Defensive Medicine in U.S. Spine Neurosurgery
| Autor: | Sandra C. Yan, Timothy R. Smith, Ryan S. Din, David J. Cote, Michael A. Acosta |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Defensive Medicine Male Risk medicine.medical_specialty Attitude of Health Personnel MEDLINE Neurosurgery Context (language use) Neurosurgical Procedures Defensive Practices Defensive medicine 03 medical and health sciences 0302 clinical medicine Spine surgery Malpractice Surveys and Questionnaires medicine Humans Orthopedics and Sports Medicine 030212 general & internal medicine business.industry Spine Surgery Spine (zoology) Cross-Sectional Studies Family medicine Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Spine. 42(3) |
| ISSN: | 1528-1159 |
| Popis: | Observational cross-sectional survey.To compare defensive practices of U.S. spine and nonspine neurosurgeons in the context of state medical liability risk.Defensive medicine is a commonly reported and costly phenomenon in neurosurgery. Although state liability risk is thought to contribute greatly to defensive practice, variation within neurosurgical specialties has not been well explored.A validated, online survey was sent via email to 3344 members of the American Board of Neurological Surgeons. The instrument contained eight question domains: surgeon characteristics, patient characteristics, practice type, insurance type, surgeon liability profile, basic surgeon reimbursement, surgeon perceptions of medical legal environment, and the practice of defensive medicine.The overall response rate was 30.6% (n = 1026), including 499 neurosurgeons performing mainly spine procedures (48.6%). Spine neurosurgeons had a similar average practice duration as nonspine neurosurgeons (16.6 vs 16.9 years, P = 0.64) and comparable lifetime case volume (4767 vs 4,703, P = 0.71). The average annual malpractice premium for spine neurosurgeons was similar to nonspine neurosurgeons ($104,480.52 vs $101,721.76, P = 0.60). On average, spine neurosurgeons had a significantly higher rate of ordering labs, medications, referrals, procedures, and imaging solely for liability concerns compared with nonspine neurosurgeons (89.2% vs 84.6%, P = 0.031). Multivariate analysis revealed that spine neurosurgeons were roughly 3 times more likely to practice defensively compared with nonspine neurosurgeons (odds ratio, OR = 2.9, P = 0.001) when controlling for high-risk procedures (OR = 7.8, P 0.001), annual malpractice premium (OR = 3.3, P = 0.01), percentage of patients publicly insured (OR = 1.1, P = 0.80), malpractice claims in the last 3 years (OR = 1.13, P = 0.71), and state medical-legal environment (OR = 1.3, P = 0.37).State-based medical legal environment is not a significant driver of increased defensive medicine associated with neurosurgical spine procedures.3. |
| Databáze: | OpenAIRE |
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