AANS Neurosurgeon | Volume 27, Number 2, 2018


NPA Report

NPA Welcomes Intermountain Healthcare to Quality Outcomes Database
Health System Joins North America’s Largest Spine Registry

Intermountain Healthcare recently signed on as NeuroPoint Alliance’s (NPA) first health system. Intermountain is participating in all of the current Quality Outcomes Databases (QOD): Lumbar, Deformity, Cervical and Neurovascular and are awaiting the fifth QOD registry, Tumor, which NPA plans to have online in 2018.

Four hospitals, representing 18 neurosurgeons and ortho-spine surgeons, are currently being trained to submit data to QOD. Two other hospitals will be added in subsequent years.

“Intermountain Healthcare has an international reputation for safe, cost-effective delivery of health care and quality improvement processes. In an effort to further elevate the level of spine and cranial surgery and procedures performed at each of our Intermountain Healthcare hospitals, our system-wide neuroscience clinical program has partnered with NPA’s QOD. Our system-wide goal, when it comes to spine and cranial patient outcomes, is real-time, standardized benchmarking: locally within our own health care system as well as regionally and nationally,” said Ben Fox, MD, medical director, neurosurgery, at Intermountain Healthcare.

“This partnership with QOD allows us to benchmark safety, cost and patient-reported outcomes locally between our various internal Intermountain Healthcare institutions where spine and cranial procedures are performed. It also allows us to use QOD’s nationwide database to compare our patient outcomes to other facilities and nationwide data in a real-time, as well as between the individual Intermountain Healthcare hospitals and the healthcare organization as a whole,” Fox added.

Robert E. Harbaugh, MD, FAANS, chair of the NPA, stated, “QOD Spine is the largest spine surgery registry in North America and has been generating reliable data for benchmarking, documenting the value of surgical care and quality improvement. We realized we needed a data reporting solution not only for individual practices but also for hospitals and hospital systems. The addition of high performing health systems like Intermountain will add to the value of the registry and to the well-being of our patients.”

As Peter Maughan, MD, medical director, Intermountain Medical Center Neurosciences Institute, added, “Participating in QOD is another step in our commitment to providing quality care that is both efficient and cost effective.”

QOD Clinical Fellow Dr. Silky Chotai Joins Neurosurgery Residency at Vanderbilt University Medical Center
As a clinical fellow at the Vanderbilt University Medical Center’s QOD Coordinating Center, Silky Chotai, MD, has been an integral part of the Quality Outcomes Database (QOD) project since August 2014. QOD Directors Anthony L. Asher, MD, FAANS, and Mohamad Bydon, MD, and the NPA Board of Directors and staff congratulate Chotai as she joins the neurosurgery residency program at Vanderbilt University Medical Center starting July 1, 2017.

“Chotai has been a critically important member of the QOD scientific team that created and now administers the nation’s largest spine registry program,” said Dr. Asher. “Her contributions to the QOD have ranged from the development of predictive models and important manuscripts, to the creation of essential registry infrastructure. It is safe to say that this unprecedented effort would not have achieved its present level of success without her efforts.”

Clinton J. Devin, MD, associate professor of Orthopedic Surgery and Neurosurgery at the Vanderbilt Spine Center adds, “We are excited, yet sad, for Chotai to begin her next chapter in life as a neurosurgical resident at Vanderbilt University Medical Center. She hit the ground running and has been one of the most talented and driven individuals I have had the privilege of working with in my professional career. Her tireless efforts have allowed her to be the go-to clinical expert for site coordinators, as well as organize the analytics and paper preparation for important QOD efforts.”

Chotai received her medical degree from the Medical College Baroda, India, and obtained basic neurosurgical training in China and South Korea. She pursued a micro-neurosurgical skull base research fellowship at The Ohio State University, in Columbus, Ohio, followed by a minimally invasive neurosurgery fellowship at Weill Cornell Medical College in New York. She joined Vanderbilt Spine Center as a post-doctoral spine fellow while serving the QOD program. She has over 50 articles in high impact peer-reviewed neurosurgical journals, along with several abstracts, book chapters and awards to her credit. She also serves as an editorial board member and reviewer for multiple national and international journals.

“Silky Chotai is an excellent clinical scientist”, said Dr. Bydon. “She has a strong background in statistics and predictive analytics in addition to all of her work on registry development. More importantly, she has excellent character: hard working, pleasant and diligent. The QOD registry would not be where it is today without her participation and effort.”

Chotai will be missed, but everyone involved in the QOD project is confident that she will excel in the next adventure in her life. Robert E. Harbaugh, MD, FAANS, chair of the NPA Board of Directors notes, “Chotai demonstrates all the qualities one associates with a successful neurosurgeon – intellect, perseverance, an outstanding work ethic and an engaging personality. I am sure she has a great neurosurgical career ahead of her.”

Along with conveying our sincerest appreciation, we wish Dr. Chotai the very best as she begins her neurosurgical training program.

RAD-PD Parkinson’s Disease Registry Project
Work continues on the Registry for Advancement of DBS (deep brain stimulation) therapy in Parkinson’s Disease (RAD-PD). The primary aim of the registry is to facilitate the creation of a well-characterized patient cohort that has undergone longitudinal assessments, analysis of which will have the potential to answer clinical questions that are not feasible using standard randomized controlled trial methodology. Registry objectives include identifying the best practices surrounding DBS therapy, identifying the adverse effects (and their determinants) of DBS therapy and identifying the health economics and disparities related to DBS therapy in a contemporary setting. 

