Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA.
Department of Neurosurgery, Virginia Mason Medical Center, Seattle, WA.
Spine (Phila Pa 1976). 2017 Sep 1;42(17):E1016-E1023. doi: 10.1097/BRS.0000000000002065.
Observational cohort pilot study.
To determine the impact of a multidisciplinary conference on treatment decisions for lumbar degenerative spine disease.
Multidisciplinary decision making improves outcomes in many disciplines. The lack of integrated systems for comprehensive care for spinal disorders has contributed to the inappropriate overutilization of spine surgery in the United States.
We implemented a multidisciplinary conference involving physiatrists, anesthesiologists, pain specialists, neurosurgeons, orthopaedic spine surgeons, physical therapists, and nursing staff. Over 10 months, we presented patients being considered for spinal fusion or who had a complex history of prior spinal surgery. We compared the decision to proceed with surgery and the proposed surgical approach proposed by outside surgeons with the consensus of our multidisciplinary conference. We also assessed comprehensive demographics and comorbidities for the patients and examined outcomes for surgical patients.
A total of 137 consecutive patients were reviewed at our multidisciplinary conference during the 10-month period. Of these, 100 patients had been recommended for lumbar spine fusion by an outside surgeon. Consensus opinion of the multidisciplinary conference advocated for nonoperative management in 58 patients (58%) who had been previously recommended for spinal fusion at another institution (χ = 26.6; P < 0.01). Furthermore, the surgical treatment plan was revised as a product of the conference in 28% (16 patients) of the patients who ultimately underwent surgery (χ = 43.6; P < 0.01). We had zero 30-day complications in surgical patients.
Isolated surgical decision making may result in suboptimal treatment recommendations. Multidisciplinary conferences can reduce the utilization of lumbar spinal fusion, possibly resulting in more appropriate use of surgical interventions with better candidate selection while providing patients with more diverse nonoperative treatment options. Although long-term patient outcomes remain to be determined, such multidisciplinary care will likely be essential to improving the quality and value of spine care.
观察性队列初步研究。
确定多学科会议对腰椎退行性脊柱疾病治疗决策的影响。
多学科决策可改善许多学科的治疗效果。美国缺乏针对脊柱疾病综合治疗的综合系统，导致脊柱手术的过度使用不合理。
我们实施了一项多学科会议，涉及物理治疗师、麻醉师、疼痛专家、神经外科医生、骨科脊柱外科医生、物理治疗师和护理人员。在 10 个月的时间里，我们展示了正在考虑脊柱融合的患者或有复杂既往脊柱手术史的患者。我们将手术决策和外部外科医生提出的手术方法与我们的多学科会议的共识进行了比较。我们还评估了患者的全面人口统计学和合并症，并检查了手术患者的结果。
在 10 个月期间，我们在多学科会议上共审查了 137 名连续患者。其中，100 名患者曾被外部外科医生推荐进行腰椎融合。多学科会议的共识意见主张对 58 名（58%）在另一家机构被推荐进行脊柱融合的患者进行非手术治疗（χ²=26.6；P<0.01）。此外，在最终接受手术的 28%（16 名）患者中，手术治疗计划因会议而发生了改变（χ²=43.6；P<0.01）。手术患者无一例 30 天内出现并发症。
孤立的手术决策可能导致治疗建议不理想。多学科会议可以减少腰椎融合的使用，可能导致更合适的手术干预，同时更好地选择患者，并为患者提供更多的非手术治疗选择。尽管长期的患者结果仍有待确定，但这种多学科护理可能对提高脊柱护理的质量和价值至关重要。
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