bluuebunny/crossref_metadata_2025 huggingface dataset:
248 Isolated Traumatic Subarachnoid Hemorrhage on Head Computed Tomography Scan May Not Be Isolated
Authors: Yue John K. , Yuh Esther , Elguindy Mahmoud , Sun Xiaoying , van Essen Thomas , Deng Hansen , Satris Gabriela , Wong Justin , DiGiorgio Anthony Michael , Tarapore Phiroz E. , Huang Michael C. , Markowitz Amy , Mukherjee Pratik , Jain Sonia , Manley Geoffrey T.
Published: March 2024

INTRODUCTION:

Isolated traumatic subarachnoid hemorrhage (tSAH) after traumatic brain injury (TBI) on head computed tomography (CT) is often regarded as a “mild” injury, with reduced need for additional workup. However, tSAH is also a predictor of unfavorable outcomes. Magnetic resonance imaging (MRI) and blood-based biomarkers may improve the diagnosis of concurrent intracranial injury.

METHODS:

The prospective, 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury study enrolled patients presenting to ED within 24 hours (h) of TBI who received a clinically-indicated head CT. A subset underwent venipuncture within 24h for plasma glial fibrillary acidic protein (GFAP) analysis, and 2-week research MRI. Participants aged = 17-years with GCS 13-15, isolated tSAH on initial CT, GFAP, and MRI data were analyzed.

RESULTS:

In 57 patients, median age was 46.0-years [quartile 1 to 3 (Q1-Q3): 34-57] and 53% were male. At ED disposition, 12.3% were discharged home, 61.4% admitted to hospital ward, and 26.3% to intensive care.MRI identified additional traumatic intracranial lesions in 45.6% of patients (1 type: 31.6%; 2 types: 14.0%); of these, 65.4% had axonal injury, 42.3% subdural hematoma, and 23.1% contusion. GFAP levels were higher in patients with additional MRI lesions (median: 630.6-pg/ml, Q1-Q3: [172.4-941.2] vs. 226.4 [105.8-436.1], p = 0.049), and correlated with axonal injury severity (none: median 226.7 [109.6-435.1], traumatic axonal injury: 716.3 [304.0-892.3], diffuse axonal injury: 873.2 [407.2-1321.4], p = 0.034).

CONCLUSIONS:

Isolated tSAH on head CT is insufficient to rule out additional traumatic injuries in GCS 13-15 TBI. Forty-six percent of patients had additional traumatic lesions on MRI. Plasma GFAP may be an important biomarker for the identification of additional injuries, including axonal injury. Patients with isolated tSAH on CT may require close clinical surveillance and follow-up.
250 Harnessing the Endogenous Stem Cell Response After Spinal Cord Injury: A Novel and Translationally Relevant Therapeutic Strategy
Authors: Hachem Laureen D. , Hong James , Velumian Alexander , Mothe Andrea , Tator Charles , Fehlings Michael G.
Published: March 2024

INTRODUCTION:

The adult spinal cord contains a population of endogenous ependymal-derived neural stem/progenitor cells (epNSPCs) that hold the potential to promote regeneration and repair after injury. epNSPCs are normally quiescent but are acutely activated after spinal cord injury (SCI). Despite this, the activation of these cells remains insufficient to promote robust neural regeneration and recovery. Understanding the mechanisms that govern the biology of epNSPCs is critical in developing a therapeutic strategy to harness their regenerative potential after SCI.

METHODS:

epNSPCs isolated from the adult spinal cord were used for in vitro mechanistic analysis. In vivo, cervical SCI was induced in adult rodents using a clinically relevant compression-contusion model of cervical SCI. FoxJ1-Cre-tdT reporter mice were used for lineage tracing studies. One-week post-SCI, animals (n = 15/group) were randomized to receive CX546 (a positive AMPA receptor modulator), or vehicle-control. Animals underwent weekly behavioural testing and spinal cords were extracted for histological/molecular analysis.

RESULTS:

Glutamate excitotoxicity, a hallmark in the pathogenesis of acute SCI, leads to calcium influx in spinal cord epNSPCs via AMPA receptors (AMPARs) and this change in calcium in concert with Notch signaling drives their proliferation and astrocytic differentiation. Blockade of AMPARs in vivo inhibits the activation of epNSPCs post-SCI. Positive modulation of AMPARs after SCI using the clinically relevant class of drugs known as ampakines, enhances epNSPC proliferation, increases pro-regenerative astrocytes and neurotrophic factor production, and promotes neuronal survival and motor recovery.

CONCLUSIONS:

We report on a novel mechanism by which AMPARs regulate the growth and phenotype of endogenous epNSPCs. Pharmacological targeting of this mechanism could be used to harness the regenerative potential of endogenous neural stem cells and improve motor recovery after SCI.
254 Initiation of Low Molecular Weight Heparin Within 24 Hours Is Safe and Effective for VTE Prophylaxis in Spinal Cord Injury Patients
Authors: Lui Austin , Chryssikos Timothy , Patel Arati , Park Christine , Torres Abel , Kyritsis Nikolaos , Hemmerle Debra P. , Fernandez Xuan Duong , Saigal Rajiv , Talbott Jason , Pan Jonathan S. , Ferguson Adam , Whetstone William , Singh Vineeta , Weinstein Philip R. , Dhall Sanjay S. , Mummaneni Praveen V. , Huie J. Russell , Pascual Lisa U. , Manley Geoffrey , Bresnahan Jacqueline , Beattie Michael , DiGiorgio Anthony Michael
Published: March 2024

INTRODUCTION:

Venous thromboembolism (VTE) following traumatic spinal cord injury (SCI) is a major clinical concern. Current guidelines recommend initiation of chemical prophylaxis within 72 hours of injury or surgery. Given the high reported incidence of VTE in this population, the safety and efficacy of earlier initiation is an important clinical question.

