Abstract:
OBJECTIVE:The Medicaid patient population and health care costs for spine surgeries among these patients have increased since 2010. Hospital length of stay (LOS) contributes appreciably to hospital costs for patients undergoing primary lumbar spine surgery (PLSS). The aim of this study was to identify independent risk factors for increased LOS in patients undergoing PLSS. PATIENTS AND METHODS:In a single-center retrospective study, we reviewed demographic and clinical data from electronic medical records for 181 consecutive adult patients who underwent PLSS involving 1-3 levels from July 2014 to July 2017. We performed regression analyses to identify independent risk factors for increased LOS and to quantify their effects as percent changes in LOS. RESULTS:Among 181 patients who underwent PLSS, the mean LOS was 3.57 days. Based on the Charlson Comorbidity Index (CCI) and American Society of Anesthesiologist (ASA) classification, patients with Medicaid insurance were healthier than non-Medicaid patients (mean CCI: 0.34 versus 0.65; p = 0.041, ASA: 1.71 versus 1.91; p = 0.046) yet Medicaid patients had a longer LOS compared with non-Medicaid patients (mean LOS: 4.03 versus 3.30 days; p = 0.047). There was no significant difference in discharge disposition between Medicaid and non-Medicaid patients (Home = 82.35 % versus 79.65 %; p = 0.855). Medicaid patients also had significantly less spinal levels involved in their surgery (1.44 versus 1.67; p = 0.027). Multivariable regression modeling identified independent risk factors positively associated with increased LOS as age (+1.0 % per year; p = 0.007), Medicaid insurance status (+28.7 %; p = 0.007), and CCI (10.1 % per increment in CCI; p = 0.030). Fusion surgery also was an independent risk factor for increased LOS when compared with laminectomy (-54.1 %; p < 0.001) or discectomy (-51.3 %; p < 0.001). CONCLUSIONS:Increasing age, Medicaid insurance status, higher CCI, and fusion surgery were independently associated with increased LOS after PLSS. This information is useful for preoperative patient counseling, shared decision-making, and risk stratification and may help to further ongoing discussion regarding contributors to rising health care costs. Findings of increased LOS among Medicaid patients will help direct efforts to identify factors that contribute to this health care expense.
journal_name
Clin Neurol Neurosurgjournal_title
Clinical neurology and neurosurgeryauthors
Dominguez JF,Kalakoti P,Chen X,Yao K,Lee NK,Shah S,Schmidt M,Cole C,Gandhi C,Al-Mufti F,Bowers CAdoi
10.1016/j.clineuro.2019.105570subject
Has Abstractpub_date
2020-01-01 00:00:00pages
105570eissn
0303-8467issn
1872-6968pii
S0303-8467(19)30366-Xjournal_volume
188pub_type
杂志文章abstract:AIMS:We performed a retrospective non-randomized study to analyze the results of microsurgery of acoustic neuromas (AN) using two different flexible hand-held laser fibers, CO2 (Omniguide(®)) and 2μ-Thulium (Revolix jr(®)). METHODS:From September 2010 to June 2015, 84 patients suffering from AN have been operated on w...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2016.03.019
更新日期:2016-06-01 00:00:00
abstract::Both migraine and vertigo are common complaints. Although they may coincide by chance, there is growing evidence for a clinical entity of recurrent vestibular symptoms related to migraine. This syndrome implies a possible causal relationship although the pathophysiology of migraine-related vertigo has not been fully e...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.clineuro.2004.07.003
更新日期:2005-02-01 00:00:00
abstract::Behcet's disease (BD) is a rare condition, more commonly seen in Turkey, the Middle East, the Mediterranean, and the Far Eastern countries. It is a multifaced disease involving the central nervous system (CNS), skin, joints, intestines and blood vessels. CNS involvement occurs in 10-25% of the patients with BD. We rep...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.clineuro.2004.07.002
更新日期:2005-06-01 00:00:00
abstract:OBJECTIVE:To describe the patient's self assessed health related quality of life (saHRQoL) based upon the medical outcome study 36-item short form health survey (SF-36) as well as the factors of influence upon the saHRQoL following surgery for petroclival (PCM) and lateral posterior surface of the pyramid (LPPM) mening...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2018.01.016
更新日期:2018-03-01 00:00:00
abstract::Recurrent aseptic meningitis in a 35-year-old caucasian woman is described. She had many attacks over a period of 9 years. The first attack occurred after travel in the tropics. In spite of extensive examinations no cause could be found for the recurrent attacks. Both the clinical presentation and characteristics of t...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/s0303-8467(00)00074-3
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVES:To evaluate the efficacy and safety of pre-operative Halo-gravity traction in the treatment of severe neurofibromatosis type 1 and congenital scoliosis patients with thoracic rotatory subluxation. PATIENTS AND METHODS:Patients with neurofibromatosis type 1 and congenital scoliosis undergoing Halo-gravity tr...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2019.105548
