Van Munster Juliëtte J C M, de Weerdt Vera, Halperin Ilan J Y, Zamanipoor Najafabadi Amir H, van Benthem Peter Paul G, Schoonman Guus G, Moojen Wouter A, van den Hout Wilbert B, Atsma Femke, Peul Wilco C
4501Leiden University Medical Center (LUMC), Leiden, Netherlands.
University Neurosurgical Center Holland, 4501Leiden University Medical Center, the Hague Medical Center, and Haga Teaching Hospitals, Leiden and the Hague, the Netherlands.
Global Spine J. 2022 Oct;12(8):1841-1851. doi: 10.1177/21925682211064855. Epub 2021 Dec 27.
Literature review.
To describe whether practice variation studies on surgery in patients with lumbar degenerative disc disease used adequate study methodology to identify unwarranted variation, and to inform quality improvement in clinical practice. Secondary aim was to describe whether variation changed over time.
Literature databases were searched up to May 4, 2021. To define whether study design was appropriate to identify unwarranted variation, we extracted data on level of aggregation, study population, and case-mix correction. To define whether studies were appropriate to achieve quality improvement, data were extracted on outcomes, explanatory variables, description of scientific basis, and given recommendations. Spearman's rho was used to determine the association between the Extreme Quotient (EQ) and year of publication.
We identified 34 articles published between 1990 and 2020. Twenty-six articles (76%) defined the diagnosis. Prior surgery cases were excluded or adjusted for in 5 articles (15%). Twenty-three articles (68%) adjusted for case-mix. Variation in outcomes was analyzed in 7 articles (21%). Fourteen articles (41%) identified explanatory variables. Twenty-six articles (76%) described the evidence on effectiveness. Recommendations for clinical practice were given in 9 articles (26%). Extreme Quotients ranged between 1-fold and 15-fold variation and did not show a significant change over time (rho= -.33, = .09).
Practice variation research on surgery in patients with degenerative disc disease showed important limitations to identify unwarranted variation and to achieve quality improvement by public reporting. Despite the availability of new evidence, we could not observe a significant decrease in variation over time.
文献综述。
描述关于腰椎退变性椎间盘疾病患者手术的实践差异研究是否采用了足够的研究方法来识别不必要的差异，并为临床实践中的质量改进提供信息。次要目的是描述差异是否随时间变化。
检索截至2021年5月4日的文献数据库。为了确定研究设计是否适合识别不必要的差异，我们提取了关于聚集水平、研究人群和病例组合校正的数据。为了确定研究是否适合实现质量改进，提取了关于结局、解释变量、科学依据描述和给出的建议的数据。使用Spearman等级相关系数来确定极端商数（EQ）与发表年份之间的关联。
我们确定了1990年至2020年期间发表的34篇文章。26篇文章（76%）定义了诊断。5篇文章（15%）排除或调整了既往手术病例。23篇文章（68%）进行了病例组合调整。7篇文章（21%）分析了结局差异。14篇文章（41%）确定了解释变量。26篇文章（76%）描述了有效性证据。9篇文章（26%）给出了临床实践建议。极端商数的变化范围在1倍至15倍之间，且未显示随时间有显著变化（rho = -0.33，P = 0.09）。
关于退变性椎间盘疾病患者手术的实践差异研究在识别不必要的差异以及通过公开报告实现质量改进方面存在重要局限性。尽管有新的证据可用，但我们未观察到差异随时间有显著下降。
