Pranav Mirpuri

Understanding the impact of social determinants of health (SDoH) on clinical outcomes in conditions such as intracerebral hemorrhage (ICH) is crucial for enhancing patient management and improving health policy. The aim of this study was to assess the impact of SDoH on the prognosis and clinical outcomes of patients with ICH. This retrospective study used the MARINER165 national administrative database, encompassing medical and surgical claims from January 2010 to October 2022. It adhered to the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. Patients with ICH were identified using International Classification of Diseases and Current Procedural Terminology codes. Propensity score matching generated 2 cohorts based on SDoH presence. Primary outcomes focused on functional status at 30 days and survival rates at 90 days and 1 year. Functional outcomes included the rates of tracheostomy and gastronomy tube placement, wheelchair dependency, mobility scores, and readmission within 30 days after ICH. Kaplan-Meier survival analysis was used to determine survival rates at 90 days and 1 year after index event. A significance level of p < 0.05 was applied. A total of 481,754 patients with ICH were included, with 240,877 individuals in each cohort after matching. Gender distribution was balanced (50.5% female), and common comorbidities included hypertension (89%), depression (47%), and diabetes mellitus (45%). The SDoH group demonstrated pronounced disparities in food security (87%), social integration (14.2%), and physical environment (8.3%). At 30 days, this group experienced worse functional outcomes with higher rates of tracheostomy (2% vs 0.9%, p < 0.001) and G-tube placement (3.2% vs 1.5%, p < 0.001), increased wheelchair dependency (3.2% vs 2.5%, p < 0.001), and lower mobility scores (3.5 vs 2.7, p < 0.001), alongside higher readmission rates (9.8% vs 6.2%, p < 0.001). Despite these challenges, the SDoH cohort demonstrated better survival rates at both 90 days (78.1% vs 72.6%, p < 0.001) and 1 year (62.1% vs 57.6%, p < 0.001). This study underscores significant disparities in functional outcomes and survival rates associated with SDoH among patients with ICH. It highlights the paradox where individuals with SDoH, despite facing greater health-related challenges and higher readmission rates, tend to survive longer. Integrating socioeconomic factors into patient management strategies is crucial for addressing these differences and improving overall health care outcomes.

Study Design: A retrospective cohort study.Purpose: To examine the effect of cannabis use history on postoperative opioid utilization in patients undergoing one- to three-level lumbar fusion for degenerative spine disease.Overview of Literature: Strategies to minimize dosing and chronic opioid use are needed for spine surgery given their widespread prescription for postsurgical pain management.Methods: In this database study, medical coding was used to identify patients who had undergone one- to three-level lumbar fusions between 2012 and 2021. Propensity score matching was used to create two equal cohorts with respect to cannabis use history. Opioid utilization rates (morphine milligram equivalents [MME]/day) and overuse rates at 6 months post-index procedure were assessed. All pvalues <0.05 were considered statistically significant.Results: Following examination of 153,500 patient records, 1,216 patients were matched into cannabis user and non-cannabis user cohorts. Cannabis users had lower rates of opioid utilization compared to non-cannabis users as early as 2 months after fusion (47.7% vs. 41.1%, p <0.05), a relationship which persisted at 6 months (46.2% vs. 37.7%, p <0.01). Additionally, cannabis users had lower rates of high-dose opioid utilization (≥100 MME per day) during the initial 14–30 days following surgery (6.91% vs. 3.79%, p <0.05).Conclusions: Patients with a history of cannabis use were less likely to be using opioids as early as 2 months postoperatively and had lower rates of high-dose opioid utilization in the immediate postoperative period. Physicians operating on these patients should consider their cannabis use patterns to provide appropriate titration of pain medication over time.

BACKGROUND AND OBJECTIVES: Significant evidence has indicated that the reporting quality of novel predictive models is poor because of confounding by small data sets, inappropriate statistical analyses, and a lack of validation and reproducibility. The Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) statement was developed to increase the generalizability of predictive models. This study evaluated the quality of predictive models reported in neurosurgical literature through their compliance with the TRIPOD guidelines. METHODS: Articles reporting prediction models published in the top 5 neurosurgery journals by SCImago Journal Rank-2 (Neurosurgery, Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of NeuroInterventional Surgery, and Journal of Neurology, Neurosurgery, and Psychiatry) between January 1st, 2018, and January 1st, 2023, were identified through a PubMed search strategy that combined terms related to machine learning and prediction modeling. These original research articles were analyzed against the TRIPOD criteria. RESULTS: A total of 110 articles were assessed with the TRIPOD checklist. The median compliance was 57.4% (IQR: 50.0%-66.7%). Models using machine learning-based models exhibited lower compliance on average compared with conventional learning-based models (57.1%, 50.0%-66.7% vs 68.1%, 50.2%-68.1%, P = .472). Among the TRIPOD criteria, the lowest compliance was observed in blinding the assessment of predictors and outcomes (n = 7, 12.7% and n = 10, 16.9%, respectively), including an informative title (n = 17, 15.6%) and reporting model performance measures such as confidence intervals (n = 27, 24.8%). Few studies provided sufficient information to allow for the external validation of results (n = 26, 25.7%). CONCLUSION: Published predictive models in neurosurgery commonly fall short of meeting the established guidelines laid out by TRIPOD for optimal development, validation, and reporting. This lack of compliance may represent the minor extent to which these models have been subjected to external validation or adopted into routine clinical practice in neurosurgery.

BACKGROUND: Neurological injury requiring ventriculoperitoneal shunt (VPS) placement often necessitates gastrostomy for nutritional support. The sequence of these procedures is debated over concerns for shunt infection and displacement requiring revisional surgery as a consequence of gastrostomy. OBJECTIVE: To determine the optimal sequence of VPS shunt and gastrostomy tube placement in adults. METHODS: In an all-payer database, adult patients undergoing gastrostomy and VPS placement were identified within 15 days between January 2010 and October 2021. Patients were categorized as receiving gastrostomy before, on the same day as, or after shunt placement. The primary outcomes of this study were rates of revision and infection. All outcomes were evaluated within 30 months after index shunting. RESULTS: In total, 3015 patients were identified as undergoing VPS and gastrostomy procedures within 15 days. After a 1:1:1 match, 1080 patient records were analyzed. Revision rates at 30 months were significantly lower among patients who received VPS and gastrostomy procedures on the same day compared with gastrostomy after VPS (odds ratio [OR] 0.61, 95% CI 0.39-0.96). In addition, patients who received gastrostomy before VPS compared with those after had lower revision rates (OR 0.61, 95% CI 0.39-0.96) and infection (OR 0.46, 95% CI 0.21-0.99). No significant differences were noted in mechanical complication or shunt displacement rates. CONCLUSION: Patients requiring VPS and gastrostomy may benefit from undergoing both procedures concurrently or with gastrostomy before VPS placement, secondary to lower revision rates. Patients undergoing gastrostomy before VPS have the added benefit of decreased infection rates.