{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T03:38:29Z","timestamp":1788233909861,"version":"build-2803163510"},"reference-count":72,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,12]]},"abstract":"\n OBJECT<\/jats:title>\n There is a paradigm shift toward rewarding providers for quality rather than volume. Complications appear to occur at a fairly consistent frequency in large aggregate data sets. Understanding how complications affect long-term patient-reported outcomes (PROs) following degenerative lumbar surgery is vital. The authors hypothesized that 90-day complications would adversely affect long-term PROs.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Nine hundred six consecutive patients undergoing elective surgery for degenerative lumbar disease over a period of 4 years were enrolled into a prospective longitudinal registry. The following PROs were recorded at baseline and 12-month follow-up: Oswestry Disability Index (ODI) score, numeric rating scales for back and leg pain, quality of life (EQ-5D scores), general physical and mental health (SF-12 Physical Component Summary [PCS] and Mental Component Summary [MCS] scores) and responses to the North American Spine Society (NASS) satisfaction questionnaire. Previously published minimum clinically important difference (MCID) threshold were used to define meaningful improvement. Complications were divided into major (surgicalsite infection, hardware failure, new neurological deficit, pulmonary embolism, hematoma and myocardial infarction) and minor (urinary tract infection, pneumonia, and deep venous thrombosis).<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Complications developed within 90 days of surgery in 13% (118) of the patients (major in 12% [108] and minor in 8% [68]). The mean improvement in ODI scores, EQ-5D scores, SF-12 PCS scores, and satisfaction at 3 months after surgery was significantly less in the patients with complications than in those who did not have major complications (ODI: 13.5 \u00b1 21.2 vs 21.7 \u00b1 19, < 0.0001; EQ-5D: 0.17 \u00b1 0.25 vs 0.23 \u00b1 0.23, p = 0.04; SF-12 PCS: 8.6 \u00b1 13.3 vs 13.0 \u00b1 11.9, 0.001; and satisfaction: 76% vs 90%, p = 0.002). At 12 months after surgery, the patients with major complications had higher ODI scores than those without complications (29.1 \u00b1 17.7 vs 25.3 \u00b1 18.3, p = 0.02). However, there was no difference in the change scores in ODI and absolute scores across all other PROs between the 2 groups. In multivariable linear regression analysis, after controlling for an array of preoperative variables, the occurrence of a major complication was not associated with worsening ODI scores 12 months after surgery. There was no difference in the percentage of patients achieving the MCID for disability (66% vs 64%), back pain (55% vs 56%), leg pain (62% vs 59%), or quality of life (19% vs 14%) or in patient satisfaction rates (82% vs 80%) between those without and with major complications.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Major complications within 90 days following lumbar spine surgery have significant impact on the short-term PROs. Patients with complications, however, do eventually achieve clinically meaningful outcomes and report satisfaction equivalent to those without major complications. This information allows a physician to counsel patients on the fact that a complication creates frustration, cost, and inconvenience; however, it does not appear to adversely affect clinically meaningful long-term outcomes and satisfaction.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2015.8.focus15302","type":"journal-article","created":{"date-parts":[[2015,12,1]],"date-time":"2015-12-01T03:37:25Z","timestamp":1448941045000},"page":"E8","source":"Crossref","is-referenced-by-count":48,"title":["Effect of complications within 90 days on patient-reported outcomes 3 months and 12 months following elective surgery for lumbar degenerative disease"],"prefix":"10.3171","volume":"39","author":[{"given":"Silky","family":"Chotai","sequence":"first","affiliation":[{"name":"Departments of Orthopaedic Surgery and\u00a0"},{"name":"Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and\u00a0"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott L.","family":"Parker","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery and\u00a0"},{"name":"Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and\u00a0"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahilan","family":"Sivaganesan","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery and\u00a0"},{"name":"Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and\u00a0"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Alex","family":"Sielatycki","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery and\u00a0"},{"name":"Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and\u00a0"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony L.","family":"Asher","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"McGirt","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clinton J.","family":"Devin","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery and\u00a0"},{"name":"Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; and\u00a0"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus15302","series-title":"Spine J","first-page":"1247","article-title":"A predictive model of complications after spine surgery: the National Surgical Quality Improvement Program (NSQIP) 2005-2010","volume":"14","author":"Bekelis","year":"2014"},{"key":"b2-focus15302","series-title":"J Neurosurg Spine","first-page":"37","article-title":"Patient comorbidity