Objective: In the digital age, patients turn to online sources for lumbar spine fusion information, necessitating a careful study of large language models (LLMs) like chat generative pre-trained transformer (ChatGPT) for patient education.Methods: Our study aims to assess the response quality of Open AI (artificial intelligence)’s ChatGPT 3.5 and Google’s Bard to patient questions on lumbar spine fusion surgery. We identified 10 critical questions from 158 frequently asked ones via Google search, which were then presented to both chatbots. Five blinded spine surgeons rated the responses on a 4-point scale from ‘unsatisfactory’ to ‘excellent.’ The clarity and professionalism of the answers were also evaluated using a 5-point Likert scale.Results: In our evaluation of 10 questions across ChatGPT 3.5 and Bard, 97% of responses were rated as excellent or satisfactory. Specifically, ChatGPT had 62% excellent and 32% minimally clarifying responses, with only 6% needing moderate or substantial clarification. Bard’s responses were 66% excellent and 24% minimally clarifying, with 10% requiring more clarification. No significant difference was found in the overall rating distribution between the 2 models. Both struggled with 3 specific questions regarding surgical risks, success rates, and selection of surgical approaches (Q3, Q4, and Q5). Interrater reliability was low for both models (ChatGPT: k = 0.041, p = 0.622; Bard: k = -0.040, p = 0.601). While both scored well on understanding and empathy, Bard received marginally lower ratings in empathy and professionalism.Conclusion: ChatGPT3.5 and Bard effectively answered lumbar spine fusion FAQs, but further training and research are needed to solidify LLMs’ role in medical education and healthcare communication.

Acute low back pain is a highly prevalent condition that poses significant challenges to healthcare systems worldwide. In this manuscript, we present the most current, evidence-based guidelines from the World Federation of Neurosurgical Societies (WFNS) Spine Committee on the epidemiology, etiology, and prevention of acute low back pain (LBP) lasting ≤ 4 weeks. We performed a literature review 2012–2022 using the PubMed, Medline, and CENTRAL databases with the keywords “acute low back pain”, “acute back pain”, “low back pain”, “epidemiology”, “etiology”, “costs”, “risk factor”, “cultural”, “developed”, “developing” and “prevention”. Systematic screening criteria were applied, resulting in 13 final articles on epidemiology and etiology of LBP, 2 manuscripts on costs, 5 articles on risk factors, and 23 articles on prevention strategies for acute LBP. These were presented at two separate international meetings, where members of the WFNS Spine Committee voted on five final consensus statements presented here. and Conclusions: There is a high incidence and prevalence of acute LBP, particularly in high-income countries, which is felt to be at least partially due to demographic shifts with an aging population and lifestyle changes including higher rates of obesity and physical inactivity. Acute LBP has a significant impact on quality of life and ability to work, resulting in high direct and indirect costs worldwide. Early diagnosis and appropriate management of acute LBP is recommended to prevent this pain from turning into chronic LBP. The WFNS Spine Committee's recommendations respresent the latest guidelies to help improve patient care for acute LBP worldwide.

Importance: Understanding gender differences in electronic health record (EHR) use among surgeons is crucial for addressing potential disparities in workload, compensation, and physician well-being.Objective: To investigate gender differences in EHR usage patterns.Design, Setting, and Participants: This cross-sectional study examined data from an EHR system (Epic Signal) at a single academic hospital from January to December 2022. Participants included 224 attending surgeons with patient encounters in the outpatient setting. Statistical analysis was performed from May 2023 to April 2024.Exposures: Surgeon’s gender.Main Outcomes and Measures: The primary outcome variables were progress note length, documentation length, time spent in medical records, and time spent documenting patient encounters. Continuous variables were summarized with median and IQR and assessed via the Kruskal-Wallis test. Categorical variables were summarized using proportion and frequency and compared using the χ² test. Multivariate linear regression was used with primary EHR usage variables as dependent variables and surgeon characteristics as independent variables.Results: This study included 222 529 patient encounters by 224 attending surgeons, of whom 68 (30%) were female and 156 (70%) were male. The median (IQR) time in practice was 14.0 (7.8-24.3) years. Male surgeons had more median (IQR) appointments per month (78.3 [39.2-130.6] vs 57.8 [25.7-89.8]; P = .005) and completed more medical records per month compared with female surgeons (43.0 [21.8-103.9] vs 29.1 [15.9-48.1]; P = .006). While there was no difference in median (IQR) time spent in the EHR system per month (664.1 [301.0-1299.1] vs 635.0 [315.6-1192.0] minutes; P = .89), female surgeons spent more time logged into the system both outside of 7am to 7pm (36.4 [7.8-67.6] vs 14.1 [5.4-52.2] min/mo; P = .05) and outside of scheduled clinic hours (134.8 [58.9-310.1] vs 105.2 [40.8-214.3] min/mo; P = .05). Female surgeons spent more median (IQR) time per note (4.8 [2.6-7.1] vs 2.5 [0.9-4.2] minutes; P < .001) compared with male surgeons. Male surgeons had a higher number of median (IQR) days logged in per month (17.7 [13.8-21.3] vs 15.7 [10.7-19.7] days; P = .03). Female surgeons wrote longer median (IQR) inpatient progress notes (6025.1 [3692.1-7786.7] vs 4307.7 [2808.9-5868.4] characters/note; P = .001) and had increased outpatient document length (6321.1 [4079.9-7825.0] vs 4445.3 [2934.7-6176.7] characters/note; P < .001). Additionally, female surgeons wrote a higher fraction of the notes manually (17% vs 12%; P = .006). After using multivariable linear regression models, male gender was associated with reduced character length for both documentations (regression coefficient, −1106.9 [95% CI, −1981.5 to −232.3]; P = .01) and progress notes (regression coefficient, −1119.0 [95% CI, −1974.1 to −263.9]; P = .01). Male gender was positively associated with total hospital medical records completed (regression coefficient, 47.3 [95% CI, 28.3-66.3]; P < .001). There was no difference associated with gender for time spent in each note, time spent outside of 7 am to 7 pm, or time spent outside scheduled clinic hours.Conclusions and Relevance: This cross-sectional study of EHR data found that female surgeons spent more time documenting patient encounters, wrote longer notes, and spent more time in the EHR system compared with male surgeons. These findings have important implications for understanding the differential burdens faced by female surgeons, including potential contributions to burnout and payment disparities.

