{"id":{"repo_id":"ohiolink","oai_identifier":"oai:etd.ohiolink.edu:case1365082448"},"canonical_url":"https://search.dev.ndltd.org/etd/ohiolink/oai:etd.ohiolink.edu:case1365082448","repository":{"repo_id":"ohiolink","name":"OhioLINK","base_url":"https://etd.ohiolink.edu/acprod/odb_etd/ws/oai/oai"},"display":{"title":"Risk, Outcomes, and Costs in Neurosurgery – The New Frontier in Health Services Research","abstract":"Introduction: Health services research driven from within neurosurgery can be used to improve access to and quality of care, while helping to control costs. Aim: To answer clinically relevant questions that make a difference in patient care.Methods: We chose to use the American College of Surgeons National Safety and Quality Improvement Project as the database for all components of this dissertation, which contains prospective, blinded, multi-institutional information about patients undergoing surgery.Results: Hemostasis history was as predictive as laboratory testing for all outcomes, with higher sensitivity. Advanced age does not increase the risk of poor outcomes after surgical resection of primary or metastatic intracranial tumors, after controlling for other risk factors. We not find smoking to be associated with early (30-day) peri-operative morbidity or mortality. All levels of anemia were significantly associated with prolonged length of hospitalization and poorer operative or 30-day outcomes in patients undergoing elective spine surgery. Conclusions: Routine hemostatic laboratory screening appears to have limited utility. Testing limited to neurosurgical patients with a positive history would save an estimated $81,942,000 annually. Age should not be used, in isolation, as an a priori factor to discourage pursuing craniotomy. Smoking cessation can be considered prior to spine surgery for reasons other then early (30-day) peri-operative morbidity or mortality. Anemia should be regarded as an independent risk factor for peri-operative and post-operative complications that deserves attention prior to elective spine surgery.","abstract_html":"Introduction: Health services research driven from within neurosurgery can be used to improve access to and quality of care, while helping to control costs. Aim: To answer clinically relevant questions that make a difference in patient care.Methods: We chose to use the American College of Surgeons National Safety and Quality Improvement Project as the database for all components of this dissertation, which contains prospective, blinded, multi-institutional information about patients undergoing surgery.Results: Hemostasis history was as predictive as laboratory testing for all outcomes, with higher sensitivity. Advanced age does not increase the risk of poor outcomes after surgical resection of primary or metastatic intracranial tumors, after controlling for other risk factors. We not find smoking to be associated with early (30-day) peri-operative morbidity or mortality. All levels of anemia were significantly associated with prolonged length of hospitalization and poorer operative or 30-day outcomes in patients undergoing elective spine surgery. Conclusions: Routine hemostatic laboratory screening appears to have limited utility. Testing limited to neurosurgical patients with a positive history would save an estimated $81,942,000 annually. Age should not be used, in isolation, as an a priori factor to discourage pursuing craniotomy. Smoking cessation can be considered prior to spine surgery for reasons other then early (30-day) peri-operative morbidity or mortality. Anemia should be regarded as an independent risk factor for peri-operative and post-operative complications that deserves attention prior to elective spine surgery.","abstract_has_math":false,"creators":["Seicean, Andreea"],"institution":"Case Western Reserve University School of Graduate Studies","degree_name":"Doctor of Philosophy","degree_level":"doctoral","degree_discipline":"Epidemiology and Biostatistics","degree_department":null,"school":null,"contributors":["Neuhauser , Duncan"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2013,"date_issued":"2013-08-19","date_published":"2013-08-19","updated_at":"2026-07-24T03:37:16Z","subjects":["Health Sciences","Neurosciences","Epidemiology","Health Care","Surgery","neurosurgery","health services research","outcomes","cost","morbidity","mortality","craniotomy","tumor","hemostasis","screening","elderly","spine","treatment","prognosis","smoking","anemia"],"languages":["English"],"rights":["unrestricted","This thesis or dissertation is protected by copyright: all rights reserved. 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Advanced age does not increase the risk of poor outcomes after surgical resection of primary or metastatic intracranial tumors, after controlling for other risk factors. We not find smoking to be associated with early (30-day) peri-operative morbidity or mortality. All levels of anemia were significantly associated with prolonged length of hospitalization and poorer operative or 30-day outcomes in patients undergoing elective spine surgery. Conclusions: Routine hemostatic laboratory screening appears to have limited utility. Testing limited to neurosurgical patients with a positive history would save an estimated $81,942,000 annually. Age should not be used, in isolation, as an a priori factor to discourage pursuing craniotomy. Smoking cessation can be considered prior to spine surgery for reasons other then early (30-day) peri-operative morbidity or mortality. Anemia should be regarded as an independent risk factor for peri-operative and post-operative complications that deserves attention prior to elective spine surgery."]},{"key":"dc:format","label":"Dc Format","values":["application/pdf","p.143","697.4 KB"]},{"key":"dc:title","label":"Title","values":["Risk, Outcomes, and Costs in Neurosurgery – The New Frontier in Health Services Research"]}]}],"canonical_facts":{"dc:contributor":["Neuhauser , Duncan"],"dc:creator":["Seicean, Andreea"],"dc:date":["2013-08-19"],"dc:description":["Introduction: Health services research driven from within neurosurgery can be used to improve access to and quality of care, while helping to control costs. Aim: To answer clinically relevant questions that make a difference in patient care.Methods: We chose to use the American College of Surgeons National Safety and Quality Improvement Project as the database for all components of this dissertation, which contains prospective, blinded, multi-institutional information about patients undergoing surgery.Results: Hemostasis history was as predictive as laboratory testing for all outcomes, with higher sensitivity. Advanced age does not increase the risk of poor outcomes after surgical resection of primary or metastatic intracranial tumors, after controlling for other risk factors. We not find smoking to be associated with early (30-day) peri-operative morbidity or mortality. All levels of anemia were significantly associated with prolonged length of hospitalization and poorer operative or 30-day outcomes in patients undergoing elective spine surgery. Conclusions: Routine hemostatic laboratory screening appears to have limited utility. Testing limited to neurosurgical patients with a positive history would save an estimated $81,942,000 annually. Age should not be used, in isolation, as an a priori factor to discourage pursuing craniotomy. Smoking cessation can be considered prior to spine surgery for reasons other then early (30-day) peri-operative morbidity or mortality. Anemia should be regarded as an independent risk factor for peri-operative and post-operative complications that deserves attention prior to elective spine surgery."],"dc:format":["application/pdf","p.143","697.4 KB"],"dc:identifier":["http://rave.ohiolink.edu/etdc/view?acc_num=case1365082448"],"dc:language":["English"],"dc:publisher":["Case Western Reserve University School of Graduate Studies / OhioLINK"],"dc:rights":["unrestricted","This thesis or dissertation is protected by copyright: all rights reserved. It may not be copied or redistributed beyond the terms of applicable copyright laws."],"dc:subject":["Health Sciences","Neurosciences","Epidemiology","Health Care","Surgery","neurosurgery","health services research","outcomes","cost","morbidity","mortality","craniotomy","tumor","hemostasis","screening","elderly","spine","treatment","prognosis","smoking","anemia"],"dc:title":["Risk, Outcomes, and Costs in Neurosurgery – The New Frontier in Health Services Research"],"dc:type":["Electronic Thesis or Dissertation"],"thesis:degree_discipline":["Epidemiology and Biostatistics"],"thesis:degree_level":["doctoral"],"thesis:degree_name":["Doctor of Philosophy"],"thesis:institution_name":["Case Western Reserve University School of Graduate Studies"]},"updated_at":"2026-07-24T03:37:16Z"}