{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T02:08:47Z","timestamp":1769306927699,"version":"3.49.0"},"reference-count":21,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2012,11]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Health care reform debate includes discussions regarding outcomes of surgical interventions. Yet quality of medical care, when judged as a health outcome, is difficult to define because of impediments affecting accuracy in data collection, analysis, and reporting. In this prospective study, the authors report the outcomes for neurosurgical treatment based on point-of-care interactions recorded in the electronic medical record (EMR).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors' neurosurgery practice collected outcome data for 19 physicians and ancillary personnel using the EMR. Data were analyzed for 5361 consecutive surgical cases, either elective or emergency procedures, performed during 2009 at multiple hospitals, offices, and an ambulatory spine surgery center. Main outcomes included complications, length of stay (LOS), and discharge disposition for all patients and for certain frequently performed procedures. Physicians, nurses, and other medical staff used validated scales to record the hospital LOS, complications, disposition at discharge, and return to work.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Of the 5361 surgical procedures performed, two-thirds were spinal procedures and one-third were cranial procedures. Organization-wide compliance with reporting rates of major complications improved throughout the year, from 80.7% in the first quarter to 90.3% in the fourth quarter. Auditing showed that rates of unreported complications decreased from 11% in the first quarter to 4% in the fourth quarter. Complication data were available for 4593 procedures (85.7%); of these, no complications were reported in 4367 (95.1%). Discharge dispositions reported were home in 86.2%, rehabilitation center in 8.9%, and nursing home in 2.5%. Major complications included culture-proven infection in 0.61%, CSF leak in 0.89%, reoperation within the same hospitalization in 0.38%, and new neurological deficits in 0.77%. For the commonly performed procedures, the median hospital LOS was 3 days for craniotomy for aneurysm or intraaxial tumor and less than 1 day for angiogram, anterior cervical discectomy with fusion, or lumbar discectomy.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>With prospectively collected outcome data for more than 5000 surgeries, the authors achieved their primary end point of institution-wide compliance and data accuracy. Components of this process included staged implementation with physician pilot studies and oversight, nurse participation, point-of-service data capture, EMR form modification, data auditing, and confidential surgeon reports.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2012.7.jns111622","type":"journal-article","created":{"date-parts":[[2012,8,10]],"date-time":"2012-08-10T13:56:55Z","timestamp":1344607015000},"page":"947-954","source":"Crossref","is-referenced-by-count":29,"title":["Measuring surgical outcomes in neurosurgery: implementation, analysis, and auditing a prospective series of more than 5000 procedures"],"prefix":"10.3171","volume":"117","author":[{"given":"Philip V.","family":"Theodosopoulos","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J.","family":"Ringer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher M.","family":"McPherson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronald E.","family":"Warnick","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles","family":"Kuntz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Zuccarello","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John M.","family":"Tew","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns111622","series-title":"N Engl J Med","first-page":"557","article-title":"A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures","volume":"361","author":"Buchbinder","year":"2009"},{"key":"b2-jns111622","series-title":"JAMA","first-page":"557","article-title":"Patterns of care for adults with newly diagnosed malignant glioma","volume":"293","author":"Chang","year":"2005"},{"key":"b3-jns111622","series-title":"N Engl J Med","first-page":"394","article-title":"Benefits and hazards of reporting medical outcomes publicly","volume":"334","author":"Chassin","year":"1996"},{"key":"b4-jns111622","series-title":"JAMA","first-page":"847","article-title":"Surgical mortality as an indicator of hospital quality: the problem with small sample size","volume":"292","author":"Dimick","year":"2004"},{"key":"b5-jns111622","series-title":"J Neurosurg Spine","first-page":"443","article-title":"Morbidity and mortality in the surgical treatment of 10,329 adults with degenerative lumbar stenosis. 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II. Is targeting effective?","volume":"266","author":"Rolph","year":"1991"},{"key":"b14-jns111622","series-title":"Neurosurgery","first-page":"1044","article-title":"Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors","volume":"42","author":"Sawaya","year":"1998"},{"key":"b15-jns111622","series-title":"Spine (Phila Pa 1976)","first-page":"E503","article-title":"Agreement between surgeons and an independent panel with respect to surgical site fusion after single-level anterior cervical spine surgery: a prospective, multicenter study","volume":"31","author":"Skolasky","year":"2006"},{"key":"b16-jns111622","series-title":"Spine (Phila Pa 1976)","first-page":"2140","article-title":"Complication rates of three common spine procedures and rates of thromboembolism following spine surgery based on 108,419 procedures: a report from the Scoliosis Research Society Morbidity and Mortality Committee","volume":"35","author":"Smith","year":"2010"},{"key":"b17-jns111622","series-title":"Br J Surg","first-page":"376","article-title":"Measurement of process as quality control in the management of acute surgical emergencies","volume":"94","author":"Stevenson","year":"2007"},{"key":"b18-jns111622","series-title":"Int J Radiat Oncol Biol Phys","first-page":"47","article-title":"The American Society for Therapeutic Radiology and Oncology (ASTRO) evidence-based review of the role of radiosurgery for malignant glioma","volume":"63","author":"Tsao","year":"2005"},{"key":"b19-jns111622","series-title":"JAMA","first-page":"907","article-title":"Patient outcomes after lumbar spinal fusions","volume":"268","author":"Turner","year":"1992"},{"key":"b20-jns111622","series-title":"N Engl J Med","first-page":"311","article-title":"A randomized, controlled trial of surgery for temporal-lobe epilepsy","volume":"345","author":"Wiebe","year":"2001"},{"key":"b21-jns111622","series-title":"J Neurosurg Spine","first-page":"360","article-title":"Early complications in spine surgery and relation to preoperative diagnosis: a single-center prospective study. 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