• Anthony L Asher, Ted Speroff, Robert S Dittus, Scott L Parker, Jason M Davies, Nathan Selden, Hui Nian, Steven Glassman, Praveen Mummaneni, Christopher Shaffrey, Clarence Watridge, Joseph S Cheng, and Mathew J McGirt.
• *Carolina Neurosurgery and Spine Associates and the Carolinas Healthcare System Neuroscience Institute, Charlotte, NC †Vanderbilt Institute for Medicine and Public Health, Vanderbilt University, Nashville, TN ‡Department of Medicine, Vanderbilt University School of Medicine and Veterans Affairs Tennessee Valley Healthcare System, Nashville §Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN ¶Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN ∥Department of Neurological Surgery, University of California San Francisco **Department of Neurological Surgery, Oregon Health & Science University, Portland ††Department of Orthopedic Surgery, University of Louisville and the Norton Leatherman Spine Center, Louisville, KY ‡‡Department of Neurosurgery, University of Virginia Medical School, Charlottesville; and §§Semmes-Murphey Neurologic and Spine Institute, Memphis, TN.
• Spine. 2014 Oct 15;39(22 Suppl 1):S106-16.

Study DesignNational Prospective Observational Registry.ObjectiveDescribe our preliminary experience with the National Neurosurgery Quality and Outcomes Database (NQOD), a national collaborative registry of quality and outcomes reporting after low back surgery.Summary Of Background DataAll major health care stakeholders are now requiring objective data regarding the value of medical services. Surgical therapies for spinal disorders have faced particular scrutiny in recent value-based discussions, in large part due to the dramatic growth in the cost and application of these procedures. Reliable data are fundamental to understanding the value of delivered health care. Clinical registries are increasingly used to provide such data.MethodsThe NQOD is a prospective observational registry designed to establish risk-adjusted expected morbidity and 1-year outcomes for the most common lumbar surgical procedures performed by spine surgeons; provide practice groups and hospitals immediate infrastructure for analyzing their 30-day morbidity and mortality and 3- and 12-month quality data in real-time; generate surgeon-, practice-, and specialty-specific quality and efficacy data; and generate nationwide quality and effectiveness data on specific surgical treatments.ResultsIn its first 2 years of operation, the NQOD has proven to be a robust data collection platform that has helped demonstrate the objective quality of surgical interventions for medically refractory disorders of the lumbar spine. Lumbar spine surgery was found to be safe and effective at the group mean level in routine practice. Subgroups of patients did not report improvement using validated outcome measures. Substantial variation in treatment response was observed among individual patients.ConclusionThe NQOD is now positioned to determine the combined contribution of patient variables to specific clinical and patient-reported outcomes. These analyses will ultimately facilitate shared decision making and encourage efficient allocation of health care resources, thus significantly advancing the value paradigm in spine care.Level Of Evidence3.

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