (22.0% vs. 53.7%; P < 0.001). Patients in the post-ACS guideline revision cohort experienced improved rates of readmission and reoperation within 30 and 90 days. However, when limited to overlapping cases only, no differences were observed in overlap outcomes pre-ACS versus post-ACS guideline revision. Similarly, when exact matched on risk-associated patient characteristics and attending surgeon, overlapping surgery patients pre-ACS and post-ACS guideline revision experienced similar rates of 30-day and 90-day outcomes., Conclusions: After the ACS guideline revision, no discernable impact was observed on postoperative outcomes after lumbar fusion performed with overlap., (Copyright © 2022. Published by Elsevier Inc.)

Objective: A hallmark of surgical training is resident involvement in operative procedures. While resident-assisted surgeries have been deemed generally safe, few studies have rigorously isolated the impact of resident post-graduate year (PGY) level on post-operative outcomes in a neurosurgical patient population. The objective of this study is to evaluate the relationship between resident training level and outcomes following single-level, posterior-only lumbar fusion, after matching on key patient demographic/clinical characteristics and attending surgeon., Patients and Methods: This coarsened-exact matching (CEM) study analyzed 2338 consecutive adult patients who underwent single-level lumbar fusion with a resident assistant surgeon at a multi-hospital university health system from 2013 to 2019. Primary outcomes were 30-day and 90-day readmissions, Emergency Department (ED) visits, reoperations, surgical complications, and mortality. First, univariate logistic regression examined the relationship between PGY level and outcomes. Then, CEM was used to control for key patient characteristics - such as race and comorbid status - and supervising attending surgeon, between the most junior (PGY-2)-assisted cases and the most senior (PGY-7)-assisted cases, thereby isolating the relationship between training level and outcomes., Results: Among all patients, resident training level was not associated with risk of adverse post-surgical outcomes. Similarly, between exact-matched cohorts of PGY-2- and PGY-7-assisted cases, no significant differences in adverse events or discharge disposition were observed. Patients with the most senior resident assistant surgeons demonstrated longer length of stay (mean 100.5 vs. 93.8 h, p = 0.022) and longer duration of surgery (mean 173.5 vs. 159.8 min, p = 0.036)., Conclusion: Training level of the resident assistant surgeon did not impact adverse outcomes provided to patients in the setting of single-level, posterior-only lumbar fusion. These findings suggest that attending surgeons appropriately manage cases with resident surgeons at different levels of training., Competing Interests: Disclosures/Conflicting Interests The authors have no personal or institutional interest with regards to the authorship and/or publication of this manuscript., (Copyright © 2022. Published by Elsevier B.V.)

Objectives: Predicting patient needs for extended care after spinal fusion remains challenging. The Risk Assessment and Prediction Tool (RAPT) was externally developed to predict discharge disposition after nonspine orthopedic surgery but remains scarcely used in neurosurgery. The present study is the first to use coarsened exact matching-which incorporated patient characteristics known to independently affect outcomes-for 1:1 matching across a large population of single-level, posterior lumbar fusions, to isolate the predictive value of preoperative RAPT score on postoperative discharge disposition., Methods: Preoperative RAPT scores were prospectively calculated for 1066 patients undergoing consecutive single-level, posterior-only lumbar fusion within a single, university healthcare system. The primary outcome was discharge disposition. Logistic regression was executed across all patients, evaluating the RAPT score as a continuous variable to predict home discharge. Subsequently, patients were retrospectively clustered into predicted risk cohorts-validated within prior orthopedic joint research-based on the RAPT score (Lowest, Intermediate, and Highest Risk). Coarsened exact matching was performed among predicted risk cohorts, and outcomes were compared between exact-matched groups., Results: Among all patients, single-point increases in the RAPT score (i.e., decrease in predicted risk) were associated a 75% increased odds of home discharge (P < 0.001). Exact-matched analysis demonstrated increased odds of home discharge by 400% when comparing the Lowest versus Highest Risk cohorts (P = 0.004), by 750% when comparing the Intermediate versus Highest Risk cohorts (P < 0.001), and by 200% when comparing the Lowest versus Intermediate Risk cohorts (P < 0.001)., Conclusions: The RAPT score, captured in preoperative evaluations, can be highly predictive of discharge disposition following single-level, posterior lumbar fusion., (Copyright © 2022. Published by Elsevier Inc.)