更新日期:2019-12-01 00:00:00
abstract::The present series of 655 brachial plexus lesions includes 240 obstetric palsies. The results of neurophysiological and radiological examinations in these cases are often disappointing in regard to the evaluation of the severity of the lesion. Timing for surgery was according to the criterium of Gilbert: lack of clini...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/0303-8467(93)90039-j
更新日期:1993-01-01 00:00:00
abstract::A man was kicked on the neck, 10 days after which he noted right-sided numbness. Clinically, he had diminished deep tendon reflexes over the left upper limb, absent left superficial abdominal reflexes, a left extensor plantar response, mild left hemiparesis, diminished pinprick, temperature and vibratory sensation up ...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/s0303-8467(03)00009-x
更新日期:2003-04-01 00:00:00
abstract:OBJECTIVES:Stroke is an important public health problem in most countries. Therefore, the treatment of stroke and its complications is important. Intracerebral hemorrhage is one of the complications of ischemic stroke. This study aimed to investigate the risk of hemorrhage in patients with acute ischemic stroke and pro...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2018.03.007
更新日期:2018-05-01 00:00:00
abstract::An apparently innocuous complaint such as a numb chin may be associated with malignant disease, either as heralding symptom or as a manifestation of metastasis. A series of 15 patients with numbness of the chin is presented in which a malignancy was diagnosed prior to the numbness. The numbness diminished or disappear...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/s0303-8467(05)80001-0
更新日期:1991-01-01 00:00:00
abstract:OBJECTIVE:The objective of this study is to investigate the application of transcranial magnetic stimulation combined with neuronavigation for preoperative mapping of the language area in neurosurgical interventions on the opercular area of the dominant hemisphere. METHODS:Five patients were operated upon gliomas in t...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2010.05.005
更新日期:2010-10-01 00:00:00
abstract:OBJECTIVES:We sought to concurrently examine the specific motor, cognitive and affective contributions to self-reported FOG symptoms. PATIENTS AND METHODS:Ninety-six patients with Parkinson's disease completed the validated freezing of gait questionnaire and had their motor function scored on section three of the Unif...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2012.06.027
更新日期:2013-05-01 00:00:00
abstract:BACKGROUND:Seizures occur more frequently in patients with an intracerebral haematoma (ICH) than in those with a cerebral infarct. However, the risk factors for seizures in association with an ICH are less well known. PURPOSE:The characteristics of medically treated patients with spontaneous ICHs, who developed seizur...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2007.04.001
更新日期:2007-07-01 00:00:00
abstract::Tic disorders are commonly considered to be childhood syndromes. Newly presenting tic disorders during adulthood are uncommon and mostly described in relation to an acquired brain lesion or as incidental tics, particularly in context with other neurological or psychiatric diseases. Tic disorder involving the ears is e...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2008.11.014
更新日期:2009-04-01 00:00:00
abstract:OBJECTIVE:Perfusion studies are increasingly used to triage acute stroke patients for endovascular recanalization therapies. We compare the safety and efficacy of CT perfusion (CTP)-guided to time-guided mechanical recanalization in acute ischemic stroke (AIS) patients. METHODS:A review was conducted on 132 patients, ...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2013.09.036
更新日期:2013-12-01 00:00:00
abstract::For the first time, Kluver Bucy syndrome (KBS) is described in young children who had no environmental learning of sex. The syndrome has so far been noted only in adults after bilateral temporal lobe affection. A few of its components, especially the hypersexuality and hypermetamorphosis, are likely to manifest differ...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/s0303-8467(98)00055-9
更新日期:1998-12-01 00:00:00
abstract:OBJECTIVE:The ultrasonography findings in the superficial temporal artery (STA) in Moyamoya disease patients treated with indirect bypass remain unclear. We evaluated the time-related changes in ultrasonography findings of the STA main trunk and branches in patients with Moyamoya disease who underwent encephalo-duro-ar...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2017.06.013
更新日期:2017-09-01 00:00:00
abstract:OBJECTIVE:Lumbar spinal stenosis (LSS) in octogenarians and beyond has a significant impact on quality of life requiring surgical decompression and hence impact on health care utilization. Risk of surgical failure and impact on health care resources is always a concern in this patient population (more so in nonagenaria...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2019.04.031
