- Email: [email protected]
Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters
The Spine Journal 18 (2018) S142 S225 baseline, during the trial period, and after permanent stimulator placement. Differences from baseline were analyzed and compared. RESULTS: A total of 100 patient charts were included in our cohort. Sixty percent of our population was female, with a roughly even age distribution ranging from 37 to 90 years of age. Patients reported significantly increased pain reduction in the trial period (median=4) from baseline compared to after permanent stimulator placement (median=2) (p=.00). A significant difference was not seen when comparing the difference in ODI scores between the trial period and baseline (median=4) versus after permanent stimulator placement and baseline (median=6) (p=.64). Finally, a significantly higher decrease in opioid medication usage (milli-morphine equivalents or day) was seen during the trial period (median=0) from baseline compared to after permanent spinal cord stimulator placement to baseline (median=0) (p=.028). CONCLUSIONS: Spinal cord stimulators remain an effective treatment option to treat lumbar back pain and radiculopathy in chronic pain and post-laminectomy syndrome patients. However, patients may receive more pain and symptom relief during their percutaneous stimulator trial than they do after their permanent stimulator is placed, leaving patients hoping and expecting long term relief that might not always arrive. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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22.8%) within 5 years. The factors associated with subsequent surgery were age, diagnosis, number of CESIs, depression, chronic obstructive pulmonary disease, alcohol use, U region, and rural versus urban location. Cardiac comorbidities other than congestive heart failure or infarction had lower risk for surgery. Patients with radiculopathy were less likely to progress to surgery following CESI than stenosis or herniation. Additional CESIs reduced the risk for subsequent surgery, with 75% (95% CI: 57%, 95%) higher risk with 1 versus 4 CESIs (p<.001). However, this relationship was dependent on the time to additional CESI, with patients undergoing a second CESI within 2 weeks having a 75% (95% CI: 57%, 95%) higher risk of surgery than those who had a repeat CESI 8 weeks or later. CONCLUSIONS: Following CESI, 22.2% of patients underwent surgery within 5 years. Multiple patient-specific risk factors for subsequent surgery were identified, and patients undergoing repeated injections were at lower risk of proceeding to surgery. Additional analyses comparing matched cohorts of surgical patients with and without prior CESI will further advance our understanding of the value and risks of CESI. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.590
https://doi.org/10.1016/j.spinee.2018.06.589
P52. Cervical epidural steroid injections: incidence and determinants of subsequent surgery John Kleimeyer, MD1, Jayme Koltsov, PhD1, Serena S. Hu, MD2; 1 Redwood City, CA, USA; 2 Stanford University School of Medicine, Redwood City, CA, USA BACKGROUND CONTEXT: Cervical epidural steroid injections (CESIs) are increasingly used in the nonsurgical management of cervical disorders despite conflicting evidence for efficacy. The proportion of patients who delay or avoid surgery with lumbar or cervical ESIs varies widely in the literature, and contradictory determinants of subsequent surgery have been described. PURPOSE: The goals of this study were to determine (1) the incidence of surgery following CESI, (2) the time between CESI and subsequent surgery, and (3) the factors associated with progression to surgery following CESI. STUDY DESIGN/SETTING: Retrospective analysis of deidentified administrative claims data. PATIENT SAMPLE: A national outpatient and inpatient database from 2007 to 2014 was reviewed, containing 149 million unique patients from 2007 to 2014. Inclusion criteria were CESI for diagnoses of cervical disc herniation, myelopathy, radiculopathy, or stenosis, and active enrollment for 1 year prior to the CESI to screen for exclusion criteria. Exclusions include prior cervical surgery, associated neoplasm, pregnancy, inflammatory spondyloarthropathies, fracture (pathologic, nonunion, stress or acute), or infection (abscess, discitis or osteomyelitis). OUTCOME MEASURES: The incidence of subsequent surgery and overall survival, measured as the time from CESI to surgery. METHODS: Patients were followed longitudinally for up to 6 years until they either underwent cervical surgery or had a lapse in health plan enrollment, at which time they were censored. Survival analyses were performed. The rate of surgery and overall survival following CESI were assessed with the Kaplan-Meier survival curve and 95% confidence interval (CI), and factors associated with subsequent surgery were assessed with multivariable Cox proportional hazard models (p<.05). RESULTS: A total of 44,621 unique CESI patients met the inclusion and exclusion criteria (age 50.1±10.7 years, 51.3% female). Fortyeight percent of patients underwent more than 1 CESI, 94.3% of which occurred within 1 year. Within 6 months of CESI, 12.2% (95% CI: 11.9%, 12.5%) of patients underwent surgery, increasing to 15.3% (95% CI: 15.0%, 15.7%) within 1 year and 22.2% (95% CI: 21.7%,
