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Spine economics

Nikhil Jain, Frank M Phillips, Tristan Weaver, Safdar N Khan
STUDY DESIGN: Retrospective, economic analysis. OBJECTIVE: To study patient profile associated with preoperative chronic opioid therapy (COT), and study COT as a risk factor for 90-day complications, emergency department (ED) visits, and readmission after primary one- to two-level posterior lumbar fusion (PLF) for degenerative spine disease. We also evaluated associated costs, risk factors, and adverse events related to long-term postoperative opioid use. SUMMARY OF BACKGROUND DATA: Chronic opioid use is associated with poor outcomes and dependence after spine surgery...
March 20, 2018: Spine
John P Kleimeyer, Ivan Cheng, Todd F Alamin, Serena S Hu, Thomas Cha, Vijay Yanamadala, Kirkham B Wood
STUDY DESIGN: This is a retrospective cohort study. OBJECTIVE: To evaluate the long-term outcomes of selective one- to two-level anterior lumbar interbody fusions (ALIFs) in the lower lumbar spine versus continued nonsurgical management. SUMMARY OF BACKGROUND DATA: Low back pain associated with lumbar intervertebral disc degeneration is common with substantial economic impact, yet treatment remains controversial. Surgical fusion has previously provided mixed results with limited durable improvement of pain and function...
March 9, 2018: Spine
Zorica Buser, Brandon Ortega, Anthony D'Oro, William Pannell, Jeremiah R Cohen, Justin Wang, Ray Golish, Michael Reed, Jeffrey C Wang
Study Design: Retrospective database study. Objective: Low back and neck pain are among the top leading causes of disability worldwide. The aim of our study was to report the current trends on spine degenerative disorders and their treatments. Methods: Patients diagnosed with lumbar or cervical spine conditions within the orthopedic subset of Medicare and Humana databases (PearlDiver). From the initial cohorts we identified subgroups based on the treatment: fusion or nonoperative within 1 year from diagnosis...
February 2018: Global Spine Journal
L Queiroz-Santos, M M Casagrande, A Specht
The cotton bollworm Helicoverpa armigera (Hübner) is a widespread lepidopteran pest found in various crops worldwide. This highly polyphagous species, commonly found both in the Old and New World, has caused significant economic damage as an invasive agricultural pest in Brazil since 2013. The goal of the present study is to provide a detailed morphological assessment of adults and immature stages of H. armigera, as this species is often confused with H. zea (Boddie), a congeneric species that is native to the New World...
February 15, 2018: Neotropical Entomology
Nikhil Jain, Frank M Phillips, Safdar N Khan
STUDY DESIGN: A retrospective, economic analysis. OBJECTIVE: The objective of this article is to analyze the distribution of 90-day payments, sources of variation, and reimbursement for complications and readmissions for primary ≥3-level posterior lumbar fusion (PLF) from Medicare data. A secondary objective was to identify risk factors for complications. SUMMARY OF BACKGROUND DATA: Bundled payments represent a single payment system to cover all costs associated with a single episode of care, typically over 90 days...
January 23, 2018: Clinical Spine Surgery
Mischa Woisetschläger, Anna Spångeus
BACKGROUND: Osteoporosis is a common but underdiagnosed and undertreated disease causing severe morbidity and economic burden. The gold standard for detection of osteoporosis is DXA (dual energy x-ray absorptiometry), which is a dedicated examination for osteoporosis. Dual energy CT (DECT) examinations are increasingly used in daily routine for a wide variety of diagnoses. In the present study, we wanted to examine whether vBMD (volume bone mass density) could be evaluated as a side product in non-contrast as well as contrast phases as well as to evaluate a correction model taking known shortcomings for DXA into account...
February 2018: European Journal of Radiology
Mary P Zhu, Lindsay A Tetreault, Fatimah Sorefan-Mangou, Philip Garwood, Jefferson R Wilson
BACKGROUND CONTEXT: Bracing is often used after spinal surgery to immobilize the spine, improve fusion, and relieve pain. However, controversy exists regarding the efficacy, necessity and safety of various bracing techniques in the post-surgical setting. PURPOSE: In this systematic review, we aimed to compare the effectiveness, safety and cost-effectiveness of postoperative bracing versus no postoperative bracing following spinal surgery in patients with several common operative spinal pathologies...