METHODS:

We analyzed prospectively collected data in a cohort of 162 SCI patients from a single quaternary center. Demographic and clinical data were recorded. Univariate and multivariate logistic regression analyses were performed to identify predictors of VTE in SCI patients treated with LMWH within 24 hours of injury or surgery.

RESULTS:

Mean age was 56.9 years (28% females). One hundred and thirty (87.8%) patients underwent SCI surgery. There was an extremity fracture in 18.2% and lumbar drain was placed in 22.3%. DVT occurred in 7.4%, PE in 6.1%, and any VTE in 12.2%. A multivariable regression model including age, sex, race, injury severity score, level of SCI, SCI surgery status, admission lower extremity motor score, and extremity fracture showed that only lower extremity motor score (OR 0.94, p=0.03) was significantly associated with VTE. There were 1.5% patients with post-SCI surgery-related bleeds requiring surgery takeback. There were 5.6% non-surgery related bleeds, and 1.2% wound dehiscence.

CONCLUSIONS:

Initiation of LMWH within 24 hours of injury or surgery maintained the incidence of any VTE event within the lower end of previously reported ranges with 1.5% of patients who underwent SCI surgery requiring surgery takeback due to bleeding complications. Admission lower extremity motor score was the sole predictor of VTE in this patient cohort.
273 A Direct Domparative Analysis of Pediatric Traumatic Brain Injury Presentation and Outcomes in the United States and Uganda
Authors: Seas Andreas , Yoon Angela , Adil Syed M , Satyadev Nihal , Warman Pranav , Najjuma Josephine , Punchak Maria , Sexton Daniel , Dunn Timothy , Kolls Brad , Haglund Michael M. , Fuller Anthony , Kitya David
Published: March 2024

INTRODUCTION:

Pediatric traumatic brain injury (pTBI) is the leading cause of death and disability among children globally. However, few studies have explored pTBI in low- and middle-income countries (LMICs) compared to high-income countries (HICs).

METHODS:

Patient records were extracted from the Duke University Hospital subset of the National Trauma Data Bank (NTDB, n = 866) and a dataset at the Mbarara Regional Referral Hospital in Uganda (MRRH, n = 571). Descriptive statistics were performed to compare across settings. Logistic regression was used to quantify the odds of mortality in each setting given ICU utilization, admission GCS, and other factors.

RESULTS:

In-hospital mortality was higher in the LMIC versus the HIC (9.4% vs 2.9%, p < 0.001), while ICU utilization was lower in the LMIC (9.0% vs 33.4%, p < 0.001). Rates of surgical management did not differ significantly (15.8% vs 17.0%). More patients presented with moderate (27.8% vs 4.3%) and severe TBI (16.5% vs 11.8%) in the LMIC (p < 0.001). No deaths were reported among patients presenting with moderate or mild TBI in the HIC setting, whereas LMIC pTBI patients died in every TBI severity category. Over 50% of LMIC ICU patients died, versus 8.1% of HIC ICU patients. In a multivariate regression model of mortality, ICU placement was associated with mortality (OR: 6.7, 95% CI: 2.1-20.9), an association not seen in the HIC setting.

CONCLUSIONS:

Pediatric TBI mortality is greater in the LMIC vs the HIC setting. The LMIC setting also had a high prevalence of moderate/severe TBI and low ICU availability and effectiveness. Future work should involve the implementation and evaluation of interventions to assess these gaps in the LMIC setting.
282 Does Axial Cervical Pain Improve With Surgical Fusion? A Meta-analysis
Authors: Harrop James S. , Gonzalez Ozuna Glenn Arturo , Qasba Reyan , Porto Guilherme Bastos , Wainwright John , Thalheimer Sara , Schorsch Merrie , Vaccaro Alexander , Ghogawala Zoher
Published: March 2024

INTRODUCTION:

Isolated axial neck pain is a prevalent condition that causes significant morbidity and productivity loss.

METHODS:

This study searched for RCTs and cohort studies in English language databases with a minimum 6-month follow-up, limited to patients with axial neck pain/cervical radiculopathy and pre/post-operative NDI and VAS scores. Literature reviews, meta-analyses, systematic reviews, surveys, and case studies were excluded. Two patient groups were analyzed: the arm pain predominant (pAP) cohort and the neck pain predominant (pNP) cohort. A 30% reduction in PROMs scores from baseline represented the Minimal Clinically Important Difference (MCID).

RESULTS:

Five studies with 5,221 patients met the inclusion criteria. Patients with pAP had a slightly greater reduction in PROMs scores than those with pNP. NDI reduction was 41.34 % (16.3/39.42) in pNP patients (p < 0.0001) and 45.12% (15.86/35.15) in pAP patients (p < 0.0001). Surgical improvement was comparable between the two groups (16.3 vs. 15.86 points, p = 0.3193) .Patients with pNP had a greater reduction in neck pain (53.4%; 3.60/6.74, p < 0.0001) compared to pAP (50.30%; 2.46/4.89, p < 0.0001), with a significant difference in VAS scores (3.6 vs. 2.46, p < 0.0134). Patients with pNP had 43.6% (1.96/4.5) improvement in arm pain (p < 0.0001), while pAP patients had 66.12% (4.43/6.7) improvement (p < 0.0001), with significantly higher VAS scores for arm pain in pAP patients (4.43 vs. 1.96 points, p < 0.0051).