P53. Management of pressure injury with a novel negative pressure device (NPD) in people with spinal cord injury (SCI) Mukesh K. Dwivedi, PhD, PhD1, Rajeshwar Srivastava, MD2; 1 Department of Orthopaedic Surgery, Lucknow, Uttar Pradesh, India; 2 King George’s Medical University, Department of Orthopaedic Surgery, Lucknow, UP, India BACKGROUND CONTEXT: Treatment of pressure injury (PI) is an ongoing clinical challenge particularly in people with SCI in developing countries where socioeconomic conditions often dictate treatment modalities. When negative pressure wound therapy (NPWT) was introduced, there were a series of devices (V.A.C., KCI, San Antonio, TX) manufactured. These devices for NPWT are costly and hard to afford by patients in developing countries like India and others. Commercially available devices are typically rented and require costly consumables. This study focuses on a novel, bellows-powered negative pressure device (NPD) that is easy to apply and does not require electricity. PURPOSE: The purpose of this study was to evaluate wound-healing outcome measures (length, width, and depth, exudate amount, and tissue type) in PIs of spinal cord-injured patients treated with NPWT using a novel negative pressure device versus PI treated with wet-moist gauze (conventional wound care). STUDY DESIGN/SETTING: Randomized controlled clinical trail (RCT) Department of Orthopaedic Surgery, King George’s Medical University, Lucknow, India. This RCT was registered and approved by our institutional ethics committee. PATIENT SAMPLE: Thirty-four (34) spinal cord injury subjects resulting traumatic paraplegia. OUTCOME MEASURES: The outcome measures were surface area (length X width) and depth of PI, granulation tissue formation, exudates, microorganisms and cost effectivenes sat week 0, 3, 6 and week 9. METHODS: Conventional therapy in our facility comprises wet to moistgauze dressings, and this intervention was used for comparison to the experimental intervention (NPWT via bellows enhanced vacuum device). The NPD dressing was changed weekly or more often if the dressing became saturated or loss of suction occurred. RESULTS: Significantly reduced length of PI in NPWT group was observed at week 6 (p=.04) which further reduced at week 9 (p=.001) as compared to conventionally treated group. Similarly significant reduction of width and depth of PI was observed in NPWT at week 9 (p<.05). The exudate decreased significantly (p=.001) in NPWT group from 6th to 9th week. Clearance of slough from wound bed and appearance of red granulation tissue was significantly higher in NPWT group (p=.001). At week 9, the wound culture
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
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The Spine Journal 18 (2018) S142 S225
was negative in all the subjects of NPWT group, while it was positive in 10 (41.6) subjects of conventional group. CONCLUSIONS: NPWT by our locally constructed indigenized novel NPD is better wound care procedure and cost effective for management of pressure injury. We also found that the NPD reduced wound exudate, cleared slough, and accelerated the formation of red granulation tissue. Improving basic knowledge of NPWT in the management of PIs may help clinicians and wound care researchers identify and proactively intervene in an effort to minimize the time and cost associated with PI healing in SCI patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.591
P54. YouTube as an educational platform in orthopedics: a novel grading system for lumbar fusion surgery videos Sandip Tarpada, BA1, Matthew Morris, MD1, Sina Rashidi, BA1, Woojin Cho, MD, PhD2; 1 Bronx, NY, USA; 2 Hartsdale, NY, USA BACKGROUND CONTEXT: Since their conception, online video platforms have increasingly been utilized within the surgical community as an educational adjunct to residency curricula. YouTube, in particular, is a commonly cited educational resource by orthopedic surgery residents. To date, despite the growing popularity of orthopedic surgery videos on YouTube among trainees, there exists no uniform system to evaluate these videos for educational value. Here, we propose such a grading scheme applied specifically to orthopedic lumbar fusion videos on YouTube. PURPOSE: To develop and apply a 20-point grading scale to assess the educational value of lumbar fusion surgery videos on YouTube. STUDY DESIGN/SETTING: Prospective study. OUTCOME MEASURES: Educational value score, video view count. METHODS: A 20-point video grading scale was devised and applied to YouTube videos of lumbar fusion surgery. The grading scale took into account a number of factors, including the procedure itself, video quality, and general educational value of the video. The following search terms were used to find relevant videos: “spinal fusion,” “lumbar spinal fusion,” “anterior lumbar interbody fusion,” “posterior lumbar interbody fusion,” “transforaminal lumbar interbody fusion,” “trans psoas interbody fusion,” and “oblique lateral lumbar interbody fusion.” Search terms were entered as plain text within the search box; Boolean operators were not used. The search was refined to include only videos with a run time of 20 or more minutes, found within the first five results pages. Videos targeting patients, from personal accounts, or created for entertainment purposes were strictly excluded. RESULTS: A search yielded 150 nonduplicate videos. Of these, 18 remained after application of inclusion and exclusion criteria. Mean video score was 13.1±2.5 points out of 20. Six videos (33%) achieved scores above 16, and were deemed as useful educational adjuncts for the orthopedic trainee. The mean number of views for videos scoring below 16 points was 11754.4±312.1, significantly greater than that of videos scoring above 16 points (8061.1±112.1; p<.003). CONCLUSIONS: Here, we describe a grading system for assessment of the educational value of lumbar fusion surgery videos on a globally popular online video platform. With the growing number of surgery videos available online, a verified video evaluation system such as ours can prove to be a valuable asset to the orthopedic trainee. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.592
P55. Recognition and management of emergent versus nonemergent spinal pathology amongst first-line providers Joseph Johnson, BS1, Jacob Babu, MD1, Wesley Durand, BS2, Adam Eltorai, MSc2, Shyam A. Patel, MD3, Alan H. Daniels, MD4; 1 Brown University, Providence, RI, USA; 2 Brown University, Warren Alpert Medical School, Providence, RI, USA; 3 LifeSpan/Rhode Island Hospital,
Providence, RI, USA; 4 Warren Alpert Medical School of BU/RI Hospital, Providence, RI, USA BACKGROUND CONTEXT: Spinal pathology, particularly spinal emergencies, require prompt identification, management, and surgical referral (if needed) from first-line providers. As such, diagnostic delays from the failure to recognize emergency conditions lead to adverse patient outcomes. In addition, even with nonemergent pathologies, the failure to provide adequate care can result in suboptimal patient outcomes and unnecessary resource utilization. PURPOSE: We sought to understand the proficiency with which different types of first-line providers can recognize and manage spinal conditions, particularly spinal emergencies. This may aid in tailoring education resources for first-line providers. STUDY DESIGN/SETTING: Cross-sectional analysis of collected single-site data. PATIENT SAMPLE: A total of 143 internal medicine, family medicine, emergency care, and neurology providers. OUTCOME MEASURES: Inter-departmental differences in management of spinal pathology, familiarity, and preparedness for the diagnosis of spinal emergencies. METHODS: A pilot survey was distributed to physicians, physician assistants, and nurse practitioners via the REDCap data collection tool. Chi square, Fisher's Exact, and Kruskal–Wallis tests were utilized, as appropriate. RESULTS: Participants were predominantly physicians (88.1%, n=126), with a smaller percentage of midlevel providers (11.9%, n=17). Bivariate analyses revealed inter-departmental differences in clinical knowledge pertaining to the management of lumbar radiculopathy (p<.0001), epidural abscess (p=.0002), and cervical myelopathy (p<.0001). Following pairwise comparisons of inter-departmental differences, emergency medicine statistically outperformed internal medicine (p=.0007) and neurology (p<.0001) on initial management of lumbar radiculopathy, while also having markedly higher success in identifying and managing epidural abscess with respect to family medicine (p<.0001). The likelihood of appropriate initial treatment of cervical myelopathy was significantly higher for neurology than for emergency medicine (p<.0001). CONCLUSIONS: Disparities exist between the first-line provider specialties with regard to clinical knowledge in managing and proficiently identifying emergent and nonemergent spinal conditions. As appropriate recognition and management of emergent spinal pathologies is essential to patient outcomes and optimal resource utilization, it is necessary that measures be taken educationally to ensure first-line providers are familiar and proficient with the established standard of care for the spinal conditions they will be treating. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.593
