Indication for spinal surgery: associated factors and regional differences in Germany.

Autor: Tesch F; Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany. Falko.Tesch@uniklinikum-dresden.de., Lange T; Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany., Dröge P; Allgemeine Ortskrankenkasse (AOK) Research Institute, Berlin, Germany., Günster C; Allgemeine Ortskrankenkasse (AOK) Research Institute, Berlin, Germany., Flechtenmacher J; German Professional Association for Orthopedics and Trauma (BVOU), Berlin, Germany., Lembeck B; German Professional Association for Orthopedics and Trauma (BVOU), Berlin, Germany., Kladny B; m&i Fachklinik Herzogenaurach, Herzogenaurach, Germany.; German Society for Orthopedics and Trauma (DGOU), Berlin, Germany., Wirtz DC; German Society for Orthopedics and Trauma (DGOU), Berlin, Germany.; Department of Orthopaedics and Traumatology, University Hospital Bonn, Bonn, Germany., Niethard FU; German Society for Orthopedics and Trauma (DGOU), Berlin, Germany., Schmitt J; Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2022 Sep 01; Vol. 22 (1), pp. 1109. Date of Electronic Publication: 2022 Sep 01.
DOI: 10.1186/s12913-022-08492-3
Abstrakt: Background: Rising surgery rates have raised questions about the indications for spinal surgery. The study investigated patient-level and regional factors associated with spinal surgery for patients with spinal diseases.
Methods: We undertook a cohort study based on routine healthcare data from Germany of 18.4 million patients within 60.9 million episodes of two patient-years before a possible spinal surgery in the time period 2008 to 2016. Using a Poisson model, the effects of a broad range of patient-related (sociodemographic, morbidity, social status), disease- and healthcare-related (physicians' specialty, conservative treatments) and regional variables were analyzed.
Results: There was substantial regional heterogeneity in the occurrence of spinal surgery which decreased by only one quarter when controlling for the various determinants assessed. Previous musculoskeletal and mental health disorders as well as physical therapy were associated with a lower probability of surgery in the fully-adjusted model. Prescriptions for pain medication and consultations of specialists were associated with a higher probability of surgery. However, the specific severity of the vertebral diseases could not be taken into account in the analysis. Furthermore, a substantial proportion of patients with surgery did not receive a consultation with an outpatient specialist (29.5%), preoperative diagnostics (37.0%) or physical therapy (48.3%) before hospital admission.
Conclusion: This large study on spinal diseases in Germany highlights important patterns in medical care of spinal diseases and their association with the probability of spinal surgery. However, only a relatively small proportion of the regional heterogeneity in spinal surgery could be explained by the extensive consideration of confounders, which suggests the relevance of other unmeasured factors like physicians' preferences.
(© 2022. The Author(s).)
Databáze: MEDLINE
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