CONCLUSIONS:

Surgical intervention is increasingly supported for primary axial neck pain, with studies demonstrating greater improvements in neck pain than arm pain, exceeding MCID and reaching SCB. However, given the multifaceted nature of the condition, further research is needed to determine optimal patients and pathologies for surgery.
284 CT-Based Assessment of Prone Versus Lateral Pedicle Screw Placement Accuracy: A Retrospective Single-surgeon Study
Authors: Brown Nolan James , Musmar Basel , Pennington Zach , Kuo Cathleen , Chakravarti Sachiv , Diaz-Aguilar Luis Daniel , Mehkri Yusuf , Singh Rohin , Pham Martin H.
Published: March 2024

INTRODUCTION:

Lateral lumbar interbody fusion (LLIF) including the anterior-to-psoas oblique lumbar interbody fusion (OLIF) has conventionally relied on pedicle screw placement (PSP) for construct stabilization. Single-position surgery with lumbar interbody fusion (LIF) in the lateral decubitus position with concomitant PSP has been associated with increased operative efficiency. What remains unclear is the accuracy of PSP with robotic guidance when compared to the more familiar prone patient positioning.

METHODS:

We identified all consecutive patients treated with interbody fusion and PSP in the prone or lateral position by a single surgeon between January 2019 and October 2022. All pedicle screws placed were analyzed using CT imaging to determine appropriate positioning according to the Gertzbein-Robbins Classification Grading System. Multivariate logistic regression models were constructed to identify risk factors for the occurrence of a radiographically significant breach.

RESULTS:

89 consecutive patients were included (n = 690 screws), of whom 46 were treated in the prone position (n = 477 screws) and 43 in the lateral decubitus position (n = 213 screws). There were fewer breaches in the prone (n = 13; 2.7%) versus lateral decubitus group (n = 15; 7.0%; p = 0.012). Nine (1.9%) radiographically significant breaches occurred in the prone group compared to 10 (4.7%) in the lateral decubitus group (p = 0.019), for a prone vs. lateral decubitus pedicle screw accuracy rate of 98.1% vs. 95.3%. There were no significant differences in BMI between prone vs. lateral decubitus cohorts (30.1 vs. 29.6) or breached patients vs. non-breached patients (31.2 vs. 29.5). In multivariate models, prone position was the only significant protective factor for screw accuracy; we did not identify any other significant risk factors for screw breach.

CONCLUSIONS:

The present data suggest pedicle screws placed with robotic assistance have higher placement accuracy in the prone position.
298 Differential Gene Expression Underlying Glioma Related Epilepsy
Authors: Mortazavi Armin , Nieblas-Bedolla Edwin , Khan Anas , Carney Ryan , Johnson Kory , Zaghloul Kareem A.
Published: March 2024

INTRODUCTION:

Seizures are a common sequalae for patients suffering from gliomas. There are several factors, such as molecular characteristics, known to influence the initiation of seizures that may ultimately drive tumor growth. However, different levels of gene expression associated with seizures for gliomas remain unclear. Here, we review current literature and analyze RNA sequencing of gliomas to further probe these differences.

METHODS:

Utilizing total RNA sequencing obtained from The Cancer Genome Atlas - Lower Grade Glioma to identify and characterize differential expression in patients that do and do not experience seizures. Utilizing QIAGEN Ingenuity Pathways Analysis (IPA), we identified canonical and functional pathways to further characterize differential expression.

RESULTS:

From 289 patients with gliomas, 83 (28.7%) had available information regarding seizures and other variables of interest. Of these, 50 (60.2%) were allocated to the seizure group and the remaining 33 (39.8%) to the non-seizure group. There were no statistically significant differences in age (p = 0.4661), sex (p = -0.1338), race/ethnicity (p = 0.7331), molecular subtype (0.8656), tumor grade (p = 0.2260), or anatomical location. When comparing the level of RNA expression from these tumors between the seizure and non-seizure groups, we identified 52 genes that were significantly differentially regulated. Critical canonical pathways were identified, most significantly RHOGDI and Semaphorin Neuronal Repulsive signaling.Finally, in the functional analysis, tumors that promoted seizures had gene sets that were significantly increased involving neuronal differentiation and synaptogenesis.

CONCLUSIONS:

In the setting of gliomas, differences in tumor gene expression exist between individuals with seizures and without seizures despite similarities in patient demographics and other tumor characteristics. There was significant difference in gene expression that were most associated with neuron development and synaptogenesis, ultimately suggesting a mechanistic role of a tumor-neuron synapse in seizure initiation and potentially tumor growth.
304 NF2 Loss-of-Function and Hypoxia Together Drive Radioresistance in Grade 2 Meningiomas
Authors: Pugazenthi Sangami , Patel Bhuvic , English Collin , Mahlokozera Tatenda , Lu Hsiang-Chih , Yang Alicia , Roberts Kaleigh , Mao Diane , Sinha Namita , Dahiya Sonika , Petti Allegra , Klish Tiemo , Harmanci Akdes , Patel Akash J. , Kim Albert H.
Published: March 2024

INTRODUCTION:

Grade 2 meningiomas (G2Ms) are associated with an aggressive natural history characterized by recurrence and resistance to radiation therapy. Histopathological necrosis is associated with worse progression-free survival (PFS) following radiation therapy in G2Ms. We seek to understand the molecular pathophysiology of radiation resistance and to identify molecular biomarkers and therapeutic targets for radioresistant G2M.

METHODS:

We performed genetic sequencing and histopathological analysis of 121 G2Ms. Using the IOMM-Lee meningioma cell line, we investigated the role of tumor hypoxia and genes of interest in radio-resistance through lentivirally targeted gene knockdown and clonogenic survival assays following exposure to ionizing radiation. Transcriptional profiling of cells in in vitro and in 38 patient G2Ms was performed using RNA sequencing.

