United States’ Trends and Regional Variations in Lumbar Spine Surgery: 1992–2003

Weinstein, James Neil; Lurie, Jon D.; Olson, Patrick R.; Bronner, Kristen K.; Fisher, Elliott S.

doi:10.1097/01.brs.0000248132.15231.fe

Cited by 788 publications

(522 citation statements)

References 17 publications

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“…Rates of ALIF and PLIF varied approximately twofold among geographic areas whereas rates of posterior interarticular fusion and combined discectomy and fusion varied threefold. The coefficient of variation in surgery rates was similar when comparing total hip arthroplasty (21.3) with standard discectomy (25.6) and laminectomy (26.2) and below the magnitude of variability in rates of fusion (at least 55.1) in accordance with the results of Weinstein et al [12]. Table 2 shows the factors associated with the use of types of spinal surgery.…”

Section: Resultssupporting

confidence: 75%

A decade’s experience in lumbar spine surgery in Belgium: sickness fund beneficiaries, 2000–2009

2012

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Purpose The purpose is to study rates, trends, geographic variations and outcome of lumbar spine surgery in the Belgian population during the last decade. Methods This is a retrospective cohort study using administrative data of the largest Belgian sickness fund from January 1, 2000 through December 31, 2009. Cases included lumbar laminectomy, combined discectomy and fusion, posterior interarticular fusion, anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF) and standard discectomy. The main outcome measures were age-and sex-adjusted rates of lumbar spine surgery, 1-year mortality, 1-year iterative surgery, no return to work (RTW) rate 1 year after surgery and length of hospital stay. Multivariate logistic regression analysis was used to determine the association between age, sex, geographic region, type of surgery, year of intervention and duration of pre-operative sick leave on outcome. Results Spine surgery rates rose 44 % from 2001 through 2009 and data for 2009 showed twofold variations in spine surgery rates among 10 Belgian provinces. Reported 1-year mortality varied from 0.6 to 2.5 % among surgical procedures performed in 2008. The overall 5-year reoperation rate was 12 %. RTW rates 1 year after standard discectomy, ALIF, PLIF and combined discectomy and fusion for the follow-up sample of 2008 were 14.4, 22.7, 26.1 and 30.6 %, respectively. The median length of hospital stay significantly decreased throughout the decade. Type of surgery and geographic region were significantly related to patient outcomes. Conclusions Regional variations highlight professional uncertainty and controversy. The study results point to the need for peer comparisons and surgeon feedback.

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Section: Resultssupporting

confidence: 75%

A decade’s experience in lumbar spine surgery in Belgium: sickness fund beneficiaries, 2000–2009

2012

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“…This is a significant limitation of the present study. Hence, given the variation of surgical indications, techniques, and methods [3,17], the present findings are not generalizable to the population at large. However, the current study is based on the setting of preference-based shared decision making.…”

Section: Discussionmentioning

confidence: 72%

Factors influencing the surgical decision for the treatment of degenerative lumbar stenosis in a preference-based shared decision-making process

et al. 2014

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Introduction In a preference-based shared decision-making system, several subjective and/or objective factors such as pain severity, degree of disability, and the radiological severity of canal stenosis may influence the final surgical decision for the treatment of lumbar spinal stenosis (LSS). However, our understanding of the shared decision-making process and the significance of each factor remain primitive. In the present study, we aimed to investigate which factors influence the surgical decision for the treatment of LSS when using a preference-based, shared decisionmaking process. Methods We included 555 patients, aged 45-80 years, who used a preference-based shared decision-making process and were treated conservatively or surgically for chronic leg and/or back pain caused by LSS from April 2012 to December 2012. Univariate and multivariableadjusted logistic regression analyses were used to assess the association of surgical decision making with age, sex, body mass index, symptom duration, radiologic stenotic grade, Oswestry Disability Index (ODI), visual analog scale (VAS) scores for back and leg pain, Short Form-36 (SF-36) subscales, and motor weakness. Results In univariate analysis, the following variables were associated with a higher odds of a surgical decision for LSS: male sex; the VAS score for leg pain; ODI; morphological stenotic grades B, C, and D; motor weakness; and the physical function, physical role, bodily pain, social function, and emotional role of the SF-36 subscales. Multivariate analysis revealed that male sex, ODI, morphological stenotic grades C and D, and motor weakness were significantly associated with a higher possibility of a surgical decision. Conclusion Motor weakness, male sex, morphological stenotic grade, and the amount of disability are critical factors leading to a surgical decision for LSS when using a preference-based shared decision-making process.

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“…These facts and the fear of adjacent level syndrome have encouraged the development of dynamic implants or disc prosthesis. Regarding lumbar fusion procedures, several studies report on notable regional differences in the number of patients operated, depending on surgeons' beliefs or on other subjective factors, such as organization and financing of health services [18,47], rather than on clinical or demographic criteria. Several studies emphasize the importance of an adequate selection of patients to undergo surgical lumbar interventions [11,12,14,39].…”

Section: Discussionmentioning

confidence: 99%

Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion

Soriano

Revuelta²,

Fabregate

et al. 2010

Eur Spine J

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There has been no agreement among different authors on guidelines to specify the situations in which arthrodesis is justified in terms of results, risks and complications. The aim of this study was to identify preoperative predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion. A prospective observational study design was performed on 203 consecutive patients. Potential preoperative predictors of outcome included sociodemographic factors as well as variables pertaining to the preoperative clinical situation, diagnosis, expectations and surgery. Separate multiple linear regression models were used to assess the association between selected predictors and outcome variables, defined as the improvement after 1 year on the visual analog scale (VAS) for back pain, VAS for leg pain, physical component scores (PCS) of SF-36 and Oswestry disability index (ODI). Follow-up was available for 184 patients (90.6%). Patients with higher educational level and optimistic preoperative expectations had a more favourable postoperative leg pain (VAS) and ODI. Smokers had less leg pain relief. Patients with better mental component score (emotional health) had greater ODI improvement. Less preoperative walking capacity predicted more leg pain relief. Patients with disc herniation had greater relief from back pain and more PCS and ODI improvement. More severe lumbar pain was predictive of less improvement on ODI and PCS. Age, sex, body mass index, analgesic use, surgeon, self-rated health, the number of decompressed levels and the length of fusion had no association with outcome. This study concludes that a higher educational level, optimistic expectations for improvement, the diagnosis of ''disc herniation'', less walking capacity and good emotional health may significantly improve clinical outcome. Smoking and more severe lumbar pain are predictors of worse results.

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United States’ Trends and Regional Variations in Lumbar Spine Surgery: 1992–2003

Cited by 788 publications

References 17 publications

A decade’s experience in lumbar spine surgery in Belgium: sickness fund beneficiaries, 2000–2009

A decade’s experience in lumbar spine surgery in Belgium: sickness fund beneficiaries, 2000–2009

Factors influencing the surgical decision for the treatment of degenerative lumbar stenosis in a preference-based shared decision-making process

Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion

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