score predicting the incidence of perioperative complications: assessing the impact of comorbidities on complications in spine surgery","volume":"16","author":"Campbell","year":"2012"},{"key":"b3-focus15302","series-title":"J Bone Joint Surg Am","first-page":"2089","article-title":"Perioperative complications of posterior lumbar decompression and arthrodesis in older adults","volume":"85-A","author":"Carreon","year":"2003"},{"key":"b4-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"230","article-title":"Risk factors for the development of perioperative complications in elderly patients undergoing lumbar decompression and arthrodesis for spinal stenosis: an analysis of 166 patients","volume":"32","author":"Cassinelli","year":"2007"},{"key":"b5-focus15302","series-title":"Spine J","first-page":"968","article-title":"Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales","volume":"8","author":"Copay","year":"2008"},{"key":"b6-focus15302","series-title":"Spine J","first-page":"8","article-title":"A systematic review of low back pain cost of illness studies in the United States and internationally","volume":"8","author":"Dagenais","year":"2008"},{"key":"b7-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"741","article-title":"The North American spine society lumbar spine outcome assessment Instrument: reliability and validity tests","volume":"21","author":"Daltroy","year":"1996"},{"key":"b8-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"1441","article-title":"United States trends in lumbar fusion surgery for degenerative conditions","volume":"30","author":"Deyo","year":"2005"},{"key":"b9-focus15302","series-title":"Health Policy","first-page":"199","article-title":"EuroQol\u2014a new facility for the measurement of health-related quality of life","volume":"16","author":"EuroQol Group","year":"1990"},{"key":"b10-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"1592","article-title":"The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1223 procedures","volume":"20","author":"Faciszewski","year":"1995"},{"key":"b11-focus15302","series-title":"Spine (Phila Pa 1976","first-page":"2940","article-title":"The Oswestry Disability Index","volume":"25","author":"Fairbank","year":"2000"},{"key":"b12-focus15302","series-title":"Eur Spine J","first-page":"178","article-title":"Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group","volume":"12","author":"Fritzell","year":"2003"},{"key":"b13-focus15302","series-title":"Orthop Clin North Am","first-page":"263","article-title":"An overview of the incidences and costs of low back pain","volume":"22","author":"Frymoyer","year":"1991"},{"key":"b14-focus15302","series-title":"Spine J","first-page":"496","article-title":"Perioperative complications of lumbar instrumentation and fusion in patients with diabetes mellitus","volume":"3","author":"Glassman","year":"2003"},{"key":"b15-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"2764","article-title":"The impact of perioperative complications on clinical outcome in adult deformity surgery","volume":"32","author":"Glassman","year":"2007"},{"key":"b16-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"1596","article-title":"Outcomes and complications of diabetes mellitus on patients undergoing degenerative lumbar spine surgery","volume":"39","author":"Guzman","year":"2014"},{"key":"b17-focus15302","series-title":"J Gen Intern Med","first-page":"487","article-title":"Surgery for herniated lumbar discs: a literature synthesis","volume":"8","author":"Hoffman","year":"1993"},{"key":"b18-focus15302","series-title":"Acta Chir Orthop Traumatol Cech","first-page":"112","article-title":"The effect of complications on the quality of life after surgery for lumbar spine degenerative disease","volume":"77","author":"Jur\u00edcek","year":"2010"},{"key":"b19-focus15302","series-title":"J Neurosurg Spine","first-page":"606","article-title":"Predictors of unplanned readmission in patients undergoing lumbar decompression: multi-institutional analysis of 7016 patients","volume":"20","author":"Kim","year":"2014"},{"key":"b20-focus15302","series-title":"J Neurosurg Spine","first-page":"265","article-title":"Impact of perioperative complications on clinical outcome scores in lumbar fusion surgery","volume":"18","author":"Lambat","year":"2013"},{"key":"b21-focus15302","series-title":"Rheumatol Int","first-page":"145","article-title":"The visual analogue scale: its use in pain measurement","volume":"5","author":"Langley","year":"1985"},{"key":"b22-focus15302","series-title":"N Engl J Med","first-page":"707","article-title":"A strategy for quality assurance in Medicare","volume":"322","author":"Lohr","year":"1990"},{"key":"b23-focus15302","series-title":"JAMA","first-page":"656","article-title":"Expenditures and health status among adults with back and neck problems","volume":"299","author":"Martin","year":"2008"},{"key":"b24-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"2077","article-title":"Trends in health care expenditures, utilization, and health status among US adults with spine problems, 1997-2006","volume":"34","author":"Martin","year":"2009"},{"key":"b25-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"1122","article-title":"Thirty-day perioperative outcomes in spinal fusion by specialty within the NSQIP database","volume":"40","author":"McCutcheon","year":"2015"},{"key":"b26-focus15302","series-title":"J Neurosurg Spine","first-page":"144","article-title":"Complications in spine surgery","volume":"13","author":"Nasser","year":"2010"},{"key":"b27-focus15302","series-title":"J Neurosurg Spine","first-page":"598","article-title":"Utility of minimum clinically