RESULTS:

NF2 loss of function mutations were significantly associated with tumor necrosis in G2Ms (p = 0.0026). Patients with NF2mutation and spontaneous necrosis had worse post-radiation PFS compared to NF2 wildtype patients without necrosis (p = 0.035). In the setting of hypoxia, NF2 knockdown significantly increased radio-resistance in vitro (p < 0.001). Gene set enrichment analysis on in vivo and in vitro data and functional assays revealed downregulation of apoptosis and upregulation of cell proliferation in NF2-deficient and necrotic group compared to control. Integration of differentially expressed genes in both NF2-deficient cells in vitro and human necrotic tumors identified shared upregulation of HES1, XDH, NOG, IGFBP3, ALOXE3, THSB1, and TRIML2, suggesting these genes may represent targets for radio-sensitization or biomarkers of radio-resistance.

CONCLUSIONS:

NF2 loss-of-function in the setting of hypoxia confers radiation resistance through a transcriptional program that promotes proliferation and DNA repair. Targeting molecular pathways identified by transcriptional profiling may improve local control in patients with radioresistant G2M.
312 Mechanical Thrombectomy With or Without Intravenous Thrombolysis for Acute Ischemic Stroke Due to Distal and Medium Vessel Occlusions: A Propensity Score Matching of Patients From 41 Academic Centers
Authors: Ghozy Sherief , Dmytriw Adam Andrew , Guenego Adrien , Lubicz Boris , Costalat Vincent , Kadirvel Ramanathan
Published: March 2024

INTRODUCTION:

To date, studies evaluating mechanical thrombectomy (MT) in distal and medium vessel occlusions (DMVOs) have failed to establish conclusive, high-quality evidence for its clinical benefit.

METHODS:

Between January 2017 and January 2022, characteristics and outcomes of patients with DMVOs treated with MT or MT + IVtPA were collected at 41 academic centers in North America, Asia, and Europe. Using R software version 4.2.3, propensity score matching using the nearest neighbor matching by controlling for all relevant variables, followed by appropriate descriptive statistics and multivariate logistic regression.

RESULTS:

After propensity score matching, all differences between groups were resolved, and there was a total of 577 patients included (315 MT alone and 262 MT +IVT). Patients treated with MT + IVT achieved greater rates of TICI 2b-3 (OR = 1.79, 95% CI = 1.02-3.15; P-value= 0.043) than those treated with MT alone, and the rate of modified Rankin score (mRS) 0-2 was greater in the MT + IVT group (n = 171, 65.3%) compared to the MT alone (n = 181, 57.5%) group (OR = 1.52, 95% CI= 1.03-2.24; p-value = 0.034). Sixty-nine patients experienced 90-day mortality, and the rate was comparable between the MT + IVtPA group (n = 30, 11.5%) and the MT alone (n = 39, 12.4%) group (OR = 0.9, 95% CI = 0.53-1.54; p-value = 0.71). Of note, the rate of intracranial hemorrhage (all types) was similar between the MT + IVtPA and MT alone group (OR = 0.85, 95% CI = 0.58-1.26; p-value = 0.43).

CONCLUSIONS:

MT + IVT showed higher efficacy than MT alone in patients with DMVOs, without higher risks.
316 Acute Ischemic Stroke Presentation Labs and Imaging Can Be Used to Model Thrombus Proteomic Composition
Authors: Akkipeddi Sajal Medha , Rahmani Redi , Ellens Nathaniel R. , Kohli Gurkirat S. , Houk Clifton , Schartz Derrek , Chittaranjan Siddharth , Jalal Muhammad Ibrahim , Haber Sam Jacob , Bhalla Tarun , Mattingly Thomas , Morrell Craig , Bender Matthew T.
Published: March 2024

INTRODUCTION:

The literature points to a strong relationship between the composition of acute ischemic stroke thrombi and their susceptibility to thrombolytic or endovascular treatment. Composition can be determined by molecular studies of the clot itself, but there is tremendous utility in being able to predict clot composition solely on data available at patient presentation.

METHODS:

Quantitative proteomes were generated using mass spectrometry of thromboembolic material retrieved by thrombectomy from 59 stroke patients. Of the 2,790 total identified proteins, marker proteins were selected to identify broad groups of thrombus components: RBCs (12 proteins), platelets (9 proteins), histones (23 proteins) and neutrophils (13 proteins). Dimensional reduction of marker proteins was done by principal component (PC) analysis for each group. A broad survey of demographic, lab, and radiographic data was gathered by retrospective chart review. Regression analysis was used to identify the combination of the four variables on chart review that most strongly associated with the PCs for each thrombus component group.

RESULTS:

After dimensional reduction, a significant amount of the variance in marker protein abundance for each group was represented by the first PC for each group (R2 > 0.94 for all). It was possible to generate linear models representing the PC associated with RBCs (R2 = 0.37, p = 0.02), platelets (R2 = 0.40, p = 0.0004), histones (R2 = 0.52 and p = 0.001), and neutrophils (R2 = 0.81, p = 1E-12) using combinations of four data points at presentation.

CONCLUSIONS:

This preliminary work suggests that the abundance of clot components may be predicted by modeling patient data available at presentation, which has the potential to drive future choice of therapy. Next steps include refining and validating the models on a prospectively maintained stroke database at our home institution.
319 A Case Series of Direct Multi-territory Cerebral Revascularizations Using a Three-Vessel Anastomosis
Authors: Rennert Robert , Atai Nadia A. , Nguyen Vincent , Abedi Aidin , Sternbach Sarah , Chu Jason , Carey Joseph , Russin Jonathan
Published: March 2024

INTRODUCTION:

The ability to perform simultaneous, multi-territory cerebral bypass using a single interposition graft has significant utility for the revascularization of multiple cerebral territories that would otherwise require multiple constructs, serial anastomoses, or a combination of direct and indirect approaches.

METHODS:

Peri-operative data and outcomes were collected retrospectively for patients undergoing multi-territory cerebral revascularization using a three-vessel anastomosis over a 4-year period (2019-2023).

