Chen Xiaolong, Chamoli Uphar, Fogel Harold, Diwan Ashish D
Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Level 3, WR Pitney Building, Kogarah, Sydney, NSW, 2217, Australia.
School of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, NSW, Australia.
Arch Orthop Trauma Surg. 2023 Jan;143(1):189-201. doi: 10.1007/s00402-021-04019-3. Epub 2021 Jul 3.
Understanding practice-based differences in treatment of lumbar disc herniations (LDHs) is vital for reducing unwarranted variation in the delivery of spine surgical health care. Identifying factors that influence surgeons' decision-making will offer useful insights for developing the most cost-effective and safest surgical strategy as well as developing surgeon education materials for common lumbar pathologies. This study was to capture any variation in techniques used by surgeons in Australia and New Zealand (ANZ) region, and perceived complications of different surgical procedures for primary and recurrent LDH (rLDH).
Web-based survey study was emailed to orthopaedic and neurosurgeons who routinely performed spinal surgery in ANZ from Decmber 20, 2018 to February 20, 2020. The response data were analyzed to assess for differences based on geography, practice setting, speciality, practice experience, practice length, and operative volume.
Invitations were sent to 150 surgeons; 96 (64%) responded. Most surgeons reported microdiscectomy as their surgical technique of choice for primary LDH (73%) and the first rLDH (72%). For the second rLDH, the preferred choice for most surgeons was fusion surgery (82%). A surgeon's practice setting (academic/private/hybrid) was a statistically significant factor in what surgical procedure was chosen for the first rLDH (P = 0.014). When stratifying based on surgeon experience, there were statisfically significant differences based on the annual volume of spine surgeries performed (perceived reherniation rates following primary discectomy, P = 0.013; perceived reherniation rates following revision surgeries, P = 0.017; perceived intraoperative complications rates following revision surgeries, P = 0.016) and based on the annual volume of lumbar discectomies performed (perceived reherniation rates following revision surgeries, P = 0.022; perceived intraoperative complications rates following revision surgeries, P = 0.036; perceived durotomy rates following primary discectomy, P = 0.023).
Surgeons' annual practice volume and practice setting have significant influences in the selection of surgical procedures and the perception of surgical complications when treating LDHs.
了解腰椎间盘突出症（LDH）治疗中基于实践的差异对于减少脊柱外科医疗服务中不必要的差异至关重要。识别影响外科医生决策的因素将为制定最具成本效益和最安全的手术策略以及开发常见腰椎疾病的外科医生教育材料提供有用的见解。本研究旨在捕捉澳大利亚和新西兰（ANZ）地区外科医生使用的技术差异，以及初次和复发性LDH（rLDH）不同手术方法的感知并发症。
2018年12月20日至2020年2月20日，通过电子邮件向在ANZ地区常规进行脊柱手术的骨科和神经外科医生开展基于网络的调查研究。对回复数据进行分析，以评估基于地理位置、执业环境、专业、执业经验、执业年限和手术量的差异。
共向150名外科医生发出邀请；96名（64%）做出回复。大多数外科医生报告称，对于初次LDH（73%）和首次rLDH（72%），显微椎间盘切除术是他们首选的手术技术。对于第二次rLDH，大多数外科医生的首选是融合手术（82%）。外科医生的执业环境（学术/私立/混合）在首次rLDH选择何种手术方法方面是一个具有统计学意义的因素（P = 0.014）。根据外科医生经验进行分层时，基于每年进行的脊柱手术量（初次椎间盘切除术后的再突出率，P = 0.013；翻修手术后的再突出率，P = 0.017；翻修手术后的术中并发症率，P = 0.016）以及基于每年进行的腰椎间盘切除术量（翻修手术后的再突出率，P = 0.022；翻修手术后的术中并发症率，P = 0.036；初次椎间盘切除术后的硬脊膜切开率，P = 0.023）存在统计学显著差异。
外科医生的年度手术量和执业环境在治疗LDH时对手术方法的选择和手术并发症的感知有重大影响。
