Publications by authors named "Advith Sarikonda"
Background And Objectives: A few studies have compared the value (outcomes per dollar spent) provided by transforaminal endoscopic discectomy (TED) vs microdiscectomy (MD) for lumbar disc herniations. Here, we attempt to address this gap using a novel Operative Value Index (OVI), which combines a procedure-specific patient-reported outcome with intraoperative cost data based on time-driven activity-based costing.
Methods: MD (n = 95) and TED (n = 23) performed by neurosurgeons at our institution from 2017 to 2022 were retrospectively identified.
Article Synopsis
- Minimally invasive spine surgery (MISS) is gaining popularity due to its benefits like smaller incisions and quicker recovery times, but online information about it often exceeds readable levels for patients.
- A study assessed the responses from ChatGPT to 15 frequently asked questions about MISS, focusing on clinical appropriateness and readability as judged by three neurosurgeons.
- Results showed that all generated responses had readability scores above the recommended levels for patient education, indicating they were difficult for average patients to understand, particularly for intraoperative questions.
Article Synopsis
- Total disc replacement (TDR) is an alternative to anterior cervical discectomy and fusion (ACDF), and this study compares their costs as we shift towards value-based healthcare.
- Using time-driven activity-based costing (TDABC), researchers reviewed the costs of both procedures, analyzing direct and indirect costs through observation and data collection from various departments.
- The results showed that TDRs had significantly higher total intraoperative costs ($12,026) compared to ACDFs ($6,776), with the majority of the cost difference attributed to more expensive supply items, particularly implants.
Article Synopsis
- There has been a growing number of cervical fusion surgeries in the U.S., but there's a lack of research on how well surgeons follow evidence-based medicine (EBM) guidelines, particularly as patients turn to large language models (LLMs) for decision-making assistance.* -
- An observational study tested four LLMs—Bard, BingAI, ChatGPT-3.5, and ChatGPT-4—against the 2023 North American Spine Society (NASS) cervical fusion guidelines, and found that none fully adhered, with only ChatGPT-4 and Bing Chat achieving 60% compliance.* -
- The findings suggest a need for better training of LLMs on clinical guidelines and highlight the necessity of
Background: The advent of Large Language Models (LLMs) like ChatGPT has introduced significant advancements in various surgical disciplines. These developments have led to an increased interest in the utilization of LLMs for Current Procedural Terminology (CPT) coding in surgery. With CPT coding being a complex and time-consuming process, often exacerbated by the scarcity of professional coders, there is a pressing need for innovative solutions to enhance coding efficiency and accuracy.
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- The text discusses how telemedicine can enhance postoperative care for pituitary patients, highlighting the shift from in-person assessments to remote monitoring using smartphone apps.
- A review identified 26 relevant apps that help track common complications after pituitary surgery, focusing on visual changes, water and electrolyte imbalances, and adrenal dysfunction.
- The findings suggest that integrating advanced medical technologies into these apps could significantly improve remote patient monitoring beyond traditional clinical visits.
Background: Tubular spine surgery has emerged as a hallmark of minimally invasive spine (MIS) procedures. In recent years, thanks to technological advances, tubular dilators and retractors have been integrated with digital cameras to allow for ergonomic, high-definition visualization of the surgical field.
Objective: To detail the evolution, ergonomics, economics, and outcomes of camera-based tubular spine surgery, spanning the origins of MIS tubular techniques to the current use of operative microscopes and tube-mounted digital cameras (TMDCs).
Article Synopsis
- Elective lumbar fusions are often criticized for being used improperly, prompting a study using a new Operative Value Index (OVI) to evaluate the cost-effectiveness of evidence-based lumbar fusions.
- A retrospective analysis of 294 patients found that a majority (92.9%) underwent evidence-based surgeries, with OVI measuring patient improvement per dollar spent showing significantly better outcomes for these procedures compared to non-evidence-based ones.
- The results indicate that adhering to evidence-based guidelines leads to greater patient improvement (2% per $1000 spent) and highlights the potential for systematic improvements in lumbar fusion practices.
Background And Objectives: Endoscopic lumbar diskectomy (ED) is a minimally invasive option for addressing lumbar disk herniations. With the introduction of value-based care systems, assessing the true cost of certain procedures is critical when creating reimbursement models and comparing procedures. Here, we compared the costs of performing a microdiskectomy (MD) and ED using time-driven activity-based costing.
View Article and Find Full Text PDFStudy Design: The present study is a single-center, retrospective cohort study of patients undergoing neurosurgical anterior cervical discectomy and fusion (ACDF).
Objective: Our objective was to use time-driven activity-based costing (TDABC) methodology to determine whether surgeons' case volume influenced the true intraoperative costs of ACDFs performed at our institution.
Summary Of Background Data: Successful participation in emerging reimbursement models, such as bundled payments, requires an understanding of true intraoperative costs, as well as the modifiable drivers of those costs.
Article Synopsis
- The study aimed to analyze and compare the marginal intraoperative costs of three methods for pedicle screw placement during transforaminal lumbar interbody fusions (TLIFs), specifically looking at robot-assisted TLIF, intraoperative navigation TLIF, and freehand TLIF.
- Data were collected from 2020 to 2022, involving 20 robot-assisted, 59 navigation, and 233 freehand procedures. Cost analysis included direct and indirect expenses, using software to extract resource usage from electronic medical records.
- Results indicated that robot-assisted TLIF was significantly more expensive ($24,838) than both intraoperative navigation TLIF ($15,991) and freehand TLIF ($
Article Synopsis
- Spine surgeons need to understand cost variations in anterior cervical discectomy and fusion (ACDF), especially how BMI affects costs and operating room (OR) times.
- A study analyzed 959 ACDF patients from 2017 to 2022 using time-driven activity-based costing, finding that while BMI did not significantly impact total surgery costs, it increased the time spent in the OR.
- The research concluded that time-driven costing can help clarify true surgical costs, highlighting that higher BMI led to longer preparatory times in the OR, even though it didn't raise the total procedure cost.
Article Synopsis
- The study aimed to compare the intraoperative costs of three surgical visualization techniques used in anterior cervical discectomy and fusion (ACDF): operative microscopes, exoscopes, and loupes, using time-driven activity-based costing (TDABC).
- Data was collected on direct and indirect costs across 960 ACDF procedures (loupes-ACDF: 882, EX-ACDF: 26, OM-ACDF: 52) through observation and medical records, and statistical analysis was conducted to evaluate cost differences considering patient-specific factors.
- Although the average costs for the different techniques showed no significant differences, exoscopes were linked to higher consumable costs compared to the other methods, highlighting a gap in understanding the
Purpose Of Review: Recent advances in the field of interventional pain management (IPM) involve minimally invasive procedures such as percutaneous lumbar decompression, interspinous spacer placement, interspinous-interlaminar fusion and sacroiliac joint fusion. These developments have received pushback from surgical professional societies, who state spinal instrumentation and arthrodesis should only be performed by spine surgeons. The purpose of this review is to evaluate the validity of this claim.
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