Clinician Experiences in Treatment Decision-Making for Patients with Spinal Metastases: A Qualitative Study.

Background: Effective management of metastatic disease requires multidisciplinary input and entails high risk of disease-related and treatment-related morbidity and mortality. The factors that influence clinician decision-making around spinal metastases are not well understood. We conducted a qualitative study that included a multidisciplinary cohort of physicians to evaluate the decision-making process for treatment of spinal metastases from the clinician's perspective.

Prospective validation of a clinical prediction score for survival in patients with spinal metastases: the New England Spinal Metastasis Score.

Background Context: The New England Spinal Metastasis Score (NESMS) was proposed as an intuitive and accessible prognostic tool for predicting survival in patients with spinal metastases. We designed an appropriately powered, prospective, longitudinal investigation to validate the NESMS.

Purpose: To prospectively validate the NESMS.

Design of the prospective observational study of spinal metastasis treatment (POST).

Background Context: There are several prognostic scores available that intend to inform decision-making for patients with spinal metastases. Many of these have not been found to reliably predict survival across the continuum of care. Recently, our group developed the New England Spinal Metastasis Score (NESMS).

Non-operative management of spinal metastases: A prognostic model for failure.

Objectives: To describe patient-specific characteristics associated with non-operative failure leading to surgery.

Patients And Methods: We conducted a retrospective review of patients treated for spinal metastases from 2005 to 2017. We deemed patients as failures if they were treated non-operatively and then received a surgical intervention within one year of starting a non-operative regimen.

Laboratory markers as useful prognostic measures for survival in patients with spinal metastases.

Background Context: Laboratory values have been found to be useful predictive measures of survival following surgery. The utility of laboratory values for prognosticating outcomes among patients with spinal metastases has not been studied.

Purpose: To determine the prognostic capacity of laboratory values at presentation including white blood cell count, serum albumin and platelet-lymphocyte ratio (PLR) in patients with spinal metastases.

Prognosticating outcomes and survival for patients with lumbar spinal metastases: Results of a bayesian regression analysis.

Objectives: To assess the impact of surgical intervention on survival, ambulatory capacity, complications and readmissions following treatment for lumbar metastases.

Patients And Methods: We identified all adult patients treated for lumbar metastases between 2005-2017. To limit the potential for inherent bias to influence determinations, we used principal component analysis to identify confounders to be included in multivariable testing.

Does Orthopaedic Outpatient Care Reduce Emergency Department Utilization After Total Joint Arthroplasty?

Background: Emergency department (ED) visits after elective surgical procedures are a potential target for interventions to reduce healthcare costs. More than 1 million total joint arthroplasties (TJAs) are performed each year with postsurgical ED utilization estimated in the range of 10%.

Questions/purposes: We asked whether (1) outpatient orthopaedic care was associated with reduced ED utilization and (2) whether there were identifiable factors associated with ED utilization within the first 30 and 90 days after TJA.

Disparities in Rates of Surgical Intervention Among Racial and Ethnic Minorities in Medicare Accountable Care Organizations.

Objective: To assess the effect of Accountable Care Organizations (ACOs) on the use of surgical services among racial and ethnic minorities.

Background: Health reform efforts were expected to reduce healthcare disparities. The impact of ACOs on existing disparities in access to surgical care remains unknown.

Outpatient Spine Clinic Utilization is Associated With Reduced Emergency Department Visits Following Spine Surgery.

Study Design: Review of TRICARE claims (2006-2014) data to assess Emergency Department (ED) utilization following spine surgery.

Objective: The aim of this study was to determine utilization rates and predictors of ED utilization following spine surgical interventions.

Summary Of Background Data: Visits to the ED following surgical intervention represent an additional stress to the healthcare system.