{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T20:47:19Z","timestamp":1785444439784,"version":"3.56.0"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The American Spine Registry (ASR) is a collaborative effort between the American Academy of Orthopaedic Surgeons and the American Association of Neurological Surgeons. The goal of this study was to evaluate how representative the ASR is of the national practice with spinal procedures, as recorded in the National Inpatient Sample (NIS).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors queried the NIS and the ASR for cervical and lumbar arthrodesis cases performed during 2017\u20132019. <jats:italic>International Classification of Diseases, 10th Revision<\/jats:italic> and Current Procedural Terminology codes were used to identify patients undergoing cervical and lumbar procedures. The two groups were compared for the overall proportion of cervical and lumbar procedures, age distribution, sex, surgical approach features, race, and hospital volume. Outcomes available in the ASR, such as patient-reported outcomes and reoperations, were not analyzed due to nonavailability in the NIS. The representativeness of the ASR compared to the NIS was assessed via Cohen\u2019s d effect sizes, and absolute standardized mean differences (SMDs) of &lt; 0.2 were considered trivial, whereas &gt; 0.5 were considered moderately large.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 24,800 arthrodesis procedures were identified in the ASR for the period between January 1, 2017, and December 31, 2019. During the same time period, 1,305,360 cases were recorded in the NIS. Cervical fusions comprised 35.9% of the ASR cohort (8911 cases) and 36.0% of the NIS cohort (469,287 cases). The two databases presented trivial differences in terms of patient age and sex for all years of interest across both cervical and lumbar arthrodeses (SMD &lt; 0.2). Trivial differences were also noted in the distribution of open versus percutaneous procedures of the cervical and lumbar spine (SMD &lt; 0.2). Among lumbar cases, anterior approaches were more common in the ASR than in the NIS (32.1% vs 22.3%, SMD = 0.22), but the discrepancy among cervical cases in the two databases was trivial (SMD = 0.03). Small differences were illustrated in terms of race, with SMDs &lt; 0.5, and a more significant discrepancy was identified in the geographic distribution of participating sites (SMDs of 0.7 and 0.74 for cervical and lumbar cases, respectively). For both of these measures, SMDs in 2019 were smaller than those in 2018 and 2017.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The ASR and NIS databases presented a very high similarity in proportions of cervical and lumbar spine surgeries, as well as similar distributions of age and sex, and distribution of open versus endoscopic approach. Slight discrepancies in anterior versus posterior approach among lumbar cases and patient race, and more significant discrepancies in geographic representation were also identified, yet decreasing trends in differences suggested the improving representativeness of the ASR over the course of time and its progressive growth. These conclusions are important to underline the external validity of quality investigations and research conclusions to be drawn from analyses in which the ASR is used.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.3.spine221264","type":"journal-article","created":{"date-parts":[[2023,5,6]],"date-time":"2023-05-06T15:53:05Z","timestamp":1683388385000},"page":"228-237","source":"Crossref","is-referenced-by-count":8,"title":["Representativeness of the American Spine Registry: a comparison of patient characteristics with the National Inpatient Sample"],"prefix":"10.3171","volume":"39","author":[{"given":"Mohamad","family":"Bydon","sequence":"first","affiliation":[{"name":"Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota;"},{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeeshan M.","family":"Sardar","sequence":"additional","affiliation":[{"name":"Departments of Orthopedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgos D.","family":"Michalopoulos","sequence":"additional","affiliation":[{"name":"Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota;"},{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"El Sammak","sequence":"additional","affiliation":[{"name":"Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota;"},{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew K.","family":"Chan","sequence":"additional","affiliation":[{"name":"Neurological Surgery, Columbia University, The Och Spine Hospital at NewYork-Presbyterian, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah Y.","family":"Carreon","sequence":"additional","affiliation":[{"name":"Norton Leatherman Spine Center, Louisville, Kentucky;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Norheim","sequence":"additional","affiliation":[{"name":"Southern California Permanente Medical Group, Downey, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John K.","family":"Ratliff","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Tumial\u00e1n","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Pugely","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Steinmetz","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wellington","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J.","family":"Knightly","sequence":"additional","affiliation":[{"name":"Atlantic Neurosurgical Specialists, Morristown, New 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Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric A.","family":"Potts","sequence":"additional","affiliation":[{"name":"Goodman Campbell Brain and Spine, St. Vincent Health, Indianapolis, Indiana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domagoj","family":"Coric","sequence":"additional","affiliation":[{"name":"Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Y.