Abstract:
BACKGROUND:Rising cost and limited resources remain major challenges to U.S. health care and neurosurgery in particular. To ensure an efficient and cost-effective health care system, it is important that referrals to neurosurgery clinics are appropriate, and that referred patients have a reasonably high probability of requiring surgical intervention or, at a minimum, ongoing neurosurgical follow-up. This retrospective study tests the null hypothesis that the probability of a referred patient requiring surgery is independent of referring provider credentials and referring service specialty. METHODS:A database of all patients referred to the neurosurgery clinic from 2015 through 2018 (n = 5677) was reviewed; the database included referring provider, referring provider specialty, number of subsequent clinic visits, and outcome of surgery or no surgery. Associations between categorical variables were tested using a χ2 analysis with post hoc relative risk (RR) calculations and binary logistical regression. RESULTS:Compared with patients referred by allopathic physicians, patients referred by osteopathic physicians (RR, 0.63; 95% confidence interval [CI], 0.48-0.84) and those referred by nurse practitioners (RR, 0.66; 95% CI, 0.51-0.86) were significantly less likely to require surgery. Probability of surgical intervention also varied by referrer specialty. Patients referred by neurologists required surgery 35% of the time, whereas patients referred by family practitioners required surgery 19% of the time, and patients referred by pediatricians required surgery only 7% of the time (P < 0.01). Binary logistic regression revealed that referrals from nurse practitioners and osteopathic physicians were independently associated with a decreased probability of surgical intervention. CONCLUSIONS:Our data strengthen the concept of having interdisciplinary teams led by physicians at the primary care level to ensure appropriate referrals. Training and adherence to guidelines must continually be reinforced to ensure proper referrals.
journal_name
World Neurosurgjournal_title
World neurosurgeryauthors
Gelinne A,Thakrar R,Tranmer BI,Durham SR,Jewell RP,Penar PL,Lollis SSdoi
10.1016/j.wneu.2019.02.095subject
Has Abstractpub_date
2019-06-01 00:00:00pages
e564-e569eissn
1878-8750issn
1878-8769pii
S1878-8750(19)30506-6journal_volume
126pub_type
杂志文章abstract::Terminal myelocystocele is a rare type of neural tube malformation, consisting of a skin-covered lumbosacral mass, highly associated with other complex abdominal malformations within the OIES complex (omphalocele, imperforate anus, exstrophy of the cloaca and spinal defects). We present a case of a premature female wi...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2020.11.135
更新日期:2020-12-19 00:00:00
abstract::Trepanation, the process of making a burr hole in the skull to access the brain, is an ancient form of a primitive craniotomy. There is widespread evidence of contributions made to this practice by ancient civilizations in Europe, Africa, and South America, where archaeologists have unearthed thousands of trepanned sk...
journal_title:World neurosurgery
pub_type: 历史文章,杂志文章,评审
doi:10.1016/j.wneu.2016.10.051
更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:Transforaminal endoscopic lumbar discectomy (TELD), a minimally invasive spinal technique, has advantages over open discectomy. Unilateral TELD for disc herniation causing bilateral symptoms is challenging. In this study, we describe a percutaneous endoscopic herniotomy technique by using a unilateral approa...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.06.191
更新日期:2017-10-01 00:00:00
abstract::Military explorations of the practical role of simulators have served as a driving force for much of the virtual reality technology that we have today. The evolution of 3-dimensional and virtual environments from the early flight simulators used during World War II to the sophisticated training simulators in the moder...