RESULTS:

Five patients underwent triple vessel bypass (median age 53 years [range 12-73]). Three patients with complex middle cerebral artery (MCA) aneurysms (one ruptured) were treated multi-territory external carotid artery (ECA)-M2-M2 revascularization using a saphenous vein interposition graft, followed by either proximal ligation or partial/complete aneurysm clip trapping. Two patients with predominately bilateral anterior cerebral artery (ACA) territory moyamoya disease were treated with proximal superficial temporal artery (STA)-A3-A3 revascularization using a radial artery or radial artery fascial flow-through free flap (RAFF) graft. Bypass patency was 100% and zero patients experienced surgery-related ischemia. One patient had new strokes from vasospasm after subarachnoid hemorrhage. One patient required a revision surgery for a post-operative hematoma and RAFF debridement that did not affect bypass patency or neurologic outcome. Median Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS) scores on discharge were 4 (range 3-5) and 2 (range 0-5), respectively. GOS and mRS scores were stable or improved on follow up in 4/5 patients; one patient died from medical complications of their original stroke.

CONCLUSIONS:

In experienced hands, three-vessel anastomosis can be a viable option for the safe, simultaneous revascularization of multiple ACA and MCA territories.
323 Meaningful Work, Organizational Commitment, and Administrative Burden Among Attending Neurosurgeons: A National Survey
Authors: Mackel Charles E. , Alterman Ron L. , Sweet Jennifer A. , Williamson Theresa , Stippler Martina
Published: March 2024

INTRODUCTION:

“Meaningful work” is a complex, subjective concept that includes finding positive, personal meaning in work and its contribution to the larger good. Increasing administrative burdens likely represent significant barriers to the practice of meaningful work. The relationship between meaningful work and administrative burden and impact on organizational commitment have not been systematically studied among neurosurgeons.

METHODS:

An online questionnaire investigating meaningfulness of work, administrative burden, burnout, and practice patterns was emailed to attending neurosurgeon members of the Congress of Neurological Surgeons.

RESULTS:

308 US-based neurosurgeons participated in the survey. The majority (85.1%) found neurosurgery a meaningful career but 59.4% thought their administrative burden was excessive. Only 16.6% of neurosurgeons believed their organization cared about administrative burden with only 31.6% of neurosurgeons feeling any loyalty to their current organization. Unreasonable administrative burden prompted 17.2% of neurosurgeons to leave a recent position and 24.5% to consider leaving a current position. Neurosurgeons considering leaving had significantly lower scores in meaningful work (p < 0.0001); however, having left a previous position due to administrative burden did not impair future meaningful work experiences (p = 0.14). On multivariable regression, increasing administrative tasks increased burnout (p < 0.05); increasing burnout reduced meaningful work experience (p < 0.001).

CONCLUSIONS:

We demonstrate that most neurosurgeons believe their work to be meaningful but do not feel a strong normative commitment to their place of employment. Increased administrative burden risks burnout, undermines meaningful work, and led 17% of neurosurgeons to leave a recent position with another 24.5% contemplating leaving a current position.
324 How Much Money Do You Actually Save Your Hospital When You Choose a Posterior Foraminotomy Instead of an ACDF for Cervical Radiculopathy?
Authors: Ali Daniyal Mansoor , Thalheimer Sara , Tecce Eric , August Ari , O'Leary; Shreya Mandloi Matthew , Sarikonda Advith , Harrop James S. , Vaccaro Alexander R. , Jallo Jack , Prasad Srinivas K. , Heller Joshua E. , Sivaganesan Ahilan
Published: March 2024

INTRODUCTION:

To our knowledge, a comparison of the true intraoperative costs of anterior cervical fusion (ACDF) vs. posterior cervical foraminotomy (PCF) has never been done.

METHODS:

Total cost was divided into direct and indirect costs. Individual costs were obtained by direct observation, electronic medical records, and through querying multiple departments. Timestamps for personnel and material resources were documented. Total intraoperative costs were estimated for all single-level ACDFs and PCFs from 2017 to 2022. Regression analyses were performed to identify factors associated with total cost.

RESULTS:

A total of 256 and 32 patients underwent single-level ACDFs and PCF for cervical radiculopathy, respectively. The average total intraoperative cost for ACDFs was $7,574 ± $3,175 versus $3,062 ± $547 for PCF. For ACDFs, supply cost (69% for ACDFs vs. 33% for PCF) was the major contributor, while personnel cost (67% for PCF vs. 31% for ACDFs) constituted most of the cost incurred during PCFs. Supply cost, particularly implant cost ($3,818 ± $2,316), appeared to influence cost variability in ACDFs, while personnel cost ($2,051 ± $419) seemingly explained cost variability in PCFs. On linear regression analysis, ACDFs (β coefficient: $4,685 ± $575, p < 0.001), males (p = 0.03), and patients with commercial insurance (p = 0.01) had significantly higher total costs when controlled for age, comorbidities, and smoking status.

CONCLUSIONS:

TDABC is a feasible methodology for estimating differences in true intraoperative costs between ACDFs and PCFs for cervical radiculopathy. The major cost contributors were supply and personnel costs. Implant cost appeared to influence total cost variability in ACDFs, while personnel costs seemingly explained cost variability among PCFs. ACDFs were associated with an additional $4,685 ± $575 of total intraoperative cost as compared to PCFs. Males and patients with commercial insurance were also associated with significantly higher total costs.
328 Medicaid Fee-for-Service Is an Independent Predictor of Increased Hospital Length of Stay After Traumatic Brain Injury
Authors: Yue John K. , Toretsky Christopher , Krishnan Nishanth , Makam Anil , DiGiorgio Anthony Michael
Published: March 2024

INTRODUCTION:

Hospital length of stay (HLOS) is a metric of injury severity, resource utilization, and healthcare access. Recent evidence has shown associations between Medicaid and increased HLOS after traumatic brain injury (TBI). Whether managed care organization (Medicaid-MCO) or fee-for-service (Medicaid-FFS) models affect HLOS is unknown.

