bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.