journal_title:World neurosurgery
pub_type: 历史文章,杂志文章
doi:10.1016/j.wneu.2012.06.014
更新日期:2012-09-01 00:00:00
abstract:OBJECTIVE:To compare the treatment results between 1-level vertebral column decancellation (VCD) and pedicle subtraction osteotomy (PSO) for correcting severe kyphotic deformity in ankylosing spondylitis (AS). VCD and PSO have been used to correct AS-related kyphotic deformity, but the differences on correcting results...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.04.011
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVE:This study aimed to present a new endoscopic technique for osteoid osteoma (OO) of the lumbar spine and sacrum and to evaluate its safety and effectiveness. METHODS:Eleven consecutive patients with spinal OO underwent percutaneous endoscopic excision and ablation (PEEA) between March 2014 and May 2018. A can...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.09.039
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVE:We aimed to describe our single-center experience in treating cerebellar arteriovenous malformations (AVMs) with microsurgical resection. METHODS:During a 16-year period, 181 patients with cerebellar AVMs were surgically treated at the Department of Neurosurgery in Beijing Tiantan Hospital. Patient functiona...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2016.08.059
更新日期:2016-11-01 00:00:00
abstract:BACKGROUND:Intraoperative use of positive end-expiratory pressure (PEEP) has a protective effect in patients with acute lung injury and is recommended during anesthesia to minimize postoperative pulmonary complications. However, high levels of pressure might also cause harm to the lung because of overdistension. This r...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.12.014
更新日期:2018-04-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:High-field intraoperative magnetic resonance imaging (ioMRI) is becoming increasingly available in neurosurgery centers, where it has to be combined with intraoperative neurophysiologic monitoring (IONM). IONM needle electrodes remain on the patient during ioMRI and may cause image distortions ...
journal_title:World neurosurgery
pub_type: 临床试验,杂志文章
doi:10.1016/j.wneu.2016.05.097
更新日期:2016-09-01 00:00:00
abstract:BACKGROUND:Chronic subdural hematoma (CSDH) is a common intracranial hematoma. The number of patients who undergo anticoagulant therapy including a direct oral anticoagulant (DOAC) is expected to increase. Recently, idarucizumab, the antidote for dabigatran, which is a DOAC, has been developed. We successfully treated ...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.10.043
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVE:The aim of the study was to evaluate the effect of systemically administrated curcumin on the prevention of peridural fibrotic tissue and adhesion formation in a rat laminectomy model. METHODS:Thirty-two Wistar albino rats were randomly selected and equally divided into 4 groups as follows: negative control ...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2020.09.140
更新日期:2021-01-01 00:00:00
abstract:OBJECTIVE:To compare bony spur resection (BR) with bony spur nonresection (BN) treatment in patients with congenital scoliosis and type I split cord malformation. METHODS:Patients with congenital scoliosis and type I split cord malformation who underwent corrective surgery in a single institution from 2008 to 2015 wer...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.01.265
更新日期:2019-05-01 00:00:00
abstract:OBJECTIVE:To retrospectively assess the surgical outcomes and complication rates following microvascular decompression (MVD) for trigeminal neuralgia, using a targeted, restricted retrosigmoid approach. METHODS:During the period 1994-2009, a total of 119 patients underwent MVD for trigeminal neuralgia. A retrospective...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2010.05.001
更新日期:2010-07-01 00:00:00
abstract:OBJECTIVE:To investigate the frequency and risk factors of contralateral epidural hematoma (CEDH) following decompressive craniectomy (DC) in patients with calvarial skull fracture contralateral to the craniectomy site. METHODS:After reviewing the medical records and radiographs over a 5-year period, 72 patients with ...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2016.02.020
更新日期:2016-05-01 00:00:00
abstract:BACKGROUND:The amount of blood detected on brain computed tomography scan is frequently used in prediction models for delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (aSAH). These models, which include coarse grading scales to assess the amount of blood, have only moderate predictive...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.06.170
更新日期:2019-10-01 00:00:00
abstract:OBJECTIVE:To provide anatomic evidence of preoperative assessment of oblique lumbar interbody fusion (OLIF) for Chinese patients. METHODS:From the hospital picture archiving and communication system, 400 lumbar magnetic resonance imaging studies of adults performed between November 2016 and January 2017 were selected....