important difference in assessing pain, disability, and health state after transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis","volume":"14","author":"Parker","year":"2011"},{"key":"b28-focus15302","series-title":"J Neurosurg Spine","first-page":"154","article-title":"Assessment of the minimum clinically important difference in pain, disability, and quality of life after anterior cervical discectomy and fusion: clinical article","volume":"18","author":"Parker","year":"2013"},{"key":"b29-focus15302","series-title":"J Neurosurg Spine","first-page":"323","article-title":"Factors influencing 2-year health care costs in patients undergoing revision lumbar fusion procedures","volume":"16","author":"Parker","year":"2012"},{"key":"b30-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"87","article-title":"Perioperative complications in revision anterior lumbar spine surgery: incidence and risk factors","volume":"34","author":"Schwender","year":"2009"},{"key":"b31-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"2108","article-title":"The cost effectiveness of surgical versus nonoperative treatment for lumbar disc herniation over two years: evidence from the Spine Patient Outcomes Research Trial (SPORT)","volume":"33","author":"Tosteson","year":"2008"},{"key":"b32-focus15302","series-title":"Pain","first-page":"137","article-title":"Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome: a systematic review of effectiveness and complications","volume":"108","author":"Turner","year":"2004"},{"issue":"2","key":"b33-focus15302","series-title":"Neurosurg Focus","first-page":"e7","article-title":"Complications associated with lumbar stenosis surgery in patients older than 75 years of age","volume":"14","author":"Wang","year":"2003"},{"key":"b34-focus15302","series-title":"Med Care","first-page":"220","article-title":"A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity","volume":"34","author":"Ware","year":"1996"},{"key":"b35-focus15302","series-title":"J Bone Joint Surg Am","first-page":"1295","article-title":"Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. Four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts","volume":"91","author":"Weinstein","year":"2009"},{"key":"b36-focus15302","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","volume":"13","author":"Yadla","year":"2010"},{"key":"b1-focus15302","series-title":"Spine J","first-page":"1247","article-title":"A predictive model of complications after spine surgery: the National Surgical Quality Improvement Program (NSQIP) 2005-2010","volume":"14","author":"Bekelis","year":"2014"},{"key":"b2-focus15302","series-title":"J Neurosurg Spine","first-page":"37","article-title":"Patient comorbidity score predicting the incidence of perioperative complications: assessing the impact of comorbidities on complications in spine surgery","volume":"16","author":"Campbell","year":"2012"},{"key":"b3-focus15302","series-title":"J Bone Joint Surg Am","first-page":"2089","article-title":"Perioperative complications of posterior lumbar decompression and arthrodesis in older adults","volume":"85-A","author":"Carreon","year":"2003"},{"key":"b4-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"230","article-title":"Risk factors for the development of perioperative complications in elderly patients undergoing lumbar decompression and arthrodesis for spinal stenosis: an analysis of 166 patients","volume":"32","author":"Cassinelli","year":"2007"},{"key":"b5-focus15302","series-title":"Spine J","first-page":"968","article-title":"Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales","volume":"8","author":"Copay","year":"2008"},{"key":"b6-focus15302","series-title":"Spine J","first-page":"8","article-title":"A systematic review of low back pain cost of illness studies in the United States and internationally","volume":"8","author":"Dagenais","year":"2008"},{"key":"b7-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"741","article-title":"The North American spine society lumbar spine outcome assessment Instrument: reliability and validity tests","volume":"21","author":"Daltroy","year":"1996"},{"key":"b8-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"1441","article-title":"United States trends in lumbar fusion surgery for degenerative conditions","volume":"30","author":"Deyo","year":"2005"},{"key":"b9-focus15302","series-title":"Health Policy","first-page":"199","article-title":"EuroQol\u2014a new facility for the measurement of health-related quality of life","volume":"16","author":"EuroQol Group","year":"1990"},{"key":"b10-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"1592","article-title":"The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1223 procedures","volume":"20","author":"Faciszewski","year":"1995"},{"key":"b11-focus15302","series-title":"Spine (Phila Pa 1976","first-page":"2940","article-title":"The Oswestry Disability Index","volume":"25","author":"Fairbank","year":"2000"},{"key":"b12-focus15302","series-title":"Eur Spine J","first-page":"178","article-title":"Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group","volume":"12","author":"Fritzell","year":"2003"},{"key":"b13-focus15302","series-title":"Orthop Clin North Am","first-page":"263","article-title":"An overview of the incidences and costs of low back pain","volume":"22","author":"Frymoyer","year":"1991"},{"key":"b14-focus15302","series-title":"Spine J","first-page":"496","article-title":"Perioperative complications of lumbar instrumentation and fusion in patients with diabetes mellitus","volume":"3","author":"Glassman","year":"2003"},{"key":"b15-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"2764","article-title":"The