Regional Variations in Low Back Surgery is Due to 'Surgeon Enthusiasm'
In contrast, variations in spinal surgery are not related to enthusiasm among patients and primary care doctors. Study leader, Dr. Samuel Bedermen, writes, "Strategies targeting surgeon practices may reduce regional variation in care and improve access disparities."
Using Ontario healthcare databases, Dr. Bedermen and fellow researchers examined data on more than 50,000 surgeries performed for degenerative dis3ease of the lumbar spine between 2002 and 2006. In Ontario, as in the United States, there are pockets of unexplained variations in the spinal surgery rate.
Differences in the back rate among Ontario counties were compared with a prior survey where surgeons, family doctors, and patients with back conditions were asked to relate their preferences for spinal surgery. Presented with different scenarios, surgeons were then asked whether they would recommend surgery, family doctors whether they would rate surgery appropriate, and patients whether they would consider surgery.
The results demonstrate that there was a correlation between surgeon enthusiasm in counties with higher rates of spinal surgery. Comparing the top fourth and bottom fourth of surgeon enthusiasm, there was a 20 percent difference in surgery rates.
Prior studies using Medicare data have also found large variations in lumbar spine surgery rates across U.S counties. These variations elicit important concerns: if surgery rates are inflated, then some patients may be receiving unnecessary surgery and health care resources are being wasted. If surgery rates are too low, then some patients who may benefit from spinal surgery aren’t receiving it.
Dr. Bederman and his fellow researchers are calling upon further research to determine why surgeons vary in their enthusiasm for surgery especially for conditions where there’s strong scientific evidence for effectiveness like slipped vertebrae and spinal canal narrowing. The authors conclude, "With a better understanding of reasons for practice variation, we may be able to modify variation, reduce costs, and improve access to care."
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