Agreement between surgeons and an independent panel with respect to surgical site fusion after single-level anterior cervical spine surgery: A prospective, multicenter study

Richard Skolasky, Anica M. Maggard, Alan S. Hilibrand, Bruce E. Northrup, Christopher G. Ullrich, Todd J. Albert, Jeffrey D. Coe, Lee H Riley

Research output: Contribution to journalArticle

Abstract

STUDY DESIGN.: Prospective multicenter cohort study. OBJECTIVE.: To assess the: (1) agreement between surgeon and independent review of fusion after single-level anterior cervical decompression and fusion, and (2) influence of surgeon impression of patient status on agreement. SUMMARY OF BACKGROUND DATA.: Failure to achieve fusion can lead to poor functional outcome. Visual inspection of plain radiographs is used to assess fusion, but this assessment's reliability is not well understood. METHODS.: Of 668 participants in the Cervical Spine Research Society Outcomes Study, 181 underwent single-level procedures. Three independent reviewers and each surgeon assessed fusion (i.e., radiographic trabecular bridging of the graft-vertebral body gap and absence of spinous process motion) on plain radiographs at 3 and 6 months after surgery. Agreement was evaluated with an intraclass correlation coefficient (ICC). The influence of surgeon impression of patient status on agreement was assessed with logistic regression analysis. RESULTS.: Agreement was high among reviewers (ICC 0.822 to 0.892) but poor between reviewers and surgeons (ICC 0.308 to 0.484); disagreement was higher when the surgeon reported medical (odds ratio [OR] = 0.19, 95%; confidence interval [CI] 0.12, 0.30; P <0.001), neurologic (OR = 0.13, 95% CI: 0.09, 0.21, P <0.001), or functional (OR = 0.19, 95% CI: 0.12, 0.29, P <0.001) improvement than when the surgeon did not report this improvement. CONCLUSIONS.: The finding that surgeons and independent reviewers disagreed on fusion assessment highlights the need for objective and reproducible measures of fusion.

Original languageEnglish (US)
JournalSpine
Volume31
Issue number15
DOIs
StatePublished - Jul 2006

Fingerprint

Multicenter Studies
Spine
Prospective Studies
Odds Ratio
Confidence Intervals
Needs Assessment
Surgeons
Decompression
Nervous System
Cohort Studies
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)
Transplants
Research

Keywords

  • Anterior cervical decompression and fusion
  • Cervical spine
  • Fusion
  • Intraclass correlation

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Agreement between surgeons and an independent panel with respect to surgical site fusion after single-level anterior cervical spine surgery : A prospective, multicenter study. / Skolasky, Richard; Maggard, Anica M.; Hilibrand, Alan S.; Northrup, Bruce E.; Ullrich, Christopher G.; Albert, Todd J.; Coe, Jeffrey D.; Riley, Lee H.

In: Spine, Vol. 31, No. 15, 07.2006.

Research output: Contribution to journalArticle

Skolasky, Richard ; Maggard, Anica M. ; Hilibrand, Alan S. ; Northrup, Bruce E. ; Ullrich, Christopher G. ; Albert, Todd J. ; Coe, Jeffrey D. ; Riley, Lee H. / Agreement between surgeons and an independent panel with respect to surgical site fusion after single-level anterior cervical spine surgery : A prospective, multicenter study. In: Spine. 2006 ; Vol. 31, No. 15.
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abstract = "STUDY DESIGN.: Prospective multicenter cohort study. OBJECTIVE.: To assess the: (1) agreement between surgeon and independent review of fusion after single-level anterior cervical decompression and fusion, and (2) influence of surgeon impression of patient status on agreement. SUMMARY OF BACKGROUND DATA.: Failure to achieve fusion can lead to poor functional outcome. Visual inspection of plain radiographs is used to assess fusion, but this assessment's reliability is not well understood. METHODS.: Of 668 participants in the Cervical Spine Research Society Outcomes Study, 181 underwent single-level procedures. Three independent reviewers and each surgeon assessed fusion (i.e., radiographic trabecular bridging of the graft-vertebral body gap and absence of spinous process motion) on plain radiographs at 3 and 6 months after surgery. Agreement was evaluated with an intraclass correlation coefficient (ICC). The influence of surgeon impression of patient status on agreement was assessed with logistic regression analysis. RESULTS.: Agreement was high among reviewers (ICC 0.822 to 0.892) but poor between reviewers and surgeons (ICC 0.308 to 0.484); disagreement was higher when the surgeon reported medical (odds ratio [OR] = 0.19, 95{\%}; confidence interval [CI] 0.12, 0.30; P <0.001), neurologic (OR = 0.13, 95{\%} CI: 0.09, 0.21, P <0.001), or functional (OR = 0.19, 95{\%} CI: 0.12, 0.29, P <0.001) improvement than when the surgeon did not report this improvement. CONCLUSIONS.: The finding that surgeons and independent reviewers disagreed on fusion assessment highlights the need for objective and reproducible measures of fusion.",
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T1 - Agreement between surgeons and an independent panel with respect to surgical site fusion after single-level anterior cervical spine surgery