January 17, 2018: Spine Journal: Official Journal of the North American Spine Society
Raoul Saggini, Emilio Ancona, Simona Maria Carmignano, Marco Supplizi, Giovanni Barassi, Rosa Grazia Bellomo
Introduction: Osteoporosis is a systemic disease of the skeleton characterized by a reduction in bone mass and alterations in microarchitecture accompanied by increase in fracture risk, with a relevant decline in quality of life and important social, economic, and health implications, representing one of the most common causes of disability and a major financial item of health cost in many Countries. The best therapy for osteoporosis is prevention, consisting in measures to avoid or slow the onset of the disease...
September 2017: Clinical Cases in Mineral and Bone Metabolism
Aladine A Elsamadicy, Amanda R Sergesketter, Michael D Frakes, Shivanand P Lad
BACKGROUND: Due to disparaging costs and rates of malpractice claims in neurosurgery, there has been significant interest in identifying high-risk specialties, types of malpractice claims, and characteristics of claim-prone physicians. OBJECTIVE: To characterize the malpractice claims against neurosurgeons. METHODS: This was a comprehensive analysis of all malpractice liability claims involving a neurosurgeon as the primary defendant, conducted using the Physician Insurers Association of America Data Sharing Project from January 1, 2003 and December 31, 2012...
January 8, 2018: Neurosurgery
Jane Nikles, Michael Yelland, Clare Bayram, Graeme Miller, Michele Sterling
BACKGROUND: Whiplash Associated Disorders (WAD) are common and costly, and are usually managed initially by general practitioners (GPs). How GPs manage WAD is largely unstudied, though there are clinical guidelines. Our aim was to ascertain the rate of management (percentage of encounters) of WAD among patients attending Australian general practice, and to review management of these problems, including imaging, medications and other treatments. METHODS: We analysed data from 2013 to 2016 collected by different random samples of approximately 1000 general practitioners (GPs) per year...
December 29, 2017: BMC Musculoskeletal Disorders
Eric G Boyce, Yvonne Mai, Christopher Pham
OBJECTIVE: To review the efficacy, safety, and economics of abaloparatide in the treatment of postmenopausal osteoporosis. DATA SOURCES: PubMed (1966 to October 2017), (October 2017), and Scopus (1970 to October 2017) were searched using abaloparatide, Tymlos, BA058, PTHrP 1-34 analog, and parathyroid hormone-related peptide 1-34 analog. STUDY SELECTION AND DATA EXTRACTION: Human studies published in peer-reviewed publications in English were the primary sources for efficacy, safety, and economic data...
December 1, 2017: Annals of Pharmacotherapy
Anna Zwierzchowska, Jacek Tuz
BACKGROUND: In Poland, about 85% of the population report low back pain (LBP) symptoms overall. Moreover, 70-80% of people aged below 20 have already experienced back pain. The primary cause of LBP is the loss of spinal lordosis, which initiates changes in geometry of the spine and has impact on limb arrangement. The aim of the study was to attempt to verify the relationship between the 2 main curvatures of the spine and its relation to symptoms in different parts of the musculoskeletal system, in a group of adults...
January 1, 2018: Medycyna Pracy
Christopher D Witiw, Fabrice Smieliauskas, Michael G Fehlings
Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord impairment worldwide. Surgical intervention has been demonstrated to be effective and is becoming standard of care. Spine surgery, however, is costly and value needs to be demonstrated. This review serves to summarize the key health economic concepts as they relate to the assessment of the value of surgery for DCM. This is followed by a discussion of current health economic research on DCM, which suggests that surgery is likely to be cost effective...
January 2018: Neurosurgery Clinics of North America
Junbin Dong, Haiquan Bao, Lai Mang
Rhinoestrus sp. (Diptera: Oestridae) is an economically important parasite that can cause severe nasal myiasis in equids and can also affect humans. The ultrastructure of all Rhinoestrus sp. larval instars from Mongolian horse was examined by light and scanning electron microscopy to characterize the features of Rhinoestrus. The structure of the anterior region, posterior region, and the spines of the third segment was analyzed for 10 specimens in each larval stage. Additionally, 34 third-instar (L3) larvae of Rhinoestrus sp...
