Who's in the driver's seat? Surgeon's enthusiasm and rates of lumbar spine surgery
Monday, March 28, 2011 at 10:18PMI personally live in an area where there is an extremely high rate of lumbar fusion and lumbar surgery generally. So, I personally have asked this question myself. Why do some places have higher rates of spine surgery than others?
Is the rate of surgery determined by the density of surgeons per capita? Is it rates of reimbursement? Is there some variation in the prevalence of spine or disc disease in a certain population?
Or is it surgeon enthusiasm for surgery?
A recent study published in Spine looked at exactly this question, examining regional variation rates of spine surgery in the province of Ontario, Canada.
The authors found “that there exists wide variation in surgical rates for treatment of the degenerative lumbar spine. Our study represents the first study that evaluates how the enthusiasm of patients, in addition to physicians, directly relates to utilization rates in a population-based study and provides insight into the drivers of DDLS surgery.”1
What they found is interesting. “Surgeon enthusiasm was found to be the dominant potentially modifiable factor influencing surgical rates.”2 In addition, they found that “Neither the supply of physicians (FPs or surgeons) nor the prevalence of disease were found to be significantly related to surgical rates.”3
The assessment of “enthusiasm” for surgery was assessed with a survey based around a series of 16 clinical vignettes presented to patients, FPs, and Spine surgeons. For each of the vignettes, these three groups (surgeon, FPs, patients) were asked to rate their recommendation for surgery.
There is an old adage, if you have a hammer everything looks like a nail. I personally think I can fix most anything with exercise. If you have a surgeon that is enthusiastic for surgery, you may look like a nail.
1SPINE Volume 36, Number 6, pp 481–489
2SPINE Volume 36, Number 6, pp 481–489
3SPINE Volume 36, Number 6, pp 481–489
Reader Comments (1)
This is a very interesting article. I personally treat my chronic orofacial pain patients with conservative treatment only. I never had a patient that failed and had to have surgery. Unless for cosmestic reasons or for other functional objectives. Not for pain management. I think this is some information to all of us reflect, and really as based on what, our clinical decisions have been based on.......
Thanks for the information