Variation in orthopaedic surgeons' perceptions about the indications for rotator cuff surgery
Variation in orthopaedic surgeons' perceptions about the indications for rotator cuff surgery
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DOI：
10.2106/jbjs.d.02944
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发表时间：
2005-09-01
影响因子：
5.3
通讯作者：
Marx, RG
中科院分区：
文献类型：
--
作者：
Dunn, WR;Schackman, BR;Marx, RG
背景：流行病学研究表明，包括肩袖修复在内的许多外科手术的人均率有很大差异。本研究的目的是了解骨科医生对肩袖手术的医疗决策的态度，并调查这些信念与报告的手术量之间的关系。方法：随机选择美国骨科医生名录中列出的骨科医生进行问卷调查。只有在前一年内曾治疗过肩袖撕裂患者或曾转介患者接受此类治疗的个人才被要求完成这份长达两页的调查。调查包括15个关于临床意见的问题，包括4个关于假设病例的问题。结果：在邮寄的1100份调查问卷中，539份被退回(回复率为49%)。在539名受访者中，316人(58.6%)在前一年治疗或转介过肩袖撕裂患者。在美国，外科医生对袖带修补失败率的估计与外科医生的手术量呈显著负相关(r=-0.21，p=0.0003)，表明手术量较小的外科医生比手术量较大的外科医生对手术结果更为悲观。14.5%、46.2%和36.6%的受访者倾向于关节镜、微型开放和开放袖带修补术。手术次数越多的外科医生越不可能进行开放手术(P<；0.0001)。在9个临床问题中只有4个在临床上达成了一致，而关于假想的四个问题中没有一个是一致的。结论：我们发现外科医生在手术决策上存在显著差异，骨科医生对肩袖手术缺乏临床上的一致意见。外科医生进行的手术数量与医生对结果的感知呈正相关，手术数量较大的外科医生比手术数量较少的外科医生对肩袖手术更有热情。
Background: Epidemiologic studies have demonstrated substantial variations in per capita rates of many surgical procedures, including rotator cuff repair. The purpose of the current study was to characterize orthopaedic surgeons' attitudes concerning medical decision-making about rotator cuff surgery and to investigate the associations between these beliefs and reported surgical volumes.Methods: A survey was mailed to randomly selected orthopaedic surgeons listed in the American Academy of Orthopaedic Surgeons directory. Only individuals who had treated patients for a rotator cuff tear, or had referred patients for such treatment, within the previous year were asked to complete the two-page survey. The survey comprised fifteen questions regarding clinical opinion, including four regarding hypothetical cases. Clinical agreement was defined as > 80% of the respondents answering similarly.Results: Of the 1100 surveys that were mailed, 539 were returned (a response rate of 49%). Of the 539 respondents, 316 (58.6%) had treated or referred patients with a rotator cuff tear in the previous year. There was a significant negative correlation between the surgeon's estimation of the failure rate of cuff repairs in the United States and that surgeon's procedure volume (r = -0.21, p = 0.0003), indicating that surgeons with a lower procedure volume are more pessimistic about the results of surgery than are those with a higher procedure volume. Arthroscopic, mini-open, and open cuff repairs were preferred by 14.5%, 46.2%, and 36.6% of the respondents, respectively. Surgeons who performed a higher volume of procedures were less likely to perform open surgery (p < 0.0001). There was clinical agreement regarding only four of the nine clinical questions and none of the four questions about the hypothetical vignettes.Conclusions: We found significant variation in surgical decision-making and a lack of clinical agreement among orthopaedic surgeons about rotator cuff surgery. There was a positive correlation between the volume of procedures performed by the surgeon and the surgeon's perception of outcome, with surgeons who had a higher procedure volume being more enthusiastic about rotator cuff surgery than those who had a lower procedure volume.