P56. Predictive factors of positive online patient ratings of spine surgeons Saisanjana Kalagara1, Eren O. Kuris, MD2, Adam Eltorai, MSc3, John M. DePasse, MD4, Alan H. Daniels, MD5; 1 USA; 2 Department of Orthopaedics, Brown University, Providence, RI, USA; 3 Warren Alpert Medical School of Brown University, Providence, RI, USA; 4 Department of Orthopaedic Surgery, Warren Alpert Brown University, Providence, RI, USA; 5 Warren Alpert Medical School of BU/RI Hospital, Providence, RI, USA BACKGROUND CONTEXT: Online physician rating websites are increasingly utilized by patients to evaluate their doctors. PURPOSE: The purpose of this investigation was to evaluate factors associated with better spine surgeon ratings. STUDY DESIGN/SETTING: Statistical analysis of publicly available data.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
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22.8%) within 5 years. The factors associated with subsequent surgery were age, diagnosis, number of CESIs, depression, chronic obstructive pulmonary disease, alcohol use, U region, and rural versus urban location. Cardiac comorbidities other than congestive heart failure or infarction had lower risk for surgery. Patients with radiculopathy were less likely to progress to surgery following CESI than stenosis or herniation. Additional CESIs reduced the risk for subsequent surgery, with 75% (95% CI: 57%, 95%) higher risk with 1 versus 4 CESIs (p<.001). However, this relationship was dependent on the time to additional CESI, with patients undergoing a second CESI within 2 weeks having a 75% (95% CI: 57%, 95%) higher risk of surgery than those who had a repeat CESI 8 weeks or later. CONCLUSIONS: Following CESI, 22.2% of patients underwent surgery within 5 years. Multiple patient-specific risk factors for subsequent surgery were identified, and patients undergoing repeated injections were at lower risk of proceeding to surgery. Additional analyses comparing matched cohorts of surgical patients with and without prior CESI will further advance our understanding of the value and risks of CESI. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.590
https://doi.org/10.1016/j.spinee.2018.06.589
P52. Cervical epidural steroid injections: incidence and determinants of subsequent surgery John Kleimeyer, MD1, Jayme Koltsov, PhD1, Serena S. Hu, MD2; 1 Redwood City, CA, USA; 2 Stanford University School of Medicine, Redwood City, CA, USA BACKGROUND CONTEXT: Cervical epidural steroid injections (CESIs) are increasingly used in the nonsurgical management of cervical disorders despite conflicting evidence for efficacy. The proportion of patients who delay or avoid surgery with lumbar or cervical ESIs varies widely in the literature, and contradictory determinants of subsequent surgery have been described. PURPOSE: The goals of this study were to determine (1) the incidence of surgery following CESI, (2) the time between CESI and subsequent surgery, and (3) the factors associated with progression to surgery following CESI. STUDY DESIGN/SETTING: Retrospective analysis of deidentified administrative claims data. PATIENT SAMPLE: A national outpatient and inpatient database from 2007 to 2014 was reviewed, containing 149 million unique patients from 2007 to 2014. Inclusion criteria were CESI for diagnoses of cervical disc herniation, myelopathy, radiculopathy, or stenosis, and active enrollment for 1 year prior to the CESI to screen for exclusion criteria. Exclusions include prior cervical surgery, associated neoplasm, pregnancy, inflammatory spondyloarthropathies, fracture (pathologic, nonunion, stress or acute), or infection (abscess, discitis or osteomyelitis). OUTCOME MEASURES: The incidence of subsequent surgery and overall survival, measured as the time from CESI to surgery. METHODS: Patients were followed longitudinally for up to 6 years until they either underwent cervical surgery or had a lapse in health plan enrollment, at which time they were censored. Survival analyses were performed. The rate of surgery and overall survival following CESI were assessed with the Kaplan-Meier survival curve and 95% confidence interval (CI), and factors associated with subsequent surgery were assessed with multivariable Cox proportional hazard models (p<.05). RESULTS: A total of 44,621 unique CESI patients met the inclusion and exclusion criteria (age 50.1±10.7 years, 51.3% female). Fortyeight percent of patients underwent more than 1 CESI, 94.3% of which occurred within 1 year. Within 6 months of CESI, 12.2% (95% CI: 11.9%, 12.5%) of patients underwent surgery, increasing to 15.3% (95% CI: 15.0%, 15.7%) within 1 year and 22.2% (95% CI: 21.7%,
