Weill Cornell Medicine, 1300 York Ave, New York, NY 10021, USA; Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
Spine J. 2024 Aug;24(8):1388-1395. doi: 10.1016/j.spinee.2024.03.007. Epub 2024 Mar 16.
Left-digit bias is a behavioral heuristic or cognitive "shortcut" in which the leftmost digit of a number, such as patient age, disproportionately influences surgical decisions.
To determine if left-digit bias in patient age influences the decision to perform arthrodesis with instrumentation vs decompression in lumbar spinal stenosis (LSS).
Retrospective cohort.
Patients with an ICD-10 diagnosis of lumbar stenosis or spondylolisthesis identified in the 2017-2021 National Surgical Quality Improvement Program (NSQIP) database.
The primary outcome was the percent of patients who underwent arthrodesis with instrumentation (AwI). Matched age group comparisons without left-digit differences (ie, 76/77 vs 78/79, 80/81 vs 82/83, etc.) were performed to isolate the effect of the heuristic. Secondary outcomes including peri-operative events and complications were also compared within AwI and decompression cohorts.
Using CPT codes, procedures were classified as either AwI or decompression. Patients were grouped into 6 cohorts based on 2-year age windows (74/75, 76/77, 78/79, 80/81, 82/83, 84/85). The cohorts were propensity matched with neighboring age groups based on the presence of spondylolisthesis, demographics, and comorbidities. The primary comparison was between those aged 78/79 vs 80/81.
After matching, the primary cohort consisted of two groups of 1,550 patients (aged 78/79 and 80/81). Patients aged 80/81 were less likely to undergo AwI than patients aged 78/79 (23.5% vs 27.2%, p=.021). AwI procedures occurred at similar rates between age groups with the same left digit. Within the decompression and AwI cohorts, there were no differences in secondary outcomes between patients aged 78/79 and 80/81.
LSS patients aged 80/81 are less likely to undergo AwI than patients aged 78/79, regardless of comorbidities. This was not seen when comparing patients with similar left digits in age. Until objective measures of physiologic capacity are established, left-digit bias may influence clinical decisions.
左位数偏差是一种行为启发式或认知“捷径”，即数字的最左边一位数（如患者年龄）会不成比例地影响手术决策。
确定患者年龄的左位数偏差是否会影响腰椎管狭窄症（LSS）中进行关节融合术与减压术的决策。
回顾性队列研究。
在国家手术质量改进计划（NSQIP）数据库中，2017 年至 2021 年期间，ICD-10 诊断为腰椎狭窄症或脊椎滑脱症的患者。
主要结局为接受关节融合术伴内固定（AwI）的患者比例。进行无左位数差异的匹配年龄组比较（即 76/77 与 78/79、80/81 与 82/83 等），以分离启发式的作用。还比较了 AwI 和减压组内的围手术期事件和并发症等次要结局。
使用 CPT 代码将手术分类为 AwI 或减压术。根据 2 年的年龄窗，患者分为 6 个队列（74/75、76/77、78/79、80/81、82/83、84/85）。根据脊椎滑脱症、人口统计学和合并症，将队列与相邻年龄组进行倾向匹配。主要比较是 78/79 岁与 80/81 岁之间的比较。
匹配后，主要队列由两组各 1550 名患者组成（年龄为 78/79 岁和 80/81 岁）。80/81 岁患者接受 AwI 的可能性低于 78/79 岁患者（23.5%比 27.2%，p=.021）。在具有相同左位数的年龄组中，AwI 手术的发生率相似。在减压和 AwI 队列中，78/79 岁和 80/81 岁患者之间的次要结局没有差异。
无论合并症如何，80/81 岁的 LSS 患者接受 AwI 的可能性低于 78/79 岁的患者。当比较具有相似左位数的患者时，不会出现这种情况。在确定生理能力的客观衡量标准之前，左位数偏差可能会影响临床决策。