Introduction: The Charlson Comorbidity Index (CCI) score has been shown to predict 10-year all-cause mortality and post-neurosurgical complications but has never been examined in a far lateral disc herniation (FLDH) population. This study aims to correlate CCI score with adverse outcomes following FLDH repair., Patients and Methods: All patients (n = 144) undergoing discectomy for FLDH at a single, multihospital academic medical system (2013-2020) were retrospectively analyzed. CCI scores were determined for all patients. Univariate logistic regression was used to determine the ability of CCI score to predict adverse outcomes., Results: Mean age of the population was 61.72 ± 11.55 years, 69 (47.9%) were female, and 126 (87.5%) were non-Hispanic white. Patients underwent either open (n = 92) or endoscopic (n = 52) FLDH repair. Average CCI score among the patient population was 2.87 ± 2.42. Each additional point in CCI score was significantly associated with higher rates of readmission (p = 0.022, p = 0.014) in the 30-day and 30-90-day post-surgery window, respectively, and emergency department visits (p = 0.011) within 30-days. CCI score also predicted risk of reoperation of any kind (p = 0.013) within 30 days of the index operation. In addition, CCI score was predictive of risk of reoperation of any kind (p = 0.008, p < 0.001; respectively) and repeat neurosurgical intervention (p = 0.027, p = 0.027) within 30-days and 90-days of the index admission (either during the same admission or after discharge)., Conclusions: This study suggests that CCI score is a useful metric to predict of numerous adverse postoperative outcomes following discectomy for FLDH., (Copyright © 2021. Published by Elsevier B.V.)

Objective: This study evaluated overlapping surgery on long-term outcomes following elective, single-level lumbar fusion on exact matched patients undergoing surgery with or without overlap., Patients and Methods: 3799 consecutive adult patients undergoing single-level, posterior-only lumbar fusion over a six-year period at a multi-hospital university health system were retrospectively followed. Reported outcomes included reoperation, emergency department (ED) visit, readmission, overall morbidity and mortality in the 90 days following surgery. Coarsened Exact Matching was used to match patients with and without overlap on key demographic factors. Patients were subsequently matched by both demographic data and by the attending surgeon performing the operation. Univariate analysis was carried out on the whole population, the demographic matched cohort, and demographic and surgeon matched cohort, with significance set at a p-value < 0.05., Results: Patients with overlap had a longer duration of surgery and were less likely to have an ED visit within 90 days of surgery (p < 0.03) but had no other significant differences. Within the demographic matched cohort and demographic/surgeon matched cohort, there was no significant difference in age, gender, history of prior surgery, ASA score, or CCI score, but patients with overlap had a longer duration of surgery (p < 0.01). Patients did not have significant differences with respect to any morbidity or mortality outcome in either the demographic or surgeon matched cohort., Conclusions: Patients undergoing overlapping, single-level lumbar fusion were not at greater risk of long-term morbidity or mortality, despite having a significantly longer duration of surgery., (Copyright © 2021. Published by Elsevier B.V.)

Objective: To assess the influence of race on short-term patient outcomes in a pituitary tumor surgery population., Patients and Methods: Coarsened exact matching was used to retrospectively analyze consecutive patients (n = 567) undergoing pituitary tumor resection over a six-year period (June 07, 2013 to April 29, 2019) at a single, multi-hospital academic medical center. Black/African American and white patients were exact matched based on twenty-nine (29) patient, procedure, and hospital characteristics. Matching characteristics included surgical costs, American Society of Anesthesiologists grade, duration of surgery, and Charlson Comorbidity Index, amongst others. Outcomes studied included unplanned 90-day readmission, emergency room (ER) evaluation, and unplanned reoperation., Results: Ninety-two (n = 92) patients were exact matched and analyzed. There was no significant difference in 90-day readmission (p = 0.267, OR (black/AA vs white) = 0.500, 95% CI = 0.131-1.653) or ER evaluation within 90 days (p = 0.092, OR = 3.000, 95% CI = 0.848-13.737) between the two cohorts. Furthermore, there was no significant difference in the rate of unplanned reoperation throughout the duration of the follow up period between matched black/African American and white patients (p = 0.607, OR = 0.750, 95% CI = 0.243-2.211)., Conclusion: This study suggests that the effect of race on post-operative outcomes is largely mitigated when equal access is attained, and when race is effectively isolated from socioeconomic factors and comorbidities in a population undergoing pituitary tumor resection., (Copyright © 2021. Published by Elsevier B.V.)

