Gadjradj Pravesh S, Harhangi Biswadjiet S, van Tulder Maurits W, Peul Wilco C, de Bekker-Grob Esther W
Department of Neurosurgery, Park MC, Hoofdweg 90, Rotterdam, the Netherlands.
Department of Neurosurgery, Erasmus MC: University Medical Center Rotterdam, Rotterdam, the Netherlands.
Eur Spine J. 2022 Feb;31(2):380-388. doi: 10.1007/s00586-021-06838-9. Epub 2021 Apr 19.
Multiple surgical techniques are practiced to treat sciatica caused by lumbar disk herniation. It is unknown which factors surgeons find important when offering certain surgical techniques. The objective of this study is threefold: 1) determine the relative weight surgeons place on various characteristics of sciatica treatment, 2) determine the trade-offs surgeons make between these characteristics and 3) identify preference heterogeneity for sciatica treatment.
A discrete choice experiment was conducted among members of two international neurosurgical organizations. Surgeons were asked on their preferences for surgical techniques using specific scenarios based on five characteristics: effectiveness on leg pain, risk of recurrent disk herniation, duration of postoperative back pain, risk of complications and recovery period.
Six-hundred and forty-one questionnaires were filled in, the majority by neurosurgeons. All characteristics significantly influenced the preferences of the respondents. Overall, the risk of complications was the most important characteristic in the decision to opt-in or opt-out for surgery (35.7%). Risk of recurrent disk herniation (19.6%), effectiveness on leg pain (18.8%), postoperative back pain duration (13.5%) and length of recovery period (12.4%) followed. Four latent classes were identified, which was partly explained by the tenure of the surgeon. Surgeons were willing to trade-off 57.8% of effectiveness on leg pain to offer a treatment that has a 1% complication risk instead of 10%.
In the context of this discrete choice experiment, it is shown that neurosurgeons consider the risk of complications as most important when a surgical technique is offered to treat sciatica, while the risk of recurrent disk herniation and effectiveness are also important factors. Neurosurgeons were prepared to trade off substantial amounts of effectiveness to achieve lower complication rates.
多种手术技术用于治疗腰椎间盘突出症引起的坐骨神经痛。目前尚不清楚外科医生在选择特定手术技术时认为哪些因素很重要。本研究的目的有三个：1）确定外科医生对坐骨神经痛治疗各种特征的相对重视程度；2）确定外科医生在这些特征之间所做的权衡；3）识别坐骨神经痛治疗的偏好异质性。
在两个国际神经外科组织的成员中进行了一项离散选择实验。根据腿部疼痛的疗效、椎间盘突出复发风险、术后背痛持续时间、并发症风险和恢复期这五个特征，通过特定场景询问外科医生对手术技术的偏好。
共填写了641份问卷，大多数是神经外科医生填写的。所有特征均显著影响受访者的偏好。总体而言，并发症风险是决定是否选择手术的最重要特征（35.7%）。其次是椎间盘突出复发风险（19.6%）、腿部疼痛疗效（18.8%）、术后背痛持续时间（13.5%）和恢复期长度（12.4%）。识别出四个潜在类别，部分原因可由外科医生的任期来解释。外科医生愿意用57.8%的腿部疼痛疗效来换取一种并发症风险为1%而非10%的治疗方法。
在这项离散选择实验的背景下，研究表明，在提供治疗坐骨神经痛的手术技术时，神经外科医生认为并发症风险最为重要，而椎间盘突出复发风险和疗效也是重要因素。神经外科医生愿意为实现更低的并发症发生率而权衡大量的疗效。
