Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307, Dresden, Germany.
Allgemeine Ortskrankenkasse (AOK) Research Institute, Berlin, Germany.
BMC Health Serv Res. 2022 Sep 1;22(1):1109. doi: 10.1186/s12913-022-08492-3.
Rising surgery rates have raised questions about the indications for spinal surgery. The study investigated patient-level and regional factors associated with spinal surgery for patients with spinal diseases.
We undertook a cohort study based on routine healthcare data from Germany of 18.4 million patients within 60.9 million episodes of two patient-years before a possible spinal surgery in the time period 2008 to 2016. Using a Poisson model, the effects of a broad range of patient-related (sociodemographic, morbidity, social status), disease- and healthcare-related (physicians' specialty, conservative treatments) and regional variables were analyzed.
There was substantial regional heterogeneity in the occurrence of spinal surgery which decreased by only one quarter when controlling for the various determinants assessed. Previous musculoskeletal and mental health disorders as well as physical therapy were associated with a lower probability of surgery in the fully-adjusted model. Prescriptions for pain medication and consultations of specialists were associated with a higher probability of surgery. However, the specific severity of the vertebral diseases could not be taken into account in the analysis. Furthermore, a substantial proportion of patients with surgery did not receive a consultation with an outpatient specialist (29.5%), preoperative diagnostics (37.0%) or physical therapy (48.3%) before hospital admission.
This large study on spinal diseases in Germany highlights important patterns in medical care of spinal diseases and their association with the probability of spinal surgery. However, only a relatively small proportion of the regional heterogeneity in spinal surgery could be explained by the extensive consideration of confounders, which suggests the relevance of other unmeasured factors like physicians' preferences.
手术率的上升引发了人们对脊柱手术适应证的质疑。本研究调查了与脊柱疾病患者脊柱手术相关的患者层面和地区因素。
我们在德国开展了一项基于常规医疗保健数据的队列研究，纳入了 2008 年至 2016 年期间可能进行脊柱手术的 1840 万患者的 6090 万例 2 年患者人次。使用泊松模型分析了广泛的患者相关因素（社会人口统计学、发病率、社会地位）、疾病和医疗保健相关因素（医生专业、保守治疗）和地区变量对手术的影响。
脊柱手术的发生存在显著的地区异质性，在控制各种评估的决定因素后，仅减少了四分之一。在完全调整模型中，先前的肌肉骨骼和心理健康障碍以及物理治疗与手术概率较低相关。疼痛药物的处方和专家咨询与手术概率较高相关。然而，在分析中无法考虑到特定的脊柱疾病严重程度。此外，相当一部分接受手术的患者在住院前未接受门诊专家咨询（29.5%）、术前诊断（37.0%）或物理治疗（48.3%）。
这项针对德国脊柱疾病的大型研究强调了脊柱疾病医疗护理的重要模式及其与脊柱手术概率的关联。然而，仅通过广泛考虑混杂因素，才能解释脊柱手术地区异质性的相对较小比例，这表明其他未测量的因素（如医生偏好）可能具有相关性。
