Risk, Outcomes, and Costs in Neurosurgery – The New Frontier in Health Services Research

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.

Name thesis:degree_name

Doctor of Philosophy

Level thesis:degree_level

doctoral

Discipline thesis:degree_discipline

Epidemiology and Biostatistics

Grantor dc:publisher

Case Western Reserve University School of Graduate Studies

Year dc:date

2013

Author dc:creator

• Seicean, Andreea

Contributors dc:contributor

• Neuhauser , Duncan

• 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

Statement 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.

Language dc:language

English

Repository record dc:identifier

http://rave.ohiolink.edu/etdc/view?acc_num=case1365082448

OAI identifier oai:identifier

oai:etd.ohiolink.edu:case1365082448