METHODS:

The Department of Health Care Access and Information Patient Discharge Database years 2017-2019 were queried for TBI patients aged =18-years (y) using ICD-10 codes (S06.0-S06.9/A). Inclusion criteria were Medicaid-MCO/Medicaid-FFS or PI not designated as death/hospice within 5-days of hospitalization. Demographic, socioeconomic status (SES), care-related, charges, and HLOS variables were compared. Subgroup analyses were performed in severe TBI (intracranial pressure monitor/craniotomy = Yes). Multivariable negative binomial regressions assessed the relationship between insurance and HLOS, adjusting for demographic, SES, injury severity, diagnosis-related group, and major complication/comorbidity. Incidence rate ratios (IRR) were reported.

RESULTS:

Overall (N = 39,834), 33.2% were Medicaid-MCO, Medicaid-FFS = 24.2%, and PI = 42.6%. Significant differences (p < 0.001) were observed for age (MCO = median 45y, FFS = 37y, PI = 44y), sex (male: MCO = 70.8%, FFS = 80.1%, PI = 68.8%), race (Hispanic: MCO = 35.0%, FFS = 51.6%, PI = 24.6%), lowest-quintile SES (MCO = 33.1%, FFS = 31.9%, PI = 9.0%), discharge to home (MCO = 72.1%, FFS = 76.8%, PI = 68.5%), and charges (MCO = median $100,297, FFS = $120,062, PI = $91,863). HLOS was longest in FFS (median = 4-days [IQR: 2-11], MCO = 4-days [2-9], PI = 3-days [1-7]). These differences were conserved in severe TBI (N = 1,650; MCO = 32.8%, FFS = 31.8%, PI = 35.3%) at greater magnitudes (home discharge: MCO = 15.5%, FFS = 25.6%, PI = 8.2%; charges: MCO = $629,625, FFS = $724,225, PI = $607,082; HLOS: MCO = 22-days [IQR: 13-34], FFS = 26-days [14-44], PI = 17-days [10-27]). On multivariable regression, Medicaid-FFS and MCO had significantly longer HLOS compared with PI in all TBI (IRR = 1.44 [95% CI: 1.41-1.48], IRR = 1.17 [1.15-1.20], respectively) and severe TBI (IRR = 1.52 (1.40-1.65), IRR = 1.25 [1.15-1.36], respectively).

CONCLUSIONS:

Medicaid-FFS had the highest likelihood of increased HLOS. Medicaid-MCO appeared to be a distinct risk stratum with shorter HLOS and lower hospital charges than Medicaid-FFS. Reasons may include different efficacies in care delivery and reimbursement, and require further investigation.
330 Accuracy and Clinical Significance of Neurosurgical Patient Safety Indicator Events Reported by Centers for Medicare Services
Authors: Benveniste Ronald Jay , Basil Gregory , Atallah Hany
Published: March 2024

INTRODUCTION:

Data on patient safety indicator (PSI) events are used by Center for Medicare Services (CMS) for determining reimbursement to hospitals, and public quality reporting. It is unclear whether the process used by CMS to detect PSI events is accurate, and whether PSI events affect clinical outcomes in neurosurgical patients.

METHODS:

We reviewed CMS reported PSI events in neurosurgical patients at our hospital from July 1, 2018, through December 31, 2019. Discharge billing codes were reviewed in order to assess whether CMS criteria for PSI were met. Charts were reviewed by experienced clinicians in order to assess the accuracy and clinical significance of CMS reported PSI events. For deep venous thrombosis/pulmonary embolism (DVT/PE) PSI events, chart reviews were performed in order to assess whether standard of care prophylaxis was administered.

RESULTS:

14 PSI events were reported in 11 patients, representing 1.3% of neurosurgical procedures in fee for service medicare patients. 7 patients underwent spinal surgery and 4 underwent cranial surgery. PSI events included DVT/PE (n = 6), postoperative hematoma (n = 2), postoperative respiratory failure (n = 5), and iatrogenic pneumothorax (n = 1). Only 10/14 PSI events (71%) met CMS criteria based on discharge billing codes, and only 8/14 PSI events (57%) met CMS criteria based on chart review. All PSI events that were confirmed based on chart review required specific medical or surgical treatment, but only 5 (63%) led to increased length of stay, and no patients had residual adverse effects at hospital discharge. 5/6 patients with chart confirmed DVT/PE (83%) received standard of care DVT prophylaxis.

CONCLUSIONS:

CMS-reported PSI events have significant rates of inaccuracy. PSI events may not correlate with meaningful adverse clinical outcomes. DVT/PE PSI events were not associated with breaches in standard of care.
331 Trends in Public and Private Funding of Neurosurgical Subspecialties From 2015 to 2021
Authors: Shah Varunil Nilesh , Das Nikita , Shah Aakash , Kelly Michael L.
Published: March 2024

INTRODUCTION:

The Centers for Medicare and Medicaid Services established the Open Payments Database (OPD), designed to track all general and research payments made by corporations to physicians, to promote greater financial transparency. While previous studies have analyzed general payments using the OPD database, there has been no investigation into public vs. private research payments related to neurosurgery from 2015 to 2021.

METHODS:

A cross-sectional analysis of the OPD and NIH RePORTER was conducted from 2015 to 2021 for research payments to neurosurgeons and payments tagged with the keyword “neurosurgery.” The data was cleaned; the primary investigators were subclassified according to the neurosurgical subspecialty of their research, and descriptive statistics were computed for payments at the provider and manufacturer levels.