P53. Management of pressure injury with a novel negative pressure device (NPD) in people with spinal cord injury (SCI) Mukesh K. Dwivedi, PhD, PhD1, Rajeshwar Srivastava, MD2; 1 Department of Orthopaedic Surgery, Lucknow, Uttar Pradesh, India; 2 King George’s Medical University, Department of Orthopaedic Surgery, Lucknow, UP, India BACKGROUND CONTEXT: Treatment of pressure injury (PI) is an ongoing clinical challenge particularly in people with SCI in developing countries where socioeconomic conditions often dictate treatment modalities. When negative pressure wound therapy (NPWT) was introduced, there were a series of devices (V.A.C., KCI, San Antonio, TX) manufactured. These devices for NPWT are costly and hard to afford by patients in developing countries like India and others. Commercially available devices are typically rented and require costly consumables. This study focuses on a novel, bellows-powered negative pressure device (NPD) that is easy to apply and does not require electricity. PURPOSE: The purpose of this study was to evaluate wound-healing outcome measures (length, width, and depth, exudate amount, and tissue type) in PIs of spinal cord-injured patients treated with NPWT using a novel negative pressure device versus PI treated with wet-moist gauze (conventional wound care). STUDY DESIGN/SETTING: Randomized controlled clinical trail (RCT) Department of Orthopaedic Surgery, King George’s Medical University, Lucknow, India. This RCT was registered and approved by our institutional ethics committee. PATIENT SAMPLE: Thirty-four (34) spinal cord injury subjects resulting traumatic paraplegia. OUTCOME MEASURES: The outcome measures were surface area (length X width) and depth of PI, granulation tissue formation, exudates, microorganisms and cost effectivenes sat week 0, 3, 6 and week 9. METHODS: Conventional therapy in our facility comprises wet to moistgauze dressings, and this intervention was used for comparison to the experimental intervention (NPWT via bellows enhanced vacuum device). The NPD dressing was changed weekly or more often if the dressing became saturated or loss of suction occurred. RESULTS: Significantly reduced length of PI in NPWT group was observed at week 6 (p=.04) which further reduced at week 9 (p=.001) as compared to conventionally treated group. Similarly significant reduction of width and depth of PI was observed in NPWT at week 9 (p<.05). The exudate decreased significantly (p=.001) in NPWT group from 6th to 9th week. Clearance of slough from wound bed and appearance of red granulation tissue was significantly higher in NPWT group (p=.001). At week 9, the wound culture
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
S166
The Spine Journal 18 (2018) S142 S225
was negative in all the subjects of NPWT group, while it was positive in 10 (41.6) subjects of conventional group. CONCLUSIONS: NPWT by our locally constructed indigenized novel NPD is better wound care procedure and cost effective for management of pressure injury. We also found that the NPD reduced wound exudate, cleared slough, and accelerated the formation of red granulation tissue. Improving basic knowledge of NPWT in the management of PIs may help clinicians and wound care researchers identify and proactively intervene in an effort to minimize the time and cost associated with PI healing in SCI patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.591
P54. YouTube as an educational platform in orthopedics: a novel grading system for lumbar fusion surgery videos Sandip Tarpada, BA1, Matthew Morris, MD1, Sina Rashidi, BA1, Woojin Cho, MD, PhD2; 1 Bronx, NY, USA; 2 Hartsdale, NY, USA BACKGROUND CONTEXT: Since their conception, online video platforms have increasingly been utilized within the surgical community as an educational adjunct to residency curricula. YouTube, in particular, is a commonly cited educational resource by orthopedic surgery residents. To date, despite the growing popularity of orthopedic surgery videos on YouTube among trainees, there exists no uniform system to evaluate these videos for educational value. Here, we propose such a grading scheme applied specifically to orthopedic lumbar fusion videos on YouTube. PURPOSE: To develop and apply a 20-point grading scale to assess the educational value of lumbar fusion surgery videos on YouTube. STUDY DESIGN/SETTING: Prospective study. OUTCOME MEASURES: Educational value score, video view count. METHODS: A 20-point video grading scale was devised and applied to YouTube videos of lumbar fusion surgery. The grading scale took into account a number of factors, including the procedure itself, video quality, and general educational value of the video. The following search terms were used to find relevant videos: “spinal fusion,” “lumbar spinal fusion,” “anterior lumbar interbody fusion,” “posterior lumbar interbody fusion,” “transforaminal lumbar interbody fusion,” “trans psoas interbody fusion,” and “oblique lateral lumbar interbody fusion.” Search terms were entered as plain text within the search box; Boolean operators were not used. The search was refined to include only videos with a run time of 20 or more minutes, found within the first five results pages. Videos targeting patients, from