Do Demographic Factors of Spine Surgeons Affect the Rate at Which Spinal Fusion Is Performed on Patients?
Do Demographic Factors of Spine Surgeons Affect the Rate at Which Spinal Fusion Is Performed on Patients?
复制标题
脊柱外科医生的人口统计因素会影响对患者进行脊柱融合术的速度吗？
作者：
Michael S. Schallmo;Ralph W. Cook;Joseph A. Weiner;Danielle S. Chun;Kathryn A. Barth;S. K. Singh;Alpesh A. Patel;W. Hsu
研究设计.回顾性研究。Objective.本研究的目的是评价脊柱外科医生的人口统计学资料与择期脊柱融合手术率之间的相关性。背景数据总结。在美国，选择性脊柱融合率的快速增长引起了一个重要的问题，即什么因素可能会推动脊柱外科医生的决策。方法.回顾性分析了来自医疗保险和医疗补助服务中心的公开脊柱外科医生实践模式数据。融合率定义为外科医生对医疗保险受益人进行的融合手术次数/所见的唯一医疗保险受益人总数。入选标准是在2011年至2013年期间对该数据库定义的Medicare患者进行了11次或更多单独脊柱融合手术的神经或骨科脊柱外科医生。人口统计信息是从公共记录中收集的。使用相对风险（RR）和相应的95%置信区间（CI）评估外科医生进行脊柱融合的概率增加。结果2011年至2013年，共有3979名在美国执业的脊柱外科医生为171，676名医疗保险患者进行了脊柱融合，符合入选标准。该数据库中外科医生的平均脊柱融合率为7.5%。融合率较高的外科医生在学术机构与私人机构执业（RR = 1.44，95% CI [1.35-1.53]; P <0.0001），更可能是神经外科医生与骨科医生（RR = 1.10，95% CI [1.05-1.15]; P <0.0001），并在美国西部与中西部、南部和东北部地区执业（RR = 1.20，95% CI [1.14-1.27]; P <0.0001）。 手术年限与融合率呈显著负相关（P <0.0001）。 结论基于实践类型、培训、地区和经验的脊柱融合率的显著差异表明对该手术的适应症缺乏共识。这些关系的知识可能有助于确定手术护理变化的根本原因，并改善手术结果。证据等级：3
Study Design. Retrospective study. Objective. The purpose of this study was to evaluate associations between spine surgeon demographics and the rate at which elective spine fusion is performed. Summary of Background Data. Rapidly increasing rates of elective spinal fusion in the United States have given rise to important questions about what factors may drive spine surgeon decision making. Methods. Publicly available spine surgeon practice pattern data from Centers for Medicare and Medicaid Services were reviewed retrospectively. Fusion rate was defined as the number of fusion procedures performed on Medicare beneficiaries by a surgeon per total number of unique Medicare beneficiaries seen. Inclusion criteria were neurological or orthopedic spine surgeons who performed 11 or more separate spine fusion procedures on Medicare patients between 2011 and 2013 as defined by this database. Demographic information was collected from public record. The increased probability of a surgeon performing spine fusion was assessed using a relative risk (RR) and corresponding 95% confidence interval (CI). Results. A total of 3979 spine surgeons who practice in the United States and performed spine fusion on 171,676 Medicare patients from 2011 to 2013 met the inclusion criteria. The average rate of spine fusion for surgeons in this database was 7.5%. Surgeons with higher fusion rates practiced in an academic versus private setting (RR = 1.44, 95% CI [1.35–1.53]; P < 0.0001), were more likely neurological versus orthopedic surgeons (RR = 1.10, 95% CI [1.05–1.15]; P < 0.0001), and practiced in the West versus Midwest, South, and Northeast region of the United States (RR = 1.20, 95% CI [1.14–1.27]; P < 0.0001). Number of years in practice was significantly associated negatively with fusion rate (P < 0.0001). Conclusion. Significant variation in the rate of spine fusion based on practice type, training, region, and experience suggests poor consensus on indications for this procedure. Knowledge of these relationships may help identify underlying reasons for variations in surgical care and improve surgical outcomes. Level of Evidence: 3