November 8, 2017: Microscopy Research and Technique
Thomas R Denninger, Chad E Cook, Cole G Chapman, Timothy McHenry, Charles A Thigpen
Study Design Retrospective study. Background Alternative models of care which allow patients to choose direct access to physical therapy have shown promise in terms of cost reduction for neck and back pain. However, real-world exploration within the U.S. healthcare system is notably limited. Objectives To compare total claims paid and patient outcomes for patients with neck and back pain who chose physical therapy intervention via direct access versus from medical referral. Methods Data were accessed for care-seeking patients (n=603) between 2012-2014 with neck or back pain who chose to begin care either through traditional medical referral or direct access to a physical therapy led spine management program...
October 26, 2017: Journal of Orthopaedic and Sports Physical Therapy
Fraence Gottschalk, Thomas Wilke, Sabrina Mueller, Kirstin Heinrich, Ulf Maywald, Andreas Fuchs, Holly Yu
BACKGROUND: This study assessed Staphylococcus aureus infection risk in patients with type 2 diabetes mellitus (T2DM) undergoing an orthopedic knee, hip, or spine surgery. PATIENTS AND METHODS: All patients with a diagnosis of T2DM in the period from 2010 to 2012 were identified from a German claims database. First inpatient knee, hip, or spine surgery was used as index date. Cumulative incidence of S. aureus infections was calculated for several time intervals...
October 12, 2017: Surgical Infections
Kitti Köhler, Antónia Marcsik, Péter Zádori, Gergely Biro, Tamás Szeniczey, Szilvia Fábián, Gábor Serlegi, Tibor Marton, Helen D Donoghue, Tamás Hajdu
At the Abony-Turjányos dűlő site, located in Central Hungary, a rescue excavation was carried out. More than 400 features were excavated and dated to the Protoboleráz horizon, at the beginning of the Late Copper Age in the Carpathian Basin, between 3780-3650 cal BC. Besides the domestic and economic units, there were two special areas, with nine-nine pits that differed from the other archaeological features of the site. In the northern pit group seven pits contained human remains belonging to 48 individuals...
2017: PloS One
Salman Abbasi Fard, Jesse Skoch, Mauricio J Avila, Apar S Patel, Kamran V Sattarov, Christina M Walter, Ali A Baaj
STUDY DESIGN: Review of the articles. OBJECTIVE: The objective of this study was to review all articles related to spinal instability to determine a consensus statement for a contemporary, practical definition applicable to thoracolumbar injuries. SUMMARY OF BACKGROUND DATA: Traumatic fractures of the thoracolumbar spine are common. These injuries can result in neurological deficits, disability, deformity, pain, and represent a great economic burden to society...
October 2017: Clinical Spine Surgery
S Harrison Farber, Jing L Han, Aladine A Elsamadicy, Qasim Hussaini, Siyun Yang, Promila Pagadala, Beth Parente, Jichun Xie, Shivanand P Lad
BACKGROUND: Failed back surgery syndrome (FBSS) is a cause of significant morbidity for up to 40% of patients following spine surgery, and is estimated to cost almost $20 billion. Treatment options for these patients currently include conventional medical management (CMM), repeat operation, or spinal cord stimulation (SCS). Much of the published data regarding cost effectiveness of SCS comprise smaller scale randomized controlled trials (RCTs) rather than large databases capturing practices throughout the US...
September 2017: Pain Physician
Joel R Martin, Timothy Y Wang, Daniel Loriaux, Rupen Desai, Maragatha Kuchibhatla, Isaac O Karikari, Carlos A Bagley, Oren N Gottfried
Hospital readmission after surgery results in a substantial economic burden, and several recent studies have investigated the impact of race and ethnicity on hospital readmission rates, with the goal to identify hospitals and patients with high readmission risk. This single-institution, retrospective cohort study assesses the impact of race, along with other risk factors, on 30-day readmission rates following spinal surgery. This study is a single-institution retrospective cohort study with accrual from January 1, 2008, to December 31, 2010...
December 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
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