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Miami, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheeraz","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv 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Tim","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darrel","family":"Brodke","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann R.","family":"Stroink","sequence":"additional","affiliation":[{"name":"Central Illinois Neuro Health Science, Bloomington, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica F.","family":"Bisson","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regis W.","family":"Haid","sequence":"additional","affiliation":[{"name":"Atlanta Brain and Spine Care, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony L.","family":"Asher","sequence":"additional","affiliation":[{"name":"Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doug","family":"Burton","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven D.","family":"Glassman","sequence":"additional","affiliation":[{"name":"Norton Leatherman Spine Center, Louisville, Kentucky;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Quality Outcomes Database Spine Care Project 2012-2020: milestones achieved in a collaborative North American outcomes registry to advance value-based spine care and evolution to the American Spine Registry","volume":"48","author":"Asher AL","year":"2020","unstructured":"Asher AL, Knightly J, Mummaneni PV,  Quality Outcomes Database Spine Care Project 2012-2020: milestones achieved in a collaborative North American outcomes registry to advance value-based spine care and evolution to the American Spine Registry. 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Accessed March 24, 2023. http:\/\/support.sas.com\/resources\/papers\/proceedings12\/335-2012.pdf"},{"key":"b13","series-title":"J Proc Asiatic Soc Bengal","first-page":"541","article-title":"On test and measures of group divergence: theoretical formulae","volume":"26","author":"Mahalanobis PC","year":"1930","unstructured":"Mahalanobis PC. On test and measures of group divergence: theoretical formulae. J Proc Asiatic Soc Bengal. 1930;26:541\u2013588."},{"key":"b14","article-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen J","year":"1998","unstructured":"Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Routledge; 1998."},{"issue":"20","key":"b15","series-title":"JAMA","first-page":"2011","article-title":"Adherence to methodological standards in research using the National Inpatient Sample","volume":"318","author":"Khera R","year":"2017","unstructured":"Khera R, Angraal S, Couch T,  Adherence to methodological standards in research using the National Inpatient Sample. JAMA. 2017;318(20):2011\u20132018.29183077"},{"issue":"9","key":"b16","series-title":"PLoS One","first-page":"e0183667","article-title":"Impact of clinical registries on quality of patient care and clinical outcomes: a systematic review","volume":"12","author":"Hoque DME","year":"2017","unstructured":"Hoque DME, Kumari V, Hoque M, Ruseckaite R, Romero L, Evans SM. Impact of clinical registries on quality of patient care and clinical outcomes: a systematic review. PLoS One. 2017;12(9):e0183667.28886607"},{"issue":"12","key":"b17","series-title":"BMJ Open","first-page":"e030984","article-title":"Economic evaluation of clinical quality registries: a systematic review","volume":"9","author":"Lee P","year":"2019","unstructured":"Lee P, Chin K, Liew D,  Economic evaluation of clinical quality registries: a systematic review. BMJ Open. 2019;9(12):e030984.31843824"},{"issue":"4","key":"b18","series-title":"Ann Surg","first-page":"619","article-title":"Cost-effectiveness of the National Surgical Quality Improvement Program","volume":"254","author":"Hollenbeak CS","year":"2011","unstructured":"Hollenbeak CS, Boltz MM, Wang L,  Cost-effectiveness of the National Surgical Quality Improvement Program. Ann Surg. 2011;254(4):619\u2013624.22039608"},{"issue":"6","key":"b19","series-title":"J Neurosurg Spine","first-page":"984","article-title":"The Nationwide Inpatient Sample database does not accurately reflect surgical indications for fusion","volume":"21","author":"Gologorsky Y","year":"2014","unstructured":"Gologorsky Y, Knightly JJ, Chi JH, Groff MW. The Nationwide Inpatient Sample database does not accurately reflect surgical indications for fusion. J Neurosurg Spine. 2014;21(6):984\u2013993."},{"key":"b20","series-title":"Evid Based Complement Alternat Med","first-page":"694804","article-title":"How to assess the external validity and model validity of therapeutic trials: a conceptual approach to systematic review methodology","volume":"2014","author":"Khorsan R","year":"2014","unstructured":"Khorsan R, Crawford C. How to assess the external validity and model validity of therapeutic trials: a conceptual approach to systematic review methodology. Evid Based Complement Alternat Med. 2014;2014:694804.24734111"},{"issue":"1","key":"b21","series-title":"Int J Epidemiol","first-page":"89","article-title":"How to assess the external validity of therapeutic trials: a conceptual approach","volume":"39","author":"Dekkers OM","year":"2010","unstructured":"Dekkers OM, von Elm E, Algra A, Romijn JA, Vandenbroucke JP. How to assess the external validity of therapeutic trials: a conceptual approach. Int J Epidemiol. 2010;39(1):89\u201394.19376882"},{"issue":"1","key":"b22","series-title":"Health Qual Life Outcomes","first-page":"106","article-title":"Impact of missing data on bias and precision when estimating change in patient-reported outcomes from a clinical registry","volume":"17","author":"Ayilara OF","year":"2019","unstructured":"Ayilara OF, Zhang L, Sajobi TT, Sawatzky R, Bohm E, Lix LM. Impact of missing data on bias and precision when estimating change in patient-reported outcomes from a clinical registry. 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