Introduction: The LACE+ (Length of Stay, Acuity of Admission, Charlson Comorbidity Index (CCI) Score, Emergency Department (ED) visits within the previous 6 months) index has never been tested in a purely spine surgery population. This study assesses the ability of LACE + to predict adverse patient outcomes following discectomy for far lateral disc herniation (FLDH)., Patients and Methods: Data were obtained for patients (n = 144) who underwent far lateral lumbar discectomy at a single, multi-hospital academic medical center (2013-2020). LACE + scores were calculated for all patients with complete information (n = 100). The influence of confounding variables was assessed and controlled with stepwise regression. Logistic regression was used to test the ability of LACE + to predict risk of unplanned hospital readmission, ED visits, outpatient office visits, and reoperation after surgery., Results: Mean age of the population was 61.72 ± 11.55 years, 69 (47.9 %) were female, and 126 (87.5 %) were non-Hispanic white. Patients underwent either open (n = 92) or endoscopic (n = 52) surgery. Each point increase in LACE + score significantly predicted, in the 30-day (30D) and 30-90-day (30-90D) post-discharge window, higher risk of readmission (p = 0.005, p = 0.009; respectively) and ED visits (p = 0.045). Increasing LACE + also predicted, in the 30D and 90-day (90D) post-discharge window, risk of reoperation (p = 0.022, p = 0.016; respectively), and repeat neurosurgical intervention (p = 0.026, p = 0.026; respectively). Increasing LACE + score also predicted risk of reoperation (p = 0.011) within 30 days of initial surgery., Conclusions: LACE + may be suitable for characterizing risk of adverse perioperative events for patients undergoing far lateral discectomy., (Copyright © 2021. Published by Elsevier B.V.)

Introduction: The relationship between degree of surgical overlap and adverse postoperative outcomes remains poorly defined. This study aims to evaluate the impact of increasing duration of overlap on lumbar fusion outcomes., Patients and Methods: 1302 adult patients undergoing overlapping surgery during single-level, posterior-only lumbar fusion at a multi-hospital, university health system were retrospectively assessed. Amount of overlap was calculated as a percentage of total overlap time. Patients were separated into groups with the most (top 10% of patients) and least amounts of overlap (bottom 40% of patients). Using Coarsened Exact Matching, patients with the most and least amounts of overlap were matched on demographics alone, then on both demographics and attending surgeon. Univariate analysis was performed for the whole population and both matched cohorts to compare amount of overlap to risk of adverse postsurgical events. Significance for all analyses was p-value < 0.05., Results: Duration of overlap was not associated with outcomes in the whole population, demographic-matched, or surgeon-matched analyses. Before exact matching, patients with the most amount of overlap had a significantly higher CCI score (p = 0.031) and shorter length of surgery (p = 0.006). In the demographic matched cohort, patients with increased overlap had a significantly shorter length of surgery (p = 0.001) only. In the surgeon matched cohort, there were no differences in length of surgery or CCI score., Conclusions: Duration of surgical overlap does not predict adverse outcomes following lumbar fusion. These results suggest that overlapping surgery is a safe practice within this common neurosurgical indication., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: Gender can contribute to adverse patient outcomes through social and biological factors. It is important to assess the effects of gender on long-term patient outcomes after care has already been accessed, in order to improve quality of care and mitigate healthcare disparities., Patients and Methods: 277 consecutive patients undergoing cerebellopontine angle tumor resection over a six-year period (June 09, 2013 - April 29, 2019) at a university health system were retrospectively evaluated. Outcomes included 90-day emergency department (ED) visit, readmission, reoperation and mortality following resection. Male and female patients in the whole population were analyzed by logistic regression. Thereafter, Coarsened Exact Matching was used to match female and male on important demographic factors, including history of prior surgery, median household income, and Charlson Comorbidity Index (CCI) score, among others. Regression was carried out in the matched population, with significance set at a p-value < 0.05., Results: In the matched population analysis, males were significantly more likely to experience mortality during the length of follow-up (p = 0.03) but not within 90-days of resection. There were no significant differences in 90-day mortality or reoperation during the length of follow-up in either the matched or pre-matched populations. No significant differences were found in any of the 90-day morbidity outcomes in either the matched or pre-matched populations., Conclusion: Gender may predict long-term outcomes in patients following CPA tumor resection. It is possible that gender also contributes to outcome disparities in other neurosurgical procedures, which future studies should evaluate., (Copyright © 2020. Published by Elsevier B.V.)

