Department of Economics, Stellenbosch University, Stellenbosch, South Africa.
Division of Orthopedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Eur Spine J. 2024 Jul;33(7):2577-2593. doi: 10.1007/s00586-024-08295-6. Epub 2024 May 20.
To investigate variation in treatment decisions among spine surgeons in South Africa and the association between surgeon characteristics and the treatment they select.
We surveyed 79 South African spine surgeons. We presented four vignettes (cervical spine distractive flexion injury, lumbar disc herniation, degenerative spondylolisthesis with stenosis, and insufficiency fracture) for them to assess and select treatments. We calculated the index of qualitative variation (IQV) to determine the degree of variability within each vignette. We used Fisher's exact, and Kruskal-Wallis tests to assess the relationships between surgeons' characteristics and their responses per vignette. We compared their responses to the recommendations of a panel of spine specialists.
IQVs showed moderate to high variability for cervical spine distractive flexion injury and insufficiency fracture and slightly lower levels of variability for lumbar disc herniation and degenerative spondylolisthesis with stenosis. This confirms the heterogeneity in South African spine surgeons' management of spinal pathologies. The surgeon characteristics associated with their treatment selection that were important were caseload, experience and training, and external funding. Also, 19% of the surgeons selected a treatment option that the Panel did not support.
The findings make a case for evaluating patient outcomes and costs to identify value-based care. Such research would help countries that are seeking to contract with providers on value. Greater uniformity in treatment and easily accessible outcomes reporting would provide guidance for patients. Further investment in training and participation in fellowship programs may be necessary, along with greater dissemination of information from the literature.
调查南非脊柱外科医生治疗决策的差异，以及外科医生特征与所选治疗方法之间的关系。
我们调查了 79 名南非脊柱外科医生。我们为他们提供了四个病例（颈椎伸展性损伤、腰椎间盘突出症、伴狭窄的退行性脊椎滑脱和骨质疏松性骨折），让他们进行评估并选择治疗方法。我们计算了定性变异指数（IQV），以确定每个病例中的变异性程度。我们使用 Fisher 精确检验和 Kruskal-Wallis 检验来评估外科医生特征与他们对每个病例的反应之间的关系。我们将他们的反应与一组脊柱专家的建议进行了比较。
颈椎伸展性损伤和骨质疏松性骨折的 IQV 显示出中度到高度的变异性，而腰椎间盘突出症和伴狭窄的退行性脊椎滑脱的变异性水平略低。这证实了南非脊柱外科医生在处理脊柱病变方面存在异质性。与他们的治疗选择相关的重要外科医生特征是病例量、经验和培训以及外部资金。此外，19%的外科医生选择了专家组不支持的治疗方案。
这些发现表明，有必要评估患者的结果和成本，以确定基于价值的护理。这种研究将有助于那些寻求基于价值与提供者签订合同的国家。治疗方法更加统一，并且更容易获得结果报告，这将为患者提供指导。可能需要进一步投资于培训和参与奖学金计划，并更广泛地传播文献中的信息。