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVE:Digital subtraction angiography is the gold standard for diagnosis of vascular pathology. The value of angiography of non-target vessels following mechanical thrombectomy for the treatment of acute ischemic stroke (AIS) is unknown. PATIENTS AND METHODS:Consecutive patients treated with mechanical thrombectom...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2020.105842
更新日期:2020-07-01 00:00:00
abstract:OBJECTIVES:Although multiple intracranial aneurysms (MIAs) are frequent and disastrous, determining treatment strategy for them is often complicated, especially in elderly patients (≥60 years old). We evaluated the safety and effectiveness of one-stage coiling versus surgical clipping for MIAs in elderly patients. MET...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2020.106415
更新日期:2020-12-05 00:00:00
abstract::Intracranial meningiomas such as olfactory groove meningioma (OGM) and tuberculum sellae meningioma (TSM) arising at the anterior skull base are amenable to surgical resection. Traditionally, this has been achieved by transcranial approaches (TCAs), however, there has been an evolution in an endoscopic endonasal appro...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章,meta分析
doi:10.1016/j.clineuro.2018.08.029
更新日期:2018-11-01 00:00:00
abstract::SPECT with Tc-99m HM-PAO as a radiopharmaceutical was performed in 17 patients meeting research criteria for Alzheimer's disease (AD), in 10 patients with a clinical diagnosis of multi-infarct-dementia (MID) and in 12 healthy volunteers. Regional tracer uptake was measured in frontal, parietal, and temporoparietal reg...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/0303-8467(91)90007-c
更新日期:1991-01-01 00:00:00
abstract:PURPOSE:Central neurocytoma is a rare intraventricular brain tumor that affects young adults and presents with increased intracranial pressure secondary to obstructive hydrocephalus. Typically, it has a favorable prognosis after adequate surgical intervention, but in some cases the clinical course is more aggressive. I...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2007.09.023
更新日期:2008-02-01 00:00:00
abstract:BACKGROUND AND PURPOSE:The presence of predicting the rupture risk of intracranial aneurysms has recently generated considerable controversy. We retrospectively investigated the risk factors for multiple intracranial aneurysms related to rupture. METHODS:Between July 2007 and July 2011, 134 patients with 294 aneurysms...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2012.08.011
更新日期:2013-06-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to objectively assess the patients' acceptance for awake craniotomy in a group of neurosurgical patients, who underwent this procedure for removal of lesions in or close to eloquent brain areas. PATIENTS AND METHODS:Patients acceptance for awake craniotomy under local anesthesia an...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2011.06.010
更新日期:2011-12-01 00:00:00
abstract:OBJECTIVE:A thorough follow-up study in which the same clinic presents the change in the surgical outcomes of acromegaly over the years, is still lacking in the endoscopic era. In this study, we intended to evaluate the clinical characteristics, radiological features, surgical and late remission rates of newly diagnose...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2020.106201
更新日期:2020-11-01 00:00:00
abstract:OBJECTIVE:Fractures of the thoracolumbar spine can cause pain, long-term reductions in quality of life (QOL), and neural deficits. The aim of this study was to investigate the effects of methylene blue (MB) on preventing postoperative pain and improving QOL in patients with throracolumbar fractures undergoing posterior...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.clineuro.2016.08.018
更新日期:2016-11-01 00:00:00
abstract:OBJECTIVE:Several neurodegenerative disorders show olfactory dysfunction. In patients with frontotemporal dementia (FTD), olfactory impairment is probably due to the involvement of the temporal and orbitofrontal lobes. We hypothesized that due to the disrupted areas in FTD, there would be an impairment in smell identif...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2016.01.003
更新日期:2016-02-01 00:00:00
abstract:OBJECTIVE:The objective of the present study was to retrospectively review the surgical outcome of 309 craniopharyngioma cases treated by a single neurosurgeon in China. PATIENTS AND METHODS:A total of 309 cases of craniopharyngioma that were treated surgically from January 1996 to May 2006. Among them, 162 (52.4%) pa...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2007.10.013
更新日期:2008-02-01 00:00:00
abstract::Colloid cyst of the third ventricle is a known primary brain tumor. The familial occurrence of this cyst and associated conditions has been rarely discussed in the literature. To our knowledge only 10 affected families have been previously reported in the literature. We report the 11th family with this potentially lif...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.clineuro.2007.04.017
更新日期:2007-09-01 00:00:00