Background: Gender is a complex social determinant of health affected by both social and biological factors. There is a need to investigate the effect of gender on outcomes, in the absence of confounding characteristics, to mitigate disparities in care., Methods: A total of 1970 consecutive patients at a university health system undergoing nonmeningioma supratentorial brain tumor resection over a 6-year period (June 9, 2013-April 26, 2019) were analyzed retrospectively. Coarsened exact matching was used to match patients on demographic factors including history of previous surgery, median household income, and race. Outcomes assessed included readmission, emergency department visit, unplanned reoperation, and mortality within 30 days of surgery. Regression analysis was performed among a prematched population and between the matched cohorts with significance set at a P value <0.05., Results: Within the matched population, no significant difference was observed between male and female patients in any of the recorded outcomes after nonmeningioma supratentorial brain tumor resection, including readmission, emergency department evaluation, unplanned reoperation, and mortality within 30 days of resection (P = 0.28-0.85). Similarly, no significant difference was found in any of the morbidity and mortality outcomes in the prematched regression analysis (P = 0.10-0.70)., Conclusions: When gender is isolated from race, household economics, and other key factors, it does not seem to independently predict morbidity or mortality in the short-term postoperative window after supratentorial brain tumor resection. Future studies should investigate the impact of gender in longer follow-up and its interrelation with other social determinants of health contributing to outcome disparity., (Copyright © 2020. Published by Elsevier Inc.)

Background: The impact of household economics on outcomes is not well understood. We examined the relationship of income and surgical outcomes, after controlling for numerous patient characteristics., Methods: Consecutive adult (≥18) patients (n = 1970, June 2013-April 2019) undergoing supratentorial brain tumor resection, at a single health system, were assessed. Univariate logistic regression was performed to assess the impact of household income on patient survival. The cohort was then separated into income quartiles (range: $18,119-$193,152). The lowest (Q1) and highest (Q4) income quartiles were then compared. Patients (Q1/Q4) subsequently underwent 1:1 coarsened exact matching based on a number of patient characteristics. Outcomes included mortality, emergency evaluations, and readmissions., Results: Regression analysis of all 1970 patients demonstrated increasing survival with increasing household income (mortality 30-day P = 0.027, 90-day P = 0.002). Logistic regression of all Q1 versus Q4 patients (n = 970) demonstrated increased survival for the highest income patients (Q4) (mortality 30-day P = 0.220, 90-day P = 0.028, all follow-up P = 0.027). Analysis of exact-matched patients (Q1 vs. Q4; n = 462), demonstrated higher income was associated with escalating, nonsignificant, survival rates at 30 (mortality 3.90% Q1 vs. 2.60% Q4, P = 0.424) and 90 days (mortality 13.42% Q1 vs. 8.66 Q4, P = 0.101) but significantly increased survival during total follow-up (mortality Q1 46.75%, Q4 35.06%, P = 0.010). No significant difference was noted for the remaining studied outcomes., Conclusions: Patients matched on a multitude of characteristics, of lesser household income, had higher long-term mortality after brain tumor resection. Further understanding of this disparity should be sought and differences mitigated., (Copyright © 2020. Published by Elsevier Inc.)

