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Neurosurgical Outcomes and Translational Research (NOTR) Lab

Neurosurgical Outcomes and Translational Research Laboratory

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Section on Administrative database research

Research in this section evaluates neurosurgical outcomes and performs population based studies using large administrative databases. Databases include VA NSQIP and PTF databases, Marketscan, Medicare, nationwide inpatient sample (NIS), state inpatient databases and cancer registries. A variety of statistical software including SAS, Stata, R, S plus, DTReg, and Treeage are used to perform multivariate analysis, predictive modeling, cost effectiveness, cost utility analysis and economic analysis of spinal surgery. A principal goal is the identification of variation and disparities in utilization and outcomes of neurosurgical care. Ongoing projects in this section include:

·        Outcomes of spinal stenosis and spinal metastases surgery

·        Spinal radiosurgery outcomes

·        Cost effectiveness of new and emerging spinal technologies such as bone morphogenic protein, X-stop interspinous process decompression, and artificial disc replacement.

·        Development of predictive models of neurological morbidity, mortality and clinical outcomes

·        Health economic evaluations of neurological outcomes

·        Risk stratification of neurosurgical patients

·        Racial and ethnic and socioeconomic health disparities in utilitization, diffusion and outcomes of neurosurgical procedures

·        Geographic variations in access, utilization and outcomes

·        Assessment of impact of clinical volume on outcomes

·        Trends in use of neurosurgical procedures and outcomes

·        Variations in physician practices and outcomes

·        Standardized measurement and assessment of complication rates


General outcomes research

Our research in this area focuses on health related quality of life, cost effectiveness and health economic evaluations after neurosurgery. We perform prospective evaluation of clinical and health related quality of life outcomes after a variety of neurosurgical procedures. Outcomes data are prospectively collected preoperatively and postoperatively using web-based HIPAA compliant tablet or ipad computers at the time of clinic visit. The lab also organizes data collection as a pilot site for the American Association of Neurological Surgeons N2QOD registry. We also manage the department of Neurosurgery spinal cord injury database and the spinal metastases registry. Ongoing studies include:

·        Item response theory and computer adaptive testing methodologies to generate more sensitive outcome instruments

·        Measurement of health utilities for cost utility research.

·        Validation of NIH Promis and NeuroQOL instruments in the evaluation of outcomes in the neurosurgical population. This includes validation of NeuroQOL in the SCI and head injury populations and validation of NIH Promis instruments in the degenerative and oncologic spinal disorders population.

·        Systematic and evidence based metaanalytic reviews of the neurosurgical literature.

·        Patient Safety and Quality improvement research

·        Implementation of evidence based recommendations.

·        Prospective collection of clinical and patient satisfaction outcomes after cranial and spinal neurosurgery.


Clinical Trials and Observational registries

This section of the lab coordinates observational studies and clinical trials. We direct the Department of Neurosurgery membership activities of the North American Clinical Trial network (NACTN). We also oversee the departmental spine trauma and spinal cord injury database.

The following clinical trials are ongoing (Riluzole) or in development:

·        Use of Riluzole, a sodium channel blocker in acute spinal cord injury-University of Louisville department of neurosurgery participates in this phase 2 multicenter clinical trial

·        Development of a VA Cooperative Studies Trial comparing X-stop to laminectomy for 1-2 level lumbar stenosis.

·        Development of Spinal radiosurgery plus kyphoplasty versus radiosurgery for management of pain and quality of life in patients with spinal vertebral metastases clinical trial

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