Spine Surgeon Treatment Variability: The Impact on Costs
Spine Surgeon Treatment Variability: The Impact on Costs
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DOI：
10.1177/2192568217739610
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发表时间：
2018-08-01
影响因子：
2.4
通讯作者：
Mroz, Thomas E.
中科院分区：
文献类型：
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作者：
Alvin, Matthew D.;Lubelski, Daniel;Mroz, Thomas E.
研究设计：横断面分析：目的：由于缺乏强有力的证据/指导方针，适当的治疗腰椎疾病，大量的变异性之间存在的手术治疗，这是与不同的成本，以治疗特定的病理。我们的目标是调查的差异，在全国范围内相同的病理在类似patients.Methods：四百四十五脊柱外科医生完成了调查的临床和影像学的情况下，复发性腰椎间盘突出症，腰痛和脊椎前移的患者的情况。被调查者被要求提供各种细节，包括他们的地理位置，专业和奖学金培训。治疗选择包括非手术、前路腰椎椎间融合、后外侧融合和经椎间孔/后路腰椎椎间融合。通过医疗保险国家支付金额估计费用。结果：对于复发性腰椎间盘突出症，首次翻修显微椎间盘切除术患者的费用无差异。然而，对于接受另一种显微椎间盘切除术的患者，手术次数200次/年（P < .001）和有5-15年经验的外科医生的费用明显高于> 15年的外科医生（P < .001）。对于腰痛的治疗，学术外科医生的成本比私人执业外科医生低约55%（P <0.001）。在治疗脊椎前移，有显着的治疗差异，而没有显着差异costs.Conclusions：手术治疗模式存在显着的差异，为不同的病理。了解为什么在不同的实践中，在相似的临床背景下，治疗选择存在差异，这对于确保脊柱外科医生提供最具成本效益的护理是很重要的。
Study Design: Cross-sectional analysis.Objectives: Given the lack of strong evidence/guidelines on appropriate treatment for lumbar spine disease, substantial variability exists among surgical treatments utilized, which is associated with differences in costs to treat a given pathology. Our goal was to investigate the variability in costs among spine surgeons nationally for the same pathology in similar patients.Methods: Four hundred forty-five spine surgeons completed a survey of clinical and radiographic case scenarios on patients with recurrent lumbar disc herniation, low back pain, and spondylolisthesis. Those surveyed were asked to provide various details including their geographical location, specialty, and fellowship training. Treatmentoptions included no surgery, anterior lumbar interbody fusion, posterolateral fusion, and transforaminal/posterior lumbar interbody fusion. Costs were estimated via Medicare national payment amounts.Results: For recurrent lumbar disc herniation, nodifference in costs existed for patients undergoing their first revision microdiscectomy. However, for patients undergoing another microdiscectomy, surgeons who operated 200 times/year (P < .001) and those with 5-15 years of experience had significantly higher costs than those with > 15 years (P < .001). For the treatment of low back pain, academic surgeons kept costs about 55% lower than private practice surgeons (P < .001). In the treatment of spondylolisthesis, there was significant treatment variability without significant differences in costs.Conclusions: Significant variability in surgical treatment paradigms exists for different pathologies. Understanding why variability in treatment selection exists in similar clinical contexts across practices is important to ensure the most cost-effective delivery of care among spine surgeons.