personal accounts, or created for entertainment purposes were strictly excluded. RESULTS: A search yielded 150 nonduplicate videos. Of these, 18 remained after application of inclusion and exclusion criteria. Mean video score was 13.1±2.5 points out of 20. Six videos (33%) achieved scores above 16, and were deemed as useful educational adjuncts for the orthopedic trainee. The mean number of views for videos scoring below 16 points was 11754.4±312.1, significantly greater than that of videos scoring above 16 points (8061.1±112.1; p<.003). CONCLUSIONS: Here, we describe a grading system for assessment of the educational value of lumbar fusion surgery videos on a globally popular online video platform. With the growing number of surgery videos available online, a verified video evaluation system such as ours can prove to be a valuable asset to the orthopedic trainee. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.592
P55. Recognition and management of emergent versus nonemergent spinal pathology amongst first-line providers Joseph Johnson, BS1, Jacob Babu, MD1, Wesley Durand, BS2, Adam Eltorai, MSc2, Shyam A. Patel, MD3, Alan H. Daniels, MD4; 1 Brown University, Providence, RI, USA; 2 Brown University, Warren Alpert Medical School, Providence, RI, USA; 3 LifeSpan/Rhode Island Hospital,
Providence, RI, USA; 4 Warren Alpert Medical School of BU/RI Hospital, Providence, RI, USA BACKGROUND CONTEXT: Spinal pathology, particularly spinal emergencies, require prompt identification, management, and surgical referral (if needed) from first-line providers. As such, diagnostic delays from the failure to recognize emergency conditions lead to adverse patient outcomes. In addition, even with nonemergent pathologies, the failure to provide adequate care can result in suboptimal patient outcomes and unnecessary resource utilization. PURPOSE: We sought to understand the proficiency with which different types of first-line providers can recognize and manage spinal conditions, particularly spinal emergencies. This may aid in tailoring education resources for first-line providers. STUDY DESIGN/SETTING: Cross-sectional analysis of collected single-site data. PATIENT SAMPLE: A total of 143 internal medicine, family medicine, emergency care, and neurology providers. OUTCOME MEASURES: Inter-departmental differences in management of spinal pathology, familiarity, and preparedness for the diagnosis of spinal emergencies. METHODS: A pilot survey was distributed to physicians, physician assistants, and nurse practitioners via the REDCap data collection tool. Chi square, Fisher's Exact, and Kruskal–Wallis tests were utilized, as appropriate. RESULTS: Participants were predominantly physicians (88.1%, n=126), with a smaller percentage of midlevel providers (11.9%, n=17). Bivariate analyses revealed inter-departmental differences in clinical knowledge pertaining to the management of lumbar radiculopathy (p<.0001), epidural abscess (p=.0002), and cervical myelopathy (p<.0001). Following pairwise comparisons of inter-departmental differences, emergency medicine statistically outperformed internal medicine (p=.0007) and neurology (p<.0001) on initial management of lumbar radiculopathy, while also having markedly higher success in identifying and managing epidural abscess with respect to family medicine (p<.0001). The likelihood of appropriate initial treatment of cervical myelopathy was significantly higher for neurology than for emergency medicine (p<.0001). CONCLUSIONS: Disparities exist between the first-line provider specialties with regard to clinical knowledge in managing and proficiently identifying emergent and nonemergent spinal conditions. As appropriate recognition and management of emergent spinal pathologies is essential to patient outcomes and optimal resource utilization, it is necessary that measures be taken educationally to ensure first-line providers are familiar and proficient with the established standard of care for the spinal conditions they will be treating. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2018.06.593
P56. Predictive factors of positive online patient ratings of spine surgeons Saisanjana Kalagara1, Eren O. Kuris, MD2, Adam Eltorai, MSc3, John M. DePasse, MD4, Alan H. Daniels, MD5; 1 USA; 2 Department of Orthopaedics, Brown University, Providence, RI, USA; 3 Warren Alpert Medical School of Brown University, Providence, RI, USA; 4 Department of Orthopaedic Surgery, Warren Alpert Brown University, Providence, RI, USA; 5 Warren Alpert Medical School of BU/RI Hospital, Providence, RI, USA BACKGROUND CONTEXT: Online physician rating websites are increasingly utilized by patients to evaluate their doctors. PURPOSE: The purpose of this investigation was to evaluate factors associated with better spine surgeon ratings. STUDY DESIGN/SETTING: Statistical analysis of publicly available data.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.