Introduction: There has been an effort to improve standardization of health care data collection to optimize patient care, follow up, documentation, and care reimbursement. Creating centralized and accurate data through which treatment outcomes can be compared is a powerful tool for studies on treatment efficacy and effectiveness. The purposes of this project were to: 1) define current practice and established outcome measurements across various spine practice settings, and 2) determine data collection needs with the future goal of standardizing collection guidelines across spine care practitioners.

Methods: Surgeons from local spine centers were invited to social and academic meetings to encourage participation commitment. Data sharing agreements and a database infrastructure were established across orthopaedic and neurosurgical departments in private practice and academic institutions. Surgeons were surveyed regarding patient populations treated, length of follow up, and medical record system utilized. Charts from 20-30 patients per site with single level degenerative or isthmic lumbar spondylolisthesis were reviewed for prevalence of demographic, surgical, operational, and outcomes variables. Based on the prevalence of variables, a consensus-based data review and needs assessment was performed to check for errors in data, missing data, and to identify uncollected variables of interest.

Results: Sequential charts for 95 adult and 20 pediatric patients were reviewed, representing 10 surgeons in orthopaedic or neurosurgical divisions across 4 sites. Variables with >90% collection rates across sites included age, gender, BMI, smoking status, diagnosis, surgery type, operating room time, estimated blood loss, discharge disposition, length of stay, 90-day readmission rate, and pre-operative back pain severity. In the pediatric population, the most common surgical approach was laminectomy with posterior fusion (53.6%). In the adult population, surgery type varied by site, with lateral approach fusions being most common (18-75%). However, this data contained errors due to heterogeneity in coding and interpretation, with 90% of surgeons identifying inconsistencies between the coded procedure and type of surgery performed. Prevalence of patient reported outcomes (PROMs) for back pain and disability varied by site, duration of follow up, and patient population (adult vs pediatricss). Back pain severity was collected in 70% of cases at 3 months, but only in 45% by 1 year. Disability was collected in 16% of cases at 3 months and remained consistent over 1 year. It was not collected in pediatric patients.  Medication use, prior treatments, and skin to skin time for staged surgeries was available for 3-23% of cases. After initial data extraction, consensus on coding and surgical type definition, and documentation of skin-to-skin time for staged surgeries were identified as areas for improvement. Variables recommended as high priority for addition included leg pain severity for adult patients, and a single metric for comorbidity assessment.

Discussion:  A successful multi-site collaborative data sharing infrastructure was established for individuals with single level lumbar spondylolisthesis. Despite high collection rates, errors and site variability in surgical coding may have a significant impact on interpretability of study designs involving chart review. Additionally, sparsity of PROMs highlights a need for improving standardized data collection procedures for long term follow up.