Objectives: The LACE+ index risk prediction tool has not been successfully used to predict short-term outcomes after neurosurgery. This study assessed the ability of LACE+ to predict 30-day (30D) adverse outcomes after supratentorial brain tumor surgery., Patients and Methods: LACE+ scores were retrospectively calculated for consecutive patients (n = 624) who received surgery for supratentorial tumors at one multi-center health system (2017-2019). Coarsened exact matching was employed to control for confounding variables. Outcomes including unplanned hospital readmission, emergency department visits, and death were compared for patients with different LACE+ score quartiles (Q1, Q2, Q3, Q4)., Results: 134 patients were matched between Q1 and Q4; 152 patients between Q2 and Q4; 192 patients between Q3 and Q4. LACE+ score was not found to predict readmission within 30D of discharge for Q1 vs Q4 (p = 0.239), Q2 vs Q4 (p = 0.336), or Q3 vs Q4 (p = 0.739). LACE + score also did not predict 30D risk of emergency department visits for Q1 vs Q4 (p = 0.210), Q2 vs Q4 (p = 0.839), or Q3 vs Q4 (p = 0.167). LACE + did predict death within 30D of surgery for Q3 vs Q4 (1.04 % vs 7.29 %, p = 0.039), but not for Q1 vs Q4 (p = 0.625) or Q2 vs Q4 (p = 0.125)., Conclusion: LACE + may not be suitable for characterizing short-term risk of certain perioperative events in a patient population undergoing supratentorial brain tumor surgery., (Copyright © 2020. Published by Elsevier B.V.)

Objective: This study assesses the impact of Median Household Income (MHI) on short- and long-term morbidity and mortality following supratentorial meningioma resection., Patients and Methods: 351 consecutive patients undergoing supratentorial meningioma tumor resection, at a single health system over a six-year period (June 09, 2013 to April 26, 2019) were analyzed retrospectively. Outcomes assessed included readmission, emergency department (ED) evaluation, and mortality within 90 days of surgery. Univariate regression analysis was conducted amongst the entire population. The population was then divided into quartiles based on median household income and univariate analysis was conducted between the lowest (Q1) and highest (Q4) quartiles. Significance was set at a P-value < 0.05. Stepwise regression was performed to identify confounding variables in the logistic model., Results: In the whole population, lower Median Household Income correlated to a significant increase in ED evaluation within 90-days of supratentorial meningioma resection. No significant difference was noted between median household income and 90-day readmission, 90-day unplanned re-operation, return to surgery after index admission within 90-days, return to surgery during the duration of the follow-up period, mortality within 90-days, and mortality during the duration of the follow-up period. In addition, when comparing Q1 (MHI ≤ $51,780) and Q4 (MHI ≥ $87,958), similar results were noted with increased ED evaluation for patients with lower MHI, but no significant difference in other factors of morbidity or mortality., Conclusion: Following supratentorial meningioma resection, a lower median household income was significantly associated with increased emergency department visits within 90 post-operative days., (Copyright © 2020. Published by Elsevier B.V.)