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.03.244
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:The effect of frailty on outcomes after angiogram-negative subarachnoid hemorrhages (ANSAH) is currently unknown. We investigated frailty's effects on ANSAH outcomes, including mortality and in-hospital complications. METHODS:Patients from 2014 to 2018 with non-traumatic subarachnoid hemorrhage and cerebral...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2019.10.003
更新日期:2020-02-01 00:00:00
abstract:INTRODUCTION:Neurocutaneous melanosis (NCM) is a rare congenital syndrome. Except for some retrospective studies, information on clinical follow-up and management of these patients are limited. This study aimed to review our experience on diagnostic protocol and clinical follow-up of patients with NCM in a referral chi...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2020.11.091
更新日期:2020-11-24 00:00:00
abstract::This study documents a risky vascular anatomic orientation that might play an important role in the postoperative hemodynamics following anterior cerebral artery (ACA) revascularization. A 71-year-old woman presented with uncontrollable frequent right lower limb transient ischemic attacks (TIAs) attributed to a left c...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2016.09.023
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:Ionizing radiation is typically used during spine surgery for localization and guidance in instrumentation placement. Minimally invasive (MI) surgical procedures are increasingly popular and often require significantly more fluoroscopy, placing surgeons at risk for increased radiation exposure and radiation-...
journal_title:World neurosurgery
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.wneu.2014.07.041
更新日期:2014-12-01 00:00:00
abstract:BACKGROUND:The neurosurgical boot camp has been fully incorporated into U.S. postgraduate education. This is the first implementation of the neurosurgical boot in a developing country. To advance neurosurgical education, we developed a similar boot camp program, in collaboration with Bolivian neurosurgeons, to determin...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.05.046
更新日期:2017-08-01 00:00:00
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journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.08.013
更新日期:2017-12-01 00:00:00
abstract:OBJECTIVE:Accurate measurement of surgical outcomes is highly desirable to optimize surgical decision-making. An important element of surgical decision making is identification of the patient cohort that will benefit from surgery before the intervention. Machine learning (ML) enables computers to learn from previous da...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2017.09.149
更新日期:2018-01-01 00:00:00
abstract:INTRODUCTION:Primary orbitofrontal cholesterol granuloma (OFCG) is rare. We present 4 cases of OFCG and a systematic literature review to examine patient characteristics, presentation, treatment, and outcome. METHODOLOGY:Our institutional records were reviewed for OFCG cases. A systematic literature review was perform...
journal_title:World neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.wneu.2015.11.095
更新日期:2016-03-01 00:00:00
abstract:BACKGROUND:Pseudoarthrosis after spinal fusion is an important cause of pain, neurologic decline, and reoperation. METHODS:The Healthcare Cost and Utilization Project State Inpatient Databases were queried in New York, California, Florida, and Washington for adult patients who had undergone new spinal fusion from 2009...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2018.08.026
更新日期:2018-12-01 00:00:00
abstract:BACKGROUND:For children who survive traumatic atlantooccipital dislocation (AOD), early surgical stabilization and arthrodesis of the occipitoatlantoaxial complex is typically performed. Because of the unique and crowded anatomy of the occipitocervical junction, the creation of a fusion construct that is both safe and ...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2011.12.079
更新日期:2012-12-01 00:00:00
abstract:OBJECTIVE:Ruptured blister aneurysms of the internal carotid artery are challenging to treat because of their difficult diagnosis and the fragility of the wall structure. Here, we sought to clarify the efficacy of extracranial-intracranial bypass followed by trapping (bypass/trapping) for ruptured blister aneurysms. M...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2020.01.081
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:Use of distal nerve transfer for improving upper limb function has been well described for patients with tetraplegic spinal cord injury and brachial plexus injuries but has not previously been described for Brown-Séquard type spinal cord injury. We describe our experience with 2 cases of combined Brown-Séqua...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2017.10.169
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVE:Spontaneous intracerebral hemorrhage (ICH) can be a devastating event. An increased glucose level in patients with ICH is known to be related to poor outcomes, including acute leukocytosis, which is a well-established response to ICH. The purpose of this study was to evaluate the association between admission...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2016.11.087
更新日期:2017-02-01 00:00:00
abstract:BACKGROUND:Occipital artery pseudoaneurysms are extremely rare pathologies that manifest after traumatic injury; only 11 cases have been reported in the literature. Because of their low incidence and vague symptoms, the initial diagnosis can be difficult. However, for correctly diagnosed occipital artery pseudoaneurysm...
journal_title:World neurosurgery
pub_type: 杂志文章
doi:10.1016/j.wneu.2016.01.095
更新日期:2016-05-01 00:00:00