T2 - A prospective, multicenter study

AU - Skolasky, Richard

AU - Maggard, Anica M.

AU - Hilibrand, Alan S.

AU - Northrup, Bruce E.

AU - Ullrich, Christopher G.

AU - Albert, Todd J.

AU - Coe, Jeffrey D.

AU - Riley, Lee H

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N2 - STUDY DESIGN.: Prospective multicenter cohort study. OBJECTIVE.: To assess the: (1) agreement between surgeon and independent review of fusion after single-level anterior cervical decompression and fusion, and (2) influence of surgeon impression of patient status on agreement. SUMMARY OF BACKGROUND DATA.: Failure to achieve fusion can lead to poor functional outcome. Visual inspection of plain radiographs is used to assess fusion, but this assessment's reliability is not well understood. METHODS.: Of 668 participants in the Cervical Spine Research Society Outcomes Study, 181 underwent single-level procedures. Three independent reviewers and each surgeon assessed fusion (i.e., radiographic trabecular bridging of the graft-vertebral body gap and absence of spinous process motion) on plain radiographs at 3 and 6 months after surgery. Agreement was evaluated with an intraclass correlation coefficient (ICC). The influence of surgeon impression of patient status on agreement was assessed with logistic regression analysis. RESULTS.: Agreement was high among reviewers (ICC 0.822 to 0.892) but poor between reviewers and surgeons (ICC 0.308 to 0.484); disagreement was higher when the surgeon reported medical (odds ratio [OR] = 0.19, 95%; confidence interval [CI] 0.12, 0.30; P <0.001), neurologic (OR = 0.13, 95% CI: 0.09, 0.21, P <0.001), or functional (OR = 0.19, 95% CI: 0.12, 0.29, P <0.001) improvement than when the surgeon did not report this improvement. CONCLUSIONS.: The finding that surgeons and independent reviewers disagreed on fusion assessment highlights the need for objective and reproducible measures of fusion.

AB - STUDY DESIGN.: Prospective multicenter cohort study. OBJECTIVE.: To assess the: (1) agreement between surgeon and independent review of fusion after single-level anterior cervical decompression and fusion, and (2) influence of surgeon impression of patient status on agreement. SUMMARY OF BACKGROUND DATA.: Failure to achieve fusion can lead to poor functional outcome. Visual inspection of plain radiographs is used to assess fusion, but this assessment's reliability is not well understood. METHODS.: Of 668 participants in the Cervical Spine Research Society Outcomes Study, 181 underwent single-level procedures. Three independent reviewers and each surgeon assessed fusion (i.e., radiographic trabecular bridging of the graft-vertebral body gap and absence of spinous process motion) on plain radiographs at 3 and 6 months after surgery. Agreement was evaluated with an intraclass correlation coefficient (ICC). The influence of surgeon impression of patient status on agreement was assessed with logistic regression analysis. RESULTS.: Agreement was high among reviewers (ICC 0.822 to 0.892) but poor between reviewers and surgeons (ICC 0.308 to 0.484); disagreement was higher when the surgeon reported medical (odds ratio [OR] = 0.19, 95%; confidence interval [CI] 0.12, 0.30; P <0.001), neurologic (OR = 0.13, 95% CI: 0.09, 0.21, P <0.001), or functional (OR = 0.19, 95% CI: 0.12, 0.29, P <0.001) improvement than when the surgeon did not report this improvement. CONCLUSIONS.: The finding that surgeons and independent reviewers disagreed on fusion assessment highlights the need for objective and reproducible measures of fusion.

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KW - Cervical spine

KW - Fusion

KW - Intraclass correlation

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