New anabolic medications (abaloparatide and romosozumab) were recently approved for osteoporosis, and data suggest that prescribing antiresorptive medications after a course of anabolic medications offers better outcomes. This study aimed to characterize prescription trends, demographics, geographical distributions, out‐of‐pocket costs, and treatment sequences for anabolic and antiresorptive osteoporosis medications. Using a commercial claims database (Clinformatics Data Mart), adult patients with osteoporosis from 2003 to 2021 were retrospectively reviewed and stratified based on osteoporosis medication class. Patient demographics and socioeconomic variables, provider types, and out‐of‐pocket costs were collected. Multivariable regression analyses were used to identify independent predictors of receiving osteoporosis treatment. A total of 2,988,826 patients with osteoporosis were identified; 616,635 (20.6%) received treatment. Patients who were female, Hispanic or Asian, in the Western US, had higher net worth, or had greater comorbidity burden were more likely to receive osteoporosis medications. Among patients who received medication, 31,112 (5.0%) received anabolic medication; these were more likely to be younger, White patients with higher education level, net worth, and greater comorbidity burden. Providers who prescribed the most anabolic medications were rheumatologists (18.5%), endocrinologists (16.8%), and general internists (15.3%). Osteoporosis medication prescriptions increased fourfold from 2003 to 2020, whereas anabolic medication prescriptions did not increase at this rate. Median out‐of‐pocket costs were $17 higher for anabolic than antiresorptive medications, though costs for anabolic medications decreased significantly from 2003 to 2020 (compound annual growth rate: −0.6%). A total of 8388 (1.4%) patients tried two or more osteoporosis medications, and 0.6% followed the optimal treatment sequence. Prescription of anabolic osteoporosis medications has not kept pace with overall osteoporosis treatment, and there are socioeconomic disparities in anabolic medication prescription, potentially driven by higher median out‐of‐pocket costs. Although prescribing antiresorptive medications after a course of anabolic medications offers better outcomes, this treatment sequence occurred in only 0.6% of the study cohort. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

BACKGROUND: Recent studies suggest that socioeconomic status (SES) influences outcomes after spinal fusion. The influence of SES on postoperative outcomes is increasingly relevant as rates of lumbar fusion rise. OBJECTIVE: To determine the influence of SES variables including race, education, net worth, and homeownership on postoperative outcomes. METHODS: Optum's deidentified Clinformatics Data Mart Database was used to conduct a retrospective review of SES variables for patients undergoing first-time, inpatient lumbar fusion from 2003 to 2021. Primary outcomes included hospital length of stay (LOS) and 30-day reoperation, readmission, and postoperative complication rates. Secondary outcomes included postoperative emergency room visits, discharge status, and total hospital charges. RESULTS: In total, 217 204 patients were identified. On multivariate analysis, Asian, Black, and Hispanic races were associated with increased LOS (Coeff. [coefficient] 0.92, 95% CI 0.68-1.15; Coeff. 0.61, 95% CI 0.51-0.71; Coeff. 0.43, 95% CI 0.32-0.55). Less than 12th grade education (vs greater than a bachelor's degree) was associated with increased odds of reoperation (OR [odds ratio] 1.88, 95% CI 1.03-3.42). Decreased net worth was associated with increased odds of readmission (OR 1.32, 95% CI 1.25-1.40) and complication (OR 1.14, 95% CI 1.10-1.20). Renting a home (vs homeownership) was associated with increased LOS, readmissions, and total charges (Coeff. 0.30, 95% CI 0.17-0.43; OR 1.19, 95% CI 1.11-1.30; Coeff. 13 200, 95% CI 9000-17 000). CONCLUSION: Black race, less than 12th grade education, <$25K net worth, and lack of homeownership were associated with poorer postoperative outcomes and increased costs. Increasing perioperative support for patients with these sociodemographic risk factors may improve postoperative outcomes.

Patients with primary or secondary central nervous system (CNS) malignancies benefit from utilization of palliative care (PC) in addition to other supportive services, such as home health and social work. Guidelines propose early initiation of PC for patients with advanced cancers. We analyzed a cohort of privately insured patients with malignant brain or spinal tumors derived from the Optum Clinformatics Datamart Database to investigate health disparities in access to and utilization of supportive services. We introduce a novel construct, “provider patient racial diversity index” (provider pRDI), which is a measure of the proportion of non-white minority patients a provider encounters to approximate a provider’s patient demographics and suggest a provider’s cultural sensitivity and exposure to diversity. Our analysis demonstrates low rates of PC, home health, and social work services among racial minority patients. Notably, Hispanic patients had low likelihood of engaging with all three categories of supportive services. However, patients who saw providers categorized into high provider pRDI (categories II and III) were increasingly more likely to interface with supportive care services and at an earlier point in their disease courses. This study suggests that prospective studies that examine potential interventions at the provider level, including diversity training, are needed.