Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Canadian Spine Outcomes and Research Network, Markdale, Ontario, Canada.
Can J Neurol Sci. 2023 Jul;50(4):604-611. doi: 10.1017/cjn.2022.259. Epub 2022 Jun 16.
To examine differences in surgical practices between salaried and fee-for-service (FFS) surgeons for two common degenerative spine conditions. Surgeons may offer different treatments for similar conditions on the basis of their compensation mechanism.
The study assessed the practices of 63 spine surgeons across eight Canadian provinces (39 FFS surgeons and 24 salaried) who performed surgery for two lumbar conditions: stable spinal stenosis and degenerative spondylolisthesis. The study included a multicenter, ambispective review of consecutive spine surgery patients enrolled in the Canadian Spine Outcomes and Research Network registry between October 2012 and July 2018. The primary outcome was the difference in type of procedures performed between the two groups. Secondary study variables included surgical characteristics, baseline patient factors, and patient-reported outcome.
For stable spinal stenosis ( = 2234), salaried surgeons performed statistically fewer uninstrumented fusion ( < 0.05) than FFS surgeons. For degenerative spondylolisthesis ( = 1292), salaried surgeons performed significantly more instrumentation plus interbody fusions ( < 0.05). There were no statistical differences in patient-reported outcomes between the two groups.
Surgeon compensation was associated with different approaches to stable lumbar spinal stenosis and degenerative lumbar spondylolisthesis. Salaried surgeons chose a more conservative approach to spinal stenosis and a more aggressive approach to degenerative spondylolisthesis, which highlights that remuneration is likely a minor determinant in the differences in practice of spinal surgery in Canada. Further research is needed to further elucidate which variables, other than patient demographics and financial incentives, influence surgical decision-making.
研究薪酬机制不同的受薪医生和按服务收费（FFS）医生在两种常见退行性脊柱疾病的手术实践方面的差异。医生可能会根据自己的薪酬机制为类似病症提供不同的治疗方法。
本研究评估了加拿大 8 个省的 63 名脊柱外科医生（39 名 FFS 医生和 24 名受薪医生）的手术实践，这些医生治疗了两种腰椎疾病：稳定型椎管狭窄症和退行性脊椎滑脱症。该研究包括对 2012 年 10 月至 2018 年 7 月期间加拿大脊柱结果和研究网络注册的连续脊柱手术患者进行的多中心前瞻性回顾。主要结果是两组之间所行手术类型的差异。次要研究变量包括手术特征、基线患者因素和患者报告的结果。
在稳定型椎管狭窄症患者（n = 2234）中，受薪医生实施的非器械融合术明显少于 FFS 医生（<0.05）。在退行性脊椎滑脱症患者（n = 1292）中，受薪医生实施的器械加椎间融合术明显更多（<0.05）。两组患者报告的结果无统计学差异。
外科医生的薪酬与治疗稳定型腰椎椎管狭窄症和退行性腰椎脊椎滑脱症的不同方法有关。受薪医生对椎管狭窄症采用了更保守的方法，对退行性脊椎滑脱症采用了更激进的方法，这表明薪酬可能是加拿大脊柱手术实践差异的一个次要决定因素。需要进一步研究以进一步阐明除患者人口统计学和经济激励因素之外，还有哪些变量影响手术决策。