RESULTS:

The total public and private funding for neurosurgery from 2015 to 2021 was $1,008,953,855.00 and $171,326,087.05, respectively. Public funding has a compound annual growth rate (CAGR) of 5.37%, and private funding has a CAGR of 7.46%. Neurovascular was the highest privately funded subspecialty at 26.2%, and neuro-oncology was the highest publicly funded subspecialty at 32.1%.

CONCLUSIONS:

We found significant growth in neurosurgery funding in the private and public sectors from 2015 to 2021. Private funding emphasizes neurovascular research the most and neurosurgical pediatric research the least, whereas public funding focuses on neuro-oncology research, with the least funding for neurosurgical spine research. These findings offer valuable insights into funding trends and characteristics in neurological research, highlighting the differences between funding sources and promoting equitable distribution to advance the field.
334 Resident Salary Compared to Living Wages at US Training Institutions
Authors: Liles Campbell , Tang Alan Ruigang , Petrovic Mark , Dambrino Robert J. , Thompson Reid C. , Chambless Lola Blackwell
Published: March 2024

INTRODUCTION:

Resident physician salaries vary by region, though it is unknown how these variations compare to differences in living wages across the United States or what factors drive residency salary discrepancies.

METHODS:

Publicly available resident salary information was obtained from full-service training centers containing a neurosurgical residency program via institution-specific websites in February 2023 with information on post-graduate year (PGY)-1 through PGY-7 resident compensation for 2022-2023. Living wage calculations by city were generated via the Massachusetts Institute of Technology (MIT) Living-Wage Calculator. Resident salary to living-wage ratios were calculated using PGY-4 salary for each family composition living-wage. Univariate and multivariable analysis of PGY-4 resident salary on affordability was performed, accounting for proportion of expected living wages to taxes, transportation, housing, medical costs, childcare, and food as well as unionization and state income-tax status.

RESULTS:

118 neurosurgery residency programs were included, 21 (17.9%) of which were unionized. Residents without children earned a salary greater than living-wage during all years, while single-parent families were unable to earn a living-wage until PGY-7. Residents with 1 child in in 2-adult (single-income) and 2-adult (double-income) families were unable to earn a living-wage until PGY-5 and PGY-3 respectively. Residents with more than 1 child failed to earn a living-wage. Multivariate regression analysis using PGY-4 salary:living-wage ratios in single-child, 2-parent homes showed food expenses and unionization status were always significant. On multivariate regression, unionization was significantly associated with lower living-wage ratios pre-stipend, improved post-stipend, and was again significantly lower after factoring in union dues.

CONCLUSIONS:

Current resident salaries often preclude a resident from earning a living-wage, especially among junior residents and those with children. Unionization is significantly associated with lower resident income to living-wage ratios.
337 Bridging the Literacy Gap for Surgical Consents: An AI-Human Expert Collaborative Approach
Authors: Ali Rohaid , Connolly Ian David , Tang Oliver Young , Mirza Fatima , Johnston Benjamin , Abdulrazeq Hael , Galamaga Paul , Libby Tiffany , Sodha Neel , Groff Michael W. , Gokaslan Ziya L. , Telfeian Albert Edward , Shin John H. , Asaad Wael , Zou James , Doberstein Curtis E.
Published: March 2024

INTRODUCTION:

Despite the importance of informed consent in healthcare, the readability and specificity of consent forms often impedes patients’ comprehension. Health literacy is linked to patient outcomes, making it essential to address these issues.

METHODS:

Consent forms from multiple institutions were assessed for readability and simplified using GPT-4, with pre- and post-simplification readability metrics compared using nonparametric tests. Independent reviews by medical authors and a malpractice defense attorney were conducted. Finally, GPT-4's potential for generating de novo procedure-specific consent forms was assessed, with forms evaluated using a validated 8-item rubric and expert subspecialty surgeon review.

RESULTS:

Analysis of 15 academic medical centers' consent forms revealed significant reductions in average reading time, word rarity, and passive sentence frequency (all P < 0.05) following GPT-4-faciliated simplification. Readability improved from an average college freshman to an 8th-grade level (P = 0.004), matching the average American's reading level. Medical and legal sufficiency consistency was confirmed. GPT-4 generated procedure-specific consent forms for five varied surgical procedures at an average 6th-grade reading level. These forms received perfect scores on a standardized consent form rubric and withstood scrutiny upon expert subspeciality surgeon review.

CONCLUSIONS:

This study demonstrates the first AI-human expert collaboration to enhance surgical consent forms, significantly improving readability without sacrificing clinical detail. Moreover, the framework we utilize here can be employed broadly to improve the accessibility of all patient-facing literature in medicine, emphasizing clear communication and mitigating disparities related to health literacy barriers. Ensuring AI technologies are safely incorporated into clinical practice is crucial to reach a wide range of patients, including the most vulnerable.
343 Regional Variability in the Management of Aneurysmal Subarachnoid Hemorrhage for Black Patients: An Analysis of Treatment Patterns, Outcomes, and End-of-life Care.
Authors: Kabangu Jean-Luc , Bhargav Adip Guruprasad , Fry Lane , Masri Ahmad , Heskett Cody , Bah Momodou G. , Peterson Jermey , Ebersole Koji C. , Eden Sonia Veronica , Camarata Paul J.
Published: March 2024

INTRODUCTION:

Disparities in the care of Black Americans with aneurysmal subarachnoid hemorrhage (aSAH) have been described. However, regional variations for Black patients with aSAH have yet to be delineated, particularly in end-of-life care.

METHODS:

We analyzed aSAH data from the Nationwide Inpatient Sample (NIS) from 2016-2020. Controlling for covariates, multivariate logistic regression models were used to assess U.S. Census region differences between Black and White patients in treatment, adverse outcomes, mortality, use of palliative care as well as do not resuscitate (DNR) and of life-sustaining interventions (mechanical ventilation, tracheostomy, gastrostomy, blood transfusion).