On March 3, 2017, the RAD-PD proposal was presented to the Michael J. Fox Foundation in New York and was met with positive feedback. The proposal is now undergoing review by the Parkinson Study Group (PSG) with a final project proposal due to the PSG in August 2017. Under this proposal, the NPA will provide registry management services for the RAD-PD in the areas of regulatory management, registry site management, data management and project management. The NPA will also provide technical platform management working with Neurotargeting, LLC. It is anticipated that the registry project will start in the fourth quarter of 2017.



Welcome to New QOD Centers

Swedish Neuroscience Institute









Louisiana State University at Shreveport

Shreveport, La.


Virginia Commonwealth University

Richmond, Va.


Intermountain Healthcare/Intermountain Medical Center

Murray, Utah


Intermountain Healthcare/Dixie Regional Medical Center

Saint George, Utah


Intermountain Healthcare/McKay-Dee Hospital

Ogden, Utah


Intermountain Healthcare/Utah Valley Hospital

Provo, Utah


Intermountain Healthcare/The Orthopedic Specialty Hospital

Murray, Utah



Intermountain Healthcare/Logan Regional Hospital

Logan, Utah



Catholic Health System/Sisters of Charity Hospital

Buffalo, N.Y.



Catholic Health System/Mercy Hospital of Buffalo

Buffalo, N.Y.



Catholic Health System/Kenmore Mercy Hospital

Kenmore, N.Y.



Orlando Health/UF Health Neurosurgery                          Orlando, Fla.


NPA 2017 AANS Annual Scientific Meeting Presentation: Lumbar Fusion for Symptomatic Mechanical Disc Collapse Without Stenosis Improves Pain, Disability and Quality of Life: Rethinking the Debate on Degenerative Disc Disease Based on Quality Outcome Database

Presenting Author: Silky Chotai, MD
The QOD, now in its sixth year, is a national prospective clinical registry for surgical procedures and practice patterns and is a major initiative of the NPA. The QOD tracks the quality of surgical care for the most common neurosurgical and spine procedures and provides practices and hospitals with an immediate infrastructure for analyzing and reporting the quality of their care. Through the NPA, actively participating academic and private-practice surgeons have the opportunity to become involved in a number of clinical outcome research projects involving the scientific analyses of the QOD aggregate dataset. The following QOD presentation was delivered at the 2017 AANS Annual Scientific Meeting in Los Angeles:

There is a lack of evidence evaluating the effectiveness of spine fusion in patients with medically refractory mechanical axial back pain and significant lumbar disc height collapse. The investigators set out to determine the 12-month patient-reported outcomes (PROs) for patients undergoing single-level lumbar fusion surgery for the diagnosis of symptomatic mechanical disc collapse.

Patients undergoing elective surgery for symptomatic mechanical disc collapse and enrolled in QOD registry were queried. Symptomatic mechanical disc collapse is defined as reproducible mechanical axial back pain with more than 50 percent disc height loss without stenosis or spondylolisthesis proven to be medically refractory for more than three months. Baseline and 12-month PROs, including Oswestry Disability Index (ODI), pain: numeric rating pain [NRS- back pain (BP) and leg pain (LP)] and quality of life (EQ-5D) and return-to-work were analyzed.

The study included 7,618 patients cases at 74 hospitals in 26 U.S. states who completed 12-month PROs. Symptomatic mechanical disc collapse represented a minority of surgical cases  [42 (0.55 percent)]. All cases were single-level fusion and associated with mean estimated blood loss (327 cc), length of stay (3.5 days), discharge to inpatient rehabilitation (12 percent), 30-day morbidity (9 percent) and 90-day all-cause readmission (9 percent). Lumbar fusion resulted in improvement in NRS-BP: 8 vs 5.3; P<0.001); NRS-LP: 6.5 vs 4.3; P<0.001; disability (ODI: 54 vs 42, P<0.001); and quality of life (EQ-5D: 0.49 vs 0.59; P<0.005) at 12 months. Postoperative return to work reached 66 percent at three months and 100 percent by 12 months. Lumbar fusion for symptomatic mechanical disc collapse without stenosis or spondylolisthesis represented the minority of surgical practice at the 74 Quality Outcomes Database centers between 2010 and 2015. Lumbar spine fusions for degenerative disc diseases are under scrutiny by physicians, patients, insurance companies and policy makers. To accurately interpret the outcomes after any intervention, it is vital to clearly define a focused study population and report consistent outcome measures. In this study, we evaluate the outcomes after fusion surgery for patients with diagnosis of single-level symptomatic mechanical disc collapse without stenosis and spondylolisthesis who are refractory to medical treatment. Symptomatic mechanical disc collapse is one of the six diagnostic categories included in the QOD registry since its inception. At 74 QOD sites across over 20 states, less than 1 percent of patients underwent fusion surgery under this focused diagnostic category. However, those patients undergoing lumbar fusion for this narrowed definition of degenerative disc disease experienced improvements in all measured domains of health, suggesting lumbar fusion is an effective treatment for back pain arising from mechanical disc collapse.


Matthew Joseph McGirt, MD, FAANS(1), Clinton J. Devin, MD(2), Deborah Pfortmiller, PhD(1), Silky Chotai, MD(2), Steven D. Glassman, MD(4), Praveen V. Mummaneni, MD, FAANS(5), Kevin T. Foley, MD, FAANS(6), Christopher I. Shaffrey, MD, FAANS(7), Mohamad Bydon, MD(8), Anthony L. Asher, MD, FAANS

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