Questions for the speakers? Mike, I have a question for you. Was the technique the same for the inner body? Were they perc screws in an inner body? The technique was exactly the same for both groups? If that trajectory continues, C-3PO is doing all the cases, right? I have a question for Dr. Zuckerman. It's a little bit of a comment in the sense that I appreciate that they're looking at complications in the short term, but we in spine surgery know that all the problems don't really become manifest until two to six months out. I know that the N2QOD was kind of set up to demonstrate how good we are, but in some ways, if we could set it up to show where we make our mistakes so that we can really hone our skills and really focus on that two to six month post-op time period, I think would be a good idea. I wonder what Dr. Zuckerman thinks. Yeah, right behind you here. I think that's a great point. And the outcomes that were initially identified were readmission length of stay, short term. I think additionally worthwhile outcomes would be longer term things. It's just a question of asking the right questions and how to do it, but couldn't agree more. Question for Dr. Zuckerman as well. How do you distinguish the protocol that you've instituted? When I see that, I see striking similarities to the ERAS protocol that Mike has brought into it in the presentation that was made this morning. There's a similarity in the early ambulation. The checklist that you demonstrated almost seems like that checklist that we would see for the ERAS protocol. Is there just overlap in between the two, trying to accomplish the same goals? Definitely. There's no reinventing the wheel here. These are the same things that need to be done for every single patient. It's just a question of implementing it and doing it in an efficient way without having a separate registry on one side, a big administrative NISQIP database on the other, having two separate entities not communicating. It's just combining things that we're already doing. I completely agree. There's really very little difference. It's just itemizing it in an organized way. One follow-up question for Dr. Zuckerman. I think one of the really important observations made by the QOD effort is this consistent finding that 15 to 20 percent of some of the patients that we operate on for some of the most straightforward things, lumbar discectomy, lumbar decompression for stenosis, don't do well. It's not a surprise for all of us in practice. This is stuff we do know. But do you see the QOD and the registry efforts being able to help us understand who are these patients who don't succeed from relatively straightforward surgery? Yeah, I think so. I think the first step is looking at that first phase, the research phase, and looking at the numbers. And it's really, really striking the variability in the routine procedures, exactly as you said. So instead of looking at all 10,000 patients, isolate those 500 or 600 patients, much smaller numbers, but those are the problem ones. So just studying those ones that are the major drivers of some of the poor outcomes. I think registries are equipped to do that, even though I think most of the work thus far has been the much grander scale of tens of thousands of patients. Paul, you reported a 9 percent readmission rate in the data, and then your presentation started out with the cost of readmission. So we can almost apply that calculus and say that this 9 percent readmission data, which is in a huge data set, because even though you had only 70 percent that were able to get full data points, it's still 7,000 patients, if I remember the slide correctly. We can almost calculate the cost based on the numbers that you put at the beginning and see what the investment needs to be to decrease that 9 percent readmission rate to, say, 4.5. I mean, we can almost extrapolate what that costs. That's a good point, Lou. If you look at the literature, readmission costs for pepper splicing, there's very little data on that. It's surprising. So all that readmission cost data is just generalized data. I mean, it's interesting that no one's really looked at it. What is the cost of readmission? We know in general it's expensive. We don't know what it is for, let's say, a spinal fusion operation or decompressive operation. We just don't know. I suspect it's going to be comparable, but that's an area where I think we need to do more. So, you know, in the sense of knowing the cost and how much is added, it's unclear. Because if you knew the cost, then you'd know what to invest, and you'd get an immediate return on investment if you were able to decrease that 9 percent. Yeah, I mean, you can show that, but we don't actually have a lot of numbers to do it. I mean, for spine surgery in particular, what it costs for readmission, it's unclear. There's really no literature. I mean, partly it's because we don't know what the charges are. I mean, you can use Medicare to charge for surgeries, but, you know, each hospital, I think a lot of them don't like to share their costs. Any other questions? All right, thanks very much, everybody.

spinal surgery outcomes

complications

registries and databases

readmissions

costs