OBJECT Anterior cervical discectomy and fusion (ACDF) is an effective procedure for the treatment of cervical radiculopathy and/or myelopathy; however, postoperative dysphagia is a significant concern. Dexamethasone, although potentially protective against perioperative dysphagia and airway compromise, could inhibit fusion, a generally proinflammatory process. The authors conducted a prospective, randomized, double-blinded, controlled study of the effects of steroids on swallowing, the airway, and arthrodesis related to multilevel anterior cervical reconstruction in patients who were undergoing ACDF at Albany Medical Center between 2008 and 2012. The objective of this study was to determine if perioperative steroid use improves perioperative dysphagia and airway edema. METHODS A total of 112 patients were enrolled and randomly assigned to receive saline or dexamethasone. Data gathered included demographics, functional status (including modified Japanese Orthopaedic Association myelopathy score, neck disability index, 12-Item Short-Form Health Survey score, and patient-reported visual analog scale score of axial and radiating pain), functional outcome swallowing scale score, interval postoperative imaging, fusion status, and complications/reoperations. Follow-up was performed at 1, 3, 6, 12, and 24 months, and CT was performed 6, 12, and 24 months after surgery for fusion assessment. RESULTS Baseline demographics were not significantly different between the 2 groups, indicating adequate randomization. In terms of patient-reported functional and pain-related outcomes, there were no differences in the steroid and placebo groups. However, the severity of dysphagia in the postoperative period up to 1 month proved to be significantly lower in the steroid group than in the placebo group (p = 0.027). Furthermore, airway difficulty and a need for intubation trended toward significance in the placebo group (p = 0.057). Last, fusion rates at 6 months proved to be significantly lower in the steroid group but lost significance at 12 months (p = 0.048 and 0.57, respectively). CONCLUSIONS Dexamethasone administered perioperatively significantly improved swallowing function and airway edema and shortened length of stay. It did not affect pain, functional outcomes, or long-term swallowing status. However, it significantly delayed fusion, but the long-term fusion rates remained unaffected. Clinical trial registration no.: NCT01065961 (clinicaltrials.gov)

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DESCRIPTION An invaluable primer on the surgical and nonsurgical treatment of aging patients with spine conditions The growing population of people aged 65 and older has significant implications for health care systems and spine care providers. Older patients today demand interventions that enable them to return to a functional lifestyle. Treatment of degenerative spine disease in aging adults requires in-depth understanding of changes in physiology, biomechanics, function, and modifiable risk factors. Equally important, providers need to listen to patients, diagnose thoughtfully, learn about the personal goals, and teach them in plain language about the risks, alternatives, and expectations of treatment options. This foundation is critical to developing informed patient-centered treatment plans to improve outcomes. Spine Surgery in an Aging Population by Nathaniel Brooks, Andrea Strayer, and a cadre of global contributors reflects a rich array of expertise. With multidisciplinary contributions from renowned specialists in neurosurgery, orthopaedic surgery, geriatrics, and rehabilitation, the book provides invaluable insights on caring for aging adults with degenerative spine disease. Throughout 21 chapters, readers are provided with key concepts, expert knowledge, and effective management strategies to avoid complications and improve outcomes for older adult spine patients. Key Highlights • Diagnosis and treatment of osteoporosis to help prevent fractures and optimize treatment approaches prior to elective surgery • Management of common pathologies of the aging spine such as cervical spondylosis, lumbar stenosis, spondylolisthesis, degenerative scoliosis and trauma • Special topics include value-based care, nonsurgical management of spinal pain, vertebral augmentation, minimally invasive surgery, and instrumentation considerations This one-stop compendium is essential reading for orthopaedic and neurosurgical residents and fellows, as well as veteran surgeons and allied health providers who care for older adults with spine conditions. This book includes complimentary access to a digital copy on https://medone.thieme.com.

Object The authors studied factors influencing hospital profitability after craniotomy in patients who underwent craniotomy coded as diagnosis-related group (DRG) 1 (17 years of age with nontraumatic disease without complication) and who met their hospital's craniotomy pathway criteria and had a hospital length of stay 4 days or less during a 20-month period. Methods Data in all patients meeting these criteria (76 cases) were collected and collated from various hospital databases. Twenty-one cases were profitable and 55 were not. Variables traditionally influencing cost of care, such as surgeon, procedure, length of operation, and pharmacy use had no significant effect on whether a patient was profitable. The most important influence on profitability was the individual payor. Cases in which care was reimbursed under the prospective payment system based on DRGs were nearly always profitable whereas those covered by per diem plans were nearly always nonprofitable. Conclusions 1) Hospital information systems should be customized to deliver consolidated data for timely analysis of cost of care for individual patients. This information may be useful in negotiating profitable contracts. 2) A clinical pathway was successful in reducing the difference in cost of care between profitable and nonprofitable postcra-niotomy cases. 3) In today's health care environment both cost containment and revenue assume importance in determining profitability.