impact of perioperative complications on clinical outcome in adult deformity surgery","volume":"32","author":"Glassman","year":"2007"},{"key":"b16-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"1596","article-title":"Outcomes and complications of diabetes mellitus on patients undergoing degenerative lumbar spine surgery","volume":"39","author":"Guzman","year":"2014"},{"key":"b17-focus15302","series-title":"J Gen Intern Med","first-page":"487","article-title":"Surgery for herniated lumbar discs: a literature synthesis","volume":"8","author":"Hoffman","year":"1993"},{"key":"b18-focus15302","series-title":"Acta Chir Orthop Traumatol Cech","first-page":"112","article-title":"The effect of complications on the quality of life after surgery for lumbar spine degenerative disease","volume":"77","author":"Jur\u00edcek","year":"2010"},{"key":"b19-focus15302","series-title":"J Neurosurg Spine","first-page":"606","article-title":"Predictors of unplanned readmission in patients undergoing lumbar decompression: multi-institutional analysis of 7016 patients","volume":"20","author":"Kim","year":"2014"},{"key":"b20-focus15302","series-title":"J Neurosurg Spine","first-page":"265","article-title":"Impact of perioperative complications on clinical outcome scores in lumbar fusion surgery","volume":"18","author":"Lambat","year":"2013"},{"key":"b21-focus15302","series-title":"Rheumatol Int","first-page":"145","article-title":"The visual analogue scale: its use in pain measurement","volume":"5","author":"Langley","year":"1985"},{"key":"b22-focus15302","series-title":"N Engl J Med","first-page":"707","article-title":"A strategy for quality assurance in Medicare","volume":"322","author":"Lohr","year":"1990"},{"key":"b23-focus15302","series-title":"JAMA","first-page":"656","article-title":"Expenditures and health status among adults with back and neck problems","volume":"299","author":"Martin","year":"2008"},{"key":"b24-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"2077","article-title":"Trends in health care expenditures, utilization, and health status among US adults with spine problems, 1997-2006","volume":"34","author":"Martin","year":"2009"},{"key":"b25-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"1122","article-title":"Thirty-day perioperative outcomes in spinal fusion by specialty within the NSQIP database","volume":"40","author":"McCutcheon","year":"2015"},{"key":"b26-focus15302","series-title":"J Neurosurg Spine","first-page":"144","article-title":"Complications in spine surgery","volume":"13","author":"Nasser","year":"2010"},{"key":"b27-focus15302","series-title":"J Neurosurg Spine","first-page":"598","article-title":"Utility of minimum clinically important difference in assessing pain, disability, and health state after transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis","volume":"14","author":"Parker","year":"2011"},{"key":"b28-focus15302","series-title":"J Neurosurg Spine","first-page":"154","article-title":"Assessment of the minimum clinically important difference in pain, disability, and quality of life after anterior cervical discectomy and fusion: clinical article","volume":"18","author":"Parker","year":"2013"},{"key":"b29-focus15302","series-title":"J Neurosurg Spine","first-page":"323","article-title":"Factors influencing 2-year health care costs in patients undergoing revision lumbar fusion procedures","volume":"16","author":"Parker","year":"2012"},{"key":"b30-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"87","article-title":"Perioperative complications in revision anterior lumbar spine surgery: incidence and risk factors","volume":"34","author":"Schwender","year":"2009"},{"key":"b31-focus15302","series-title":"Spine (Phila Pa 1976)","first-page":"2108","article-title":"The cost effectiveness of surgical versus nonoperative treatment for lumbar disc herniation over two years: evidence from the Spine Patient Outcomes Research Trial (SPORT)","volume":"33","author":"Tosteson","year":"2008"},{"key":"b32-focus15302","series-title":"Pain","first-page":"137","article-title":"Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome: a systematic review of effectiveness and complications","volume":"108","author":"Turner","year":"2004"},{"issue":"2","key":"b33-focus15302","series-title":"Neurosurg Focus","first-page":"e7","article-title":"Complications associated with lumbar stenosis surgery in patients older than 75 years of age","volume":"14","author":"Wang","year":"2003"},{"key":"b34-focus15302","series-title":"Med Care","first-page":"220","article-title":"A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity","volume":"34","author":"Ware","year":"1996"},{"key":"b35-focus15302","series-title":"J Bone Joint Surg Am","first-page":"1295","article-title":"Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. Four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts","volume":"91","author":"Weinstein","year":"2009"},{"key":"b36-focus15302","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","volume":"13","author":"Yadla","year":"2010"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/39\/6\/article-pE8.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/39\/6\/article-pE8.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/39\/6\/article-pE8.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T08:23:59Z","timestamp":1775895839000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/39\/6\/article-pE8.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,12]]},"references-count":72,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2015.8.focus15302","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,12]]}}}