Publications by authors named "Melanie A Horowitz"

4 Publications

  • Page 1 of 1

Predictors of Academic Neurosurgical Career Trajectory among International Medical Graduates Training Within the United States.

Neurosurgery 2021 Aug;89(3):478-485

Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Background: Within the literature, there has been limited research tracking the career trajectories of international medical graduates (IMGs) following residency training.

Objective: To compare the characteristics of IMG and US medical school graduate (USMG) neurosurgeons holding academic positions in the United States and also analyze factors that influence IMG career trajectories following US-based residency training.

Methods: We collected data on 243 IMGs and 2506 USMGs who graduated from Accreditation Council for Graduate Medical Education (ACGME)-accredited neurosurgery residency programs. We assessed for significant differences between cohorts, and a logistic regression model was used for the outcome of academic career trajectory.

Results: Among the 2749 neurosurgeons in our study, IMGs were more likely to pursue academic neurosurgery careers relative to USMGs (59.7% vs 51.1%; P = .011) and were also more likely to complete a research fellowship before beginning residency (odds ratio [OR] = 9.19; P < .0001). Among current US academic neurosurgeons, USMGs had significantly higher pre-residency h-indices relative to IMGs (1.23 vs 1.01; P < .0001) with no significant differences between cohorts when comparing h-indices during (USMG = 5.02, IMG = 4.80; P = .67) or after (USMG = 14.05, IMG = 13.90; P = .72) residency. Completion of a post-residency clinical fellowship was the only factor independently associated with an academic career trajectory among IMGs (OR = 1.73, P = .046).

Conclusion: Our study suggests that while IMGs begin their US residency training with different research backgrounds and achievements relative to USMG counterparts, they attain similar levels of academic productivity following residency. Furthermore, IMGs are more likely to pursue academic careers relative to USMGs. Our work may be useful for better understanding IMG career trajectories following US-based neurosurgery residency training.
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http://dx.doi.org/10.1093/neuros/nyab194DOI Listing
August 2021

Predicting High-Value Care Outcomes After Surgery for Skull Base Meningiomas.

World Neurosurg 2021 05 7;149:e427-e436. Epub 2021 Feb 7.

Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address:

Background: Although various predictors of adverse postoperative outcomes among patients with meningioma have been established, research has yet to develop a method for consolidating these findings to allow for predictions of adverse health care outcomes for patients diagnosed with skull base meningiomas. The objective of the present study was to develop 3 predictive algorithms that can be used to estimate an individual patient's probability of extended length of stay (LOS) in hospital, experiencing a nonroutine discharge disposition, or incurring high hospital charges after surgical resection of a skull base meningioma.

Methods: The present study used data from patients who underwent surgical resection for skull base meningiomas at a single academic institution between 2017 and 2019. Multivariate logistic regression analysis was used to predict extended LOS, nonroutine discharge, and high hospital charges, and 2000 bootstrapped samples were used to calculate an optimism-corrected C-statistic. The Hosmer-Lemeshow test was used to assess model calibration, and P < 0.05 was considered statistically significant.

Results: A total of 245 patients were included in our analysis. Our cohort was mostly female (77.6%) and white (62.4%). Our models predicting extended LOS, nonroutine discharge, and high hospital charges had optimism-corrected C-statistics of 0.768, 0.784, and 0.783, respectively. All models showed adequate calibration (P>0.05), and were deployed via an open-access, online calculator: https://neurooncsurgery3.shinyapps.io/high_value_skull_base_calc/.

Conclusions: After external validation, our predictive models have the potential to aid clinicians in providing patients with individualized risk estimation for health care outcomes after meningioma surgery.
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http://dx.doi.org/10.1016/j.wneu.2021.02.007DOI Listing
May 2021

An Online Calculator for Predicting Academic Career Trajectory in Neurosurgery in the United States.

World Neurosurg 2021 01 5;145:e155-e162. Epub 2020 Oct 5.

Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address:

Objective: Determining factors that predict a career in academic neurosurgery can help to improve neurosurgical training and faculty mentoring efforts. Although many academic career predictors have been established in the literature, no method has yet been developed to allow for individualized predictions of an academic career trajectory. The objective of the present study was to develop a Web-based calculator for predicting the probability of a career in academic neurosurgery.

Methods: The present study used data from neurosurgeons listed in the American Association of Neurological Surgeons database. A logistic regression model was used to predict probability of an academic career, and bootstrapping with 2000 samples was used to calculate an optimism-corrected C-statistic. P < 0.05 was considered statistically significant.

Results: A total of 1818 neurosurgeons were included in our analysis. Most surgeons were male (89.7%) and employed in nonacademic positions (60.2%). Factors independently associated with an academic career were female sex, attending a residency program affiliated with a top 10 U.S. News medical school, attaining a Doctor of Philosophy (PhD) degree, attaining a Master of Science (MS) degree, higher h-index during residency, more months of protected research time during residency, and completing a clinical fellowship. Our final model had an optimism-corrected C-statistic of 0.74. This model was incorporated into a Web-based calculator (https://neurooncsurgery.shinyapps.io/academic_calculator/).

Conclusions: The present study consolidates previous research investigating neurosurgery career predictors into a simple, open-access tool. Our work may serve to better clarify the many factors influencing trainees' likelihood of pursuing a career in academic neurosurgery.
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http://dx.doi.org/10.1016/j.wneu.2020.09.161DOI Listing
January 2021

Predictors of Nonroutine Discharge Disposition Among Patients with Parasagittal/Parafalcine Meningioma.

World Neurosurg 2020 10 9;142:e344-e349. Epub 2020 Jul 9.

Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address:

Objective: Discharge disposition is an important outcome for neurosurgeons to consider in the context of high-quality, value-based care. There has been limited research into how the unique anatomic considerations associated with parasagittal/parafalcine meningioma resection may influence discharge disposition. We investigated the effects of various predictors on discharge disposition within a cohort of patients with parasagittal/parafalcine meningioma.

Methods: A total of 154 patients treated at a single institution were analyzed (2016-2019). Bivariate analysis was conducted using the Mann-Whitney U and Fisher exact tests. Multivariate analysis was conducted using logistic regression. An optimism-corrected C-statistic was calculated using 2000 bootstrap samples to assess logistic regression model performance.

Results: Our cohort was mostly female (67.5%) and white (72.7%), with a mean age of 57.29 years. Most patients had tumors associated with the middle third of the superior sagittal sinus (SSS) (60.4%) and had tumors that were not fully occluding the SSS (74.0%). In multivariate analysis, independent predictors of nonroutine discharge disposition included 5-factor Modified Frailty Index score (odds ratio [OR], 2.06; P = 0.0088), Simpson grade IV resection (OR, 4.22; P = 0.0062), and occurrence of any postoperative complication (OR, 2.89; P = 0.031). The optimism-corrected C-statistic of our model was 0.757.

Conclusions: In our single-institution experience, neither extent of SSS invasion nor location along the SSS predicted nonroutine discharge, suggesting that tumor invasion and posterior location along the SSS are not necessarily contraindications to surgery. Our results also highlight the importance of frailty and tumor size in stratifying patients at risk of nonroutine discharge disposition.
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http://dx.doi.org/10.1016/j.wneu.2020.06.239DOI Listing
October 2020
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