Trends and variations in the use of spine surgery
Trends and variations in the use of spine surgery
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DOI：
10.1097/01.blo.0000198726.62514.75
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发表时间：
2006-02-01
影响因子：
4.2
通讯作者：
Mirza, Sohail K.
中科院分区：
文献类型：
--
作者：
Deyo, Richard A.;Mirza, Sohail K.
研究临床护理的趋势和地理差异，可以深入了解临床决策的变化。我们总结了美国脊柱手术率、趋势和变化的数据，以突出专业不确定性和未来研究的问题。美国是世界上脊柱手术率最高的国家，但脊柱手术的地理差异比其他大多数手术都要大。例如，2001年的医疗保险数据显示，美国城市之间的脊柱手术率有6倍的差异，脊柱融合率有10倍的差异。美国的脊柱手术率在20世纪80年代上升了55%。在20世纪90年代，手术率的研究变得更加困难，因为20%的椎间盘切除术转移到门诊。从有门诊手术数据的州推断，整个20世纪90年代腰椎手术率持续上升。增长最快的是脊柱融合术，在20世纪90年代增长了两倍，在所有脊柱手术中所占的比例越来越大。一些增长与新的外科植入物的引入相吻合。尽管采用了新技术，但融合后再次手术的发生率并不低于单纯减压后的发生率。随着脊柱外科新技术的不断发展，我们预计手术模式将发生重大变化。分析基于人口的数据可能有助于监测变化及其影响。
Examining trends and geographic variations in clinical care offers insights into changes in clinical decision making. We summarized data on spine surgical rates, trends, and variations in the United States to highlight areas of professional uncertainty and questions for future research. The United States has the highest rate of spine surgery in the world, but spine surgery shows wider geographic variations than most other procedures. For example, Medicare data for 2001 showed sixfold variations in spine surgery rates among United States cities, and 10-fold variations in spine fusion rates. United States spine surgery rates rose 55% in the 1980s. In the 1990s, studies of surgical rates became more difficult because 20% of discectomies shifted to an outpatient setting. Extrapolations from states with ambulatory surgery data suggest overall lumbar surgery rates continued to rise throughout the 1990s. The most rapid increase was for spinal fusion, which tripled during the 1990s and accounted for an increasing proportion of all spine procedures. Some increases coincided with the introduction of new surgical implants. Despite new technologies, rates of repeat surgery after fusion were no lower than the rates after decompression alone. As new technology for spine surgery is introduced at an accelerating pace, we anticipate substantial changes in surgery patterns. Analysis of population-based data may be useful for surveillance of changes and their impacts.