RESULTS:

Black patients in the East-North Central (ENC) division were less likely to have inpatient morality following aSAH (OR 0.68, 95% CI 055 – 0.83, p <0.001), yet more likely to have tracheostomy (OR 1.83, 95% CI 1.39 - 2.49, p < 0.001) and gastrostomy (OR 1.66, 95% CI 1.31 - 2.11, p < 0.001) tube placement than the national average. Furthermore, Black patients in the ENC were less likely to have palliative care (OR 0.42, 95% CI 0.22 - 0.80, p = 0.008) This trend continued in the West South-Central (WSC) division for tracheostomy (OR 1.86, 95% CI 1.29 - 2.66, p = 0.001), gastrostomy (OR 1.95, 95% CI 1.44 - 2.63, p < 0.001), and palliative care (OR .67, 95% CI 0.51 - 0.87, p = 0.003).

CONCLUSIONS:

Geographic variations exist in the treatment of Black patients with aSAH. Nationally and regionally Black patients have lower mortality rates than White patients, due in part to disparities in end-of-life care. Black patients receive more life-sustaining interventions, and less palliative care and DNR; this is most evident in the ENC and WSC regions. Paradoxically, regions with more Black residents fare worse.
344 The World Neurosurgery Global Champions Program: First-year Experience of a Model Initiative for Reducing Disparities in Global Neurosurgical Literature
Authors: Shlobin Nathan A. , Savage Simon , Savage Alexander , Torbati Tania , Wang Zhe , Salas-Vega Sebastian , Mota Marcella , Pando Alejandro , Sheldon Breanna , Westrup Alison Megan , Ogulnick Jonathan , Zreik Jad , Alkahtani Nada Ayedh , Jesuyajolu Damilola , Larrey Kasereka Kamabu , Fadalla Tarig , Mahajan Uma V. , Manjila Nihal , Singh Rohin , Wang Andrew , Kanmounye Ulrick Sidney , Moore Christine , Benzel Edward C. , Rosseau Gail Linskey
Published: March 2024

INTRODUCTION:

Most surgical journals are published in English, representing a challenge for individuals from non-Anglophone countries and contributing to disparities in research globally.

METHODS:

The GCP was advertised via the journal website and social media. Applicants were selected to be a reviewer for the GCP if they demonstrated English proficiency. Authors received information about the program if their article was rejected on the basis of poor English language. The workflow is shown.The demographics of GCP members and characteristics and outcomes of articles edited by the GCP during its first year were reviewed. Surveys of GCP members and authors who used the service were conducted.

RESULTS:

Twenty-one individuals became part of the GCP, representing 8 countries and 16 languages apart from English. A total of 380 manuscripts were peer-reviewed and a final decision given by the editor-in-chief to have potentially worthwhile content but rejected due to poor language. The authors of these manuscripts were informed of the existence of this language assistance program. Forty-nine articles (12.9%) were edited by the GCP in 41.6 ± 22.8 days. Of 40 articles resubmitted to World Neurosurgery, 24 (60.0%) were accepted. GCP members and authors understood the purpose and workflow of the program and recognized improvements in article quality and the probability of acceptance through their participation.

CONCLUSIONS:

The World Neurosurgery Global Champions Program mitigated a critical barrier to publication in an English language journal for authors from non-Anglophone countries and promoted research equity by providing a free, largely medical student and trainee operated, English language editing service. This model or a similar service can be replicated by other journals.
346 Durable Responses at 24 Months With High-Frequency Spinal Cord Stimulation for Nonsurgical Refractory Back Pain
Authors: Patel Naresh P. , Kapural Leonardo , Jameson Jessica , Johnson Curtis , Kloster Dan , Calodney Aaron K. , Kosek Peter , Pilitsis Julie G. , Bendel Markus A. , Petersen Erika A. , Wu Chengyuan , Cherry Taissa , Lad Nandan P. , Yu Cong , Sayed Dawood , Province-Azalde Rose
Published: March 2024

INTRODUCTION:

Chronic refractory back pain causes significant disability and is one of the most common reasons for patients seeking health care. Few treatment options exist for chronic back pain patients who have failed conventional medical management (CMM) and who have not had and are not candidates for spine surgery, a condition we refer to as non-surgical refractory back pain (NSRBP).

METHODS:

Patients with NSRBP were evaluated after 1:1 randomization to 10kHz SCS plus CMM or CMM alone. Primary endpoint and secondary endpoints were assessed, and optional crossover was allowed at 6 months, with observational follow-up over 12 months (Kapural, 2022). All patients treated with 10kHz SCS were eligible for follow-up through 24 months after implantation. Outcomes included pain, Oswestry Disability Index (ODI), quality-of-life (EQ-5D-5L), 3-item Pain Sleep Questionnaire (PSQ-3), opioid use, patient’s global impression of change (PGIC), and safety.

RESULTS:

Of the 125 patients who received a permanent implant, 121 completed 12-month follow-up, 101 reconsented for extended follow-up, and 98 completed 24-month follow-up. At 24 months after implantation 82% achieved =50% pain relief. All outcome measures improved by at least double the minimal clinically important difference. Ninety-percent of patients met at least one of the multidimensional outcomes. Of those who reported opioid use during the study, and 62% of decreased or stopped. Through 24 months, 3 of 125 (2.4%) devices were explanted due to patient dissatisfaction with SCS therapy.

CONCLUSIONS:

The addition of 10kHz SCS to CMM in patients with NSRBP offers profound improvements at 24 months in pain, function, quality-of-life, and reduced opioid use. This study provides much-needed evidence to inform current clinical practice for managing patients with NSRBP.