Background: This study assesses the influence of race on patient outcomes in a brain tumor surgery population., Methods: Coarsened exact matching was used to retrospectively analyze 1700 supratentorial brain tumor procedures over a 6-year period (June 7, 2013 to April 29, 2019) at a single, multihospital academic medical center. Outcome measures included readmission, mortality, emergency room visits, and reoperation., Results: McNemar test (mid-P) showed no significant difference in 90-day mortality between the 2 races (P = 0.3018). However, there was a significant difference in 90-day readmissions between the 2 races (P = 0.0237). There was no significant difference in 90-day emergency room visits (P = 0.0579), 90-day return to surgery after index admission (P = 0.6015), or return to surgery within 90 days (P = 0.6776) between the 2 races. There was also no significant difference in return to surgery for the duration of the follow-up period (P = 0.8728)., Conclusions: This study suggests that race alone does not result in disparate outcomes; however, there was an associated difference in 90-day postsurgical readmissions. Despite coarsened exact matching, persistent differences in median household income may play a role in the disparate outcome noted., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: The potential of length of stay, acuity of admission, Charlson Comorbidity Index score, and emergency department visits in the past 6 months (LACE+) scores in patients undergoing cardiac surgery to predict short-term undesirable outcomes was examined., Methods: Coarsened exact matching was used to assess the predictive capacity of the LACE+ index among all cardiac surgery cases over a 2-year period (2016-2018) at 1 health system (n = 4001). Study subjects were matched according to characteristics not assessed by LACE+, including duration of surgery, wound class, body mass index, insurance type, median household income, and race. For a comparison of outcomes, LACE score was divided into quartiles and otherwise matched populations were compared in reference to LACE quartile (Q): Q4 versus Q1, Q4 versus Q2, and Q4 versus Q3., Results: Escalating LACE+ score significantly predicted increased readmission (6.99% versus 25.92% for Q1 versus Q4, 12.79% versus 26.74% for Q2 versus Q4, and 20.52% versus 27.66% for Q3 versus Q4, respectively; P < .001, P < .001, and P = .003), reoperation (2.39% versus 7.73% for Q1 versus Q4, and 4.33% versus 7.67% for Q2 versus Q4, respectively; P < .001 and P = .015, respectively), and emergency room visits at 30 days after surgery (6.64% versus 13.65% for Q1 versus Q4, and 11.20% versus 14.84% for Q2 versus Q4, respectively; P < .001 and P = .041, respectively) as well as readmission, reoperation, and emergency room visits from 30 to 90 days and 0 to 90 days after surgery. Increasing LACE score predicted higher rates of death during follow-up within 30 and 90 postoperative days (P < .001)., Conclusions: The LACE+ index may be suitable as a prediction model for important patient outcomes in a cardiac surgery population., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: The relationship between race and neurosurgical outcomes is poorly characterized despite its importance. The influence of race on short-term patient outcomes in a pituitary tumor surgery population was assessed., Methods: Coarsened exact matching was used to retrospectively analyze 567 consecutive pituitary tumor cases from a 6-year period (June 7, 2013, to April 29, 2019) at a single, multihospital academic medical center. Outcomes studied included 30-day readmission, mortality, and reoperation., Results: There were 92 exact-matched cases suitable for analysis. There was a significant difference in 30-day emergency department visits between the 2 races (black/African American vs. white odds ratio = 4.5, 95% confidence interval = 1.072-30.559, P = 0.0386). There was no observed mortality over the 30-day postoperative period. There was no significant difference in 30-day readmission between the 2 race cohorts (P = 0.3877), in return to surgery after index admission within 30 days (P = 1.000), or in return to surgery within 30 days (P = 0.3750)., Conclusions: This study suggests that the effect of race on outcomes is partly mitigated for individuals who can attain access, and when socioeconomic factors and comorbidities are controlled for. The noted significant difference in emergency department visits could be indicative of confounding variables that were not well controlled for and requires further exploration., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Previously undiagnosed obstructive sleep apnea (OSA) is a known contributor to negative postoperative outcomes. The STOP-Bang questionnaire is a screening tool for OSA that has been validated in both medical and surgical populations. The authors have previously studied this screening tool in a brain tumor population at 30 days. The present study seeks to investigate the effectiveness of this questionnaire, for predicting 90-day readmissions in a population of brain tumor patients with previously undiagnosed OSA., Methods: Included for analysis were all patients undergoing craniotomy for supratentorial neoplasm at a multihospital, single academic medical center. Data were collected from supratentorial craniotomy cases for which the patient was alive at 90 days after surgery (n = 238). Simple logistic regression analyses were used to assess the ability of the STOP-Bang questionnaire and subsequent single variables to accurately predict patient outcomes at 90 days., Results: The sample included 238 brain tumor admissions, of which 50% were female (n = 119). The average STOP-Bang score was 1.95 ± 1.24 (range 0-7). A 1-unit higher increase in STOP-Bang score accurately predicted 90-day readmissions (odds ratio [OR] = 1.65, P = 0.001), 30- to 90-day emergency department visits (OR = 1.85, P < 0.001), and 30- to 90-day reoperation (OR = 2.32, P < 0.001) with fair accuracy as confirmed by the receiver operating characteristic (C-statistic = 0.65-0.76). However, the STOP-Bang questionnaire did not correlate with home discharge (P = 0.315)., Conclusions: The results of this study suggest that undiagnosed OSA, as evaluated by the STOP-Bang questionnaire, is an effective predictor of readmission risk and health system utilization in a brain tumor craniotomy population with previously undiagnosed OSA., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: The LACE + index (Length of stay, Acuity of admission, Charlson Comorbidity Index (CCI) score, and Emergency department visits in the past 6 months) is a tool utilized to predict 30-90 day readmission and other secondary outcomes. We sought to examine the effectiveness of this predictive tool in patients undergoing brain tumor surgery., Patients and Methods: Admissions and readmissions for patients undergoing craniotomy for supratentorial neoplasm at a single, multi-hospital, academic medical center, were analyzed. Key data was prospectively collected with the Neurosurgery Quality Improvement Initiative (NQII)-EpiLog tool. This included all supratentorial craniotomy cases for which the patient was alive at 90 days after surgery (n = 238). Simple logistic regression analyses were used to assess the ability of the LACE + index and subsequent single variables to accurately predict the outcome measures of 30-90 day readmission, 30-90 day emergency department (ED) visit, and 30-90 day reoperation. Analysis of the model's or variable's discrimination was determined by the receiver operating characteristic curve as represented by the C-statistic., Results: The sample included admissions for craniotomy for supratentorial neoplasm (n = 238) from 227 patients, of which 50.00% were female (n = 119). The average LACE + index score was 53.48 ± 16.69 (Range 9-83). The LACE + index did not accurately predict 30-90 day readmissions (P = 0.127), 30-90 day ED visits (P = 0.308), nor reoperations (P = 0.644). ROC confirmed that the LACE + index was little better than random chance at predicting these events in this population (C-statistic = 0.51-0.58). However, a single unit increase in LACE + leads to a 0.97 times reduction in the odds of being discharged home with fair predictive accuracy (P < 0.001, CI = 0.96-0.98, C-statistic = 0.69)., Conclusion: The results of this study show that the LACE + index is ill-equipped to predict 30-90 day readmissions in the brain tumor population and further analysis of significant covariates or other prediction tools should be undertaken., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: The LACE+ index (Length of stay, Acuity of admission, Charlson Comorbidity Index score, and Emergency department [ED] visits in the past 6 months) is a tool used to predict 30-day readmissions. We sought to examine this predictive tool in patients undergoing brain tumor surgery., Methods: Admissions and readmissions for patients undergoing craniotomy for supratentorial neoplasm at a single multihospital academic medical center were analyzed. All brain tumor cases for which the patient was alive at 30 days after surgery were included (n = 352). Simple logistic regression analyses were used to assess the ability of the LACE+ index and subsequent single variables to accurately predict the outcome measures of 30-day readmission, reoperation, and ED visit. Analysis of the model's or variable's discrimination was determined by the receiver operating characteristic curve as represented by the C-statistic., Results: The sample included admissions for craniotomy for supratentorial neoplasm (n = 352). Assessment of the LACE+ index demonstrates a 1.02× increased odds of 30-day readmission for every 1-unit increase in LACE+ score (P = 0.031, CI = 1.00-1.03). Despite this, analysis of the receiver operating characteristic curve indicates that LACE+ index has poor specificity in predicting 30-day readmission (C-statistic = 0.58). A 1-unit increase in LACE+ score also predicts a 0.98× reduction in odds of home discharge (P < 0.001, CI = 0.97-0.99, C-statistic = 0.70). But LACE+ index does not predict 30-day reoperation (P = 0.945) or 30-day ED visits (P = 0.218)., Conclusions: The results of this study demonstrate that the LACE+ index is not yet suitable as a prediction model for 30-day readmission in a brain tumor population., (Copyright © 2019 